Diagnosis and Treatment of Injuries, Pains and Aches

I am not a doctor. Nor physical therapist. Nor any kind of licensed health worker. I am a certified yoga instructor. I am a science-curious, anatomy-fascinated, yoga practitioner who studied so that she could share information about yoga with other people in a safe, productive, interesting and functional way. I am learning about how the body works (or doesn't work) through my own practice, and self-study, and hope to inspire other people to do the same.

That being said, I MAY have had an experience or studied about an experience that MAY be able to help you improve your practice AND prevent injury during it. I MAY, however, not be able to.

Some yoga instructors in fact ARE PTs or MDs or PhDs in the health profession and may be able to not only diagnose a problem but also offer a route to wellness.

So, if you have a condition/problem/ache/pain that has been bugging you for more than, oh, say, two weeks and hurts MORE when you practice yoga (or when you are still), PLEASE go see a qualified medical professional to diagnose the problem and hopefully send you down the path of healing that may include a yoga practice.

Some modalities of self care and healing may be more obvious.

1 - If it hurts when you engage the muscle, it's possible you have injured the muscle, the tendon, or fascia. Stretching may NOT be the smartest option. You just may need to REST it. Take an Epsom salt bath, drink a lot of water, do the anti inflammatory meds thing if you are so inclined. Exercise in a way that doesn't exacerbate the discomfort. Seems obvious, but I can identify two stories just this week where someone had pain when using a muscle, told me it had gone on for years, yet they continue to overwork the area of discomfort instead of letting it heal/rest.

2 - If you have a lump, a bump, a bruise that won't go away, or a sharp pain when you move, PLEASE see a doctor. Growths that cause pain, things that don't heal, and sharp pains MAY be indicative of something that may not be fixable with a lunge pose or just a deep breath. They may be nothing, but seriously, if your child or best friend winced in pain when you touched something on their body, wouldn't you recommend they go to see a specialist versus try to just "asana it out?" It may be a tumor, it may not be. But you won't know unless you check it out.

3 - If you take a pose and you feel like it's your bones that just won't let you move more deeply in a pose, it may very well be that you have an anatomical structure that disallows that variation of a pose. Few folks have hip joints that allow opening the legs to 180 degrees, and as few have shoulders that rotate fully with arms parallel. Sacral joints are ones of stability, not flexibility (quote from Judith Lassiter). Destabilizing a joint without proper support (and instruction in a practice like Yin yoga) can, yes, lead to injury, so, be okay with where your body is (and is not).

4 - If you get really dizzy when standing up quickly or moving from standing to bending forward or vice versa, you may have a blood pressure issue (If you get nauseated this could mean something more dire - see a doctor asap). Make sure when you stand up from a forward fold or squat that you move on the inhales, to help counteract drops in blood pressure. If you typically have low blood pressure, don't expect your body to "fix" this - enjoy your sought-after systolic/diastolic status and stand up SLOWLY to minimize the chance you'll end up back on the ground without warning.

5 - Drink a lot of water, even during your practice. Yes, some practices of yoga dictate when you can drink water and when to take breaks, so if you like that dogmatic style then fine. But even if you are participating in those practices, if you feel faint, dizzy, weak, or sick, then DRINK, for heaven's sake.

6 - Let any injury heal, and know that it may change your practice drastically once you do, or it may not change it at all. But you have to be open to observing how that injury affects even the small movements, and be willing to start slow and be patient. The bigger the injury, the more acceptance you may have to do. Hamstring tears take months (or longer) just to heal, and overstretching or overworking them too soon will just re-injure.

7 - Contrary to popular tee shirts, pain is NOT weakness leaving the body. Pain is the sign something is amiss. It may be small or large, but you need to go within to figure out if it's physical discomfort, emotional discomfort, small ache, or real pain. Be honest with yourself, try not to react but rather observe, whatever the scenario, Be open to solutions that your intuition offers and try not to second guess yourself. Ask for a professional opinion, Don't judge yourself for taking care of yourself. And don't suffer. PLEASE.

Injuries, research, physical therapy, and teaching (and a little rambling)

I have a lot to cover on this post and I apologize for my blog absence. I am struggling with a low back injury (and consequential pain all the way up my spine) and how to modify my physical yoga practice and teaching to keep me healthy and continue to do what I love... teach.

I have been under the care of two physical therapists that were treating different problems but with similar therapies. One expressed that I had some SI joint issues, and had me doing some nifty exercises to strengthen the core and stabilize the SI joint (hips). She also advised to forgo vinyasa-style yoga as the SI joint problems are MOBILITY issues... the dysfunction was happening when I moved (from neutral or extension to flexion). Hence, not doing fast forward folds was the way to go.

One exercise worked the outer hip flexor (abductor) of the dysfunctional side well, and another worked, alternately, the adductors (inner thighs) and then abductors (outer). The interesting part her is that when I first did the inner thigh work, I felt a small but releasing pop in my pubic area, which was the pubic symphasis (the joint at the front of the pelvis where the two halves meet, created your public "bone") realigning.

A few others were meant to help strengthen the core but required twisting on my back with legs bent. At first this was a good exercise, and made me feel capable. But now, six weeks later, any twisting is out of the question. The problem has increased rather than decreased, perhaps in part to my resistance to 'slow down' and in part my carelessness in doing exercerbating tasks like putting Eli into his car seat, bending forward to reach into the fridge or laundry, or even turning the wrong way in the shower to wash (no joke).

I went to the HMO-based PT and was working on the strict diagnosis from the radiologist of spondylolysis (a defect or break in the pars or one of the bony processes along the side of a vertabrae) and grade 1 spondylisthesis (shifting of position of the affected vertabrae). These symptoms can exist in someone and they might NEVER know it. Pain is one indicator of a problem, that could mean some nerve (and there are many radiating here) is being irritated. Another indicator would be weakness in the lower limbs, bowel/UT issues, backache, numbness, etc. Ever since I moved to CA I have had discomfort in my low back that I thought was just a chronic issue that was alleviated with regular yoga and chiropractic visits.

But now I'm coming to think that THAT was the first indication that something was amiss with my L5-S1 joint (the connection between the lowest lumbar vertabrae and upper sacral one). And then more recently, when extending my spine deeply in up-dog (urdvha muka savanasana) or even warrior 1 (virabhadrasana 1) I would get this sudden and disconcerting weakness in my legs.

In any event, this summer I went to an SI joint workshop, and while trying to get deep into a twist, something popped. Maybe it was the last straw, or maybe it just took me to a place so deep (with incorrect pelvic positioning) that I FINALLY felt the defect in all it's irritating glory.

Note: If you have SI or low back issues, when twisting, it is recommended to LET THE HIPS MOVE WITH THE SPINE..in other words, DO NOT fix the hips and try to twist the spine away from them. That lumbar/sacral area only allows 5 degrees of axial rotation, so forcing it can punish the SI joint, making it flex rather than stabilize, and/or overtax the thoracic and other lumbar vertabral joints, creating more problems.

So I have been doing some reading about the spine, and trying so hard to NOT further compromise my life line during my practice and teaching. It's so important for me to be a good example of yoga, which would include demonstrating poses accurately...and yet I cease to follow my own advice when I take chances with my own health and stability by overdoing it. I need to continue to develop my teaching skills to create a learning environment where I can TALK to what needs to be done, use my hands to help students align properly, and create SPACE for the motion of breath which EXCLUDES putting yourself into postures that cause PAIN. I have to think of myself not so much as a teacher than as a facilitator...one who is ALSO a student that needs to be mindful. Today I am going to see a rheumatologist who I hope will offer me advice on what is really wrong, what I can do to help heal, and maybe an MRI too so I can SEE what is going on.

I hope that I do not disappoint my students by being restricted in my own movements. I want to offer then a good yogic experience even if I can't throw down with a Parsvottanasana that embodies strength and grace and looks like a page from Yoga Journal. So much of that is letting go of ego, I know, but also from wanting to feel capable, healthy and secure in my own body.

I know this process is helping me to truly practice yoga off the mat..and that is what makes me a better facilitator because I can exemplify the yogic skills gained that have nothing to do with asana - things like removing dukha (bad space) and filling up with sukha (good space)...like regulating the flows of apana (downward/outward energy) and prana (upward/inward energy), and ultimately, calming the mind to free it.

Sacroiliac Joint - what to do when this hurts

Here are a couple of articles based on information from Judith Lasater (from whom I took a seminar at the most recent YJ Conference on just this issue).

It's not always intuitive on how to prevent or care for SI injuries or pain in yoga, In fact often we'll hear gross adjustment cues like "Tuck the Tailbone" but this isn't always the best instruction. Examine your own practice and explore this information - see if it assists in relieving (or preventing further exacerbation of) pain in this sensitive locale.

http://www.yogajournal.com/health/562
http://www.bayoga.org/2006/01/mysterious-sacroiliac-joint-judith.html
http://thejoyofyoga.blogspot.com/2010/03/yoga-for-sacroiliac-si-joint-pain.html