Slow and Steady Yoga Injury Recovery

Lets get this out of the way. I am not a doctor. This information comes from my 14 year experience with healing my own injuries through Yoga and working with Yoga students.

Yoga injuries should not stick around for years.

The average healing time for most common movement injuries is 3-6 weeks.  If it is pretty bad, maybe 3 months. If it is really bad, 6 months.

Years, not so much.  Don’t believe me, ask Google or your doctor.

If the yoga injury is still there, it is usually one of three things:

  • Not giving it time to heal
  • Not fixing the movements that caused the injury in the first place
  • Your body healed it but your brain doesn’t think so

Time to Heal

When I had my piriformis/hamstring thingee (yes that is the technical name LOL), it took a long time to heal. Why? Because when is started to feel better, I would start pushing into it again. It would come back. I would back off. Once it felt better again, I would be back to the grind. This pattern kept me stuck in a cycle of on again, off again pain.

What stopped this pattern? Two things. I attended a workshop with certified Ashtanga teacher, Kino MacGregor and she talked about hamstring injuries . She said, and I paraphrase, every time you feel the pain at the attachment of the hamstring, add 6 weeks to your healing. This statement scared me into taking responsibility for my part in continuing my injury. It wasn’t some random thing that happened to me. Yoga wasn’t doing it to me, I was doing it to me.  I couldn’t bear the thought of having the injury for 6 more weeks because of my ego. I wanted to get back to my normal yoga practice as soon as possible.

The second thing, that stopped the pattern, is I gave myself time to heal. When my hamstring started to feel better, I did not immediately start doing my old practice. Every week, I would do a little bit more. If it continued to feel better, I would do a little bit more, wait to see what happened, and then a little bit more. For example, when my injury was at its worst, I could not forward fold. In standing forward folds, I would came to the half way point, contract my quads and breathe 5 breaths. That was it. When it started to feel better, I didn’t immediately place my head on the floor or start grabbing my feet. Instead, I folded another inch or two and breathed for 5 breaths. Slowly, over time, I worked my head back to the floor in Prasarita Padotanasana (a standing wide leg forward fold). It took even longer to bind my wrists in seated forward folds. I most likely could have done it quicker but slow and steady ensured that once I did get my forward folds back, they would be back for good. Before the injury got bad, I was given the first part of Third series. It was probably a year or so before I picked it back up because I chose to slowly work my way back through all the series.

No need to rush. Don’t let your ego thwart your healing.

 

Not Fixing the Movement Pattern that Caused It

This goes hand in hand with proper diagnosis. You cannot start your healing journey until you know what is hurt and what caused the hurt in the first place. It is not always what you think. Just because your hamstring hurts, it does not mean the injury was caused by a forward fold. Because your low back hurts, it doesn’t mean your injury came from backbends. As a matter of fact, those could be the very movements that heal you.

Go to your favorite health care professional and figure out what is wrong. If you are lucky, they also understand movement and/or Yoga and can also advise you on your practice. If you are not so lucky, you can do a diagnostic practice. Whenever I go to the doctor, they push on and examine all the places I hurt to get a diagnosis…all while apologizing profusely. That is essentially what you are doing with the diagnostic practice. During this practice, you slowly move through enough of your Yoga practice to see where your pain is being triggered. With the help of a yogi or teacher you trust, you determine what is causing the pain and how to change the movement pattern that caused it.

Do not continue your regular practice until you figure it out. If you cannot figure it out, it is better to skip all the poses that trigger the pain or stop practice until you can find someone who can help you figure it out.

My injury was due to practicing in a hot room ( not Ashtanga)  and pushing past my limits. Heat blocks pain signals. I did not know my hamstring was compromised until it was too late. Instead of chilling for a while, I kept pushing into it. Also, I had a habit of not engaging my muscles for forward folds and also having my hips out of alignment. All of this together made the injury worse. Once I knew this, I could fix it.

Samskara: When Your Brain Does Not Believe It Is Healed

This is real science. Don’t believe me. Get on Google. Our brain can convince us that we have an injury long after it is healed.  My grandfather had a back surgery. He never walked again. The doctor adamantly swore up and down that there was nothing keeping him from walking. The surgery was a success.

One of my favorite movement specialist yoga teacher people (yes, that is technical title lol) is Jenni Rawlings. Jenni is a mobility and anatomy specialist who has done research on the brain body connection.  In her article, “4 Basic Pain Science Concepts For Yoga Teachers Pt1“, she lists 4 pain facts that are accepted by science.

PAIN SCIENCE FACT #1: Pain and tissue damage do not always correlate.

In fact, when it comes to persistent pain (often defined as pain lasting more than 3 months), the link between pain and tissue damage is often significantly weaker. (And yes, if you experience a pain that “comes and goes” versus a constant, steady pain that is always there, that is still considered persistent pain if it’s been going on for longer than 3 months.)

Reason this is important: just because someone experiences pain somewhere in their body, this does not necessarily mean that there is *actual injured tissue* inside of their body.

PAIN SCIENCE FACT #2: Pain is an output of the brain.

Typically, when we experience pain, we tend to think of the pain as being located “in our tissues”, and our brain then senses it there and THEN we feel it. In this view, pain is an INPUT to the brain because it first exists “out there” in the periphery of our body, and then we sense it centrally (in our brain).

As intuitive as this “input” idea seems, it’s actually the opposite of how pain really works! In reality, there is no pain *anywhere* in our tissues that is inputted to our brain. Instead, pain is a creation OF the brain that is meant to signal us to take protective action against a perceived threat. If you feel pain in your shoulder, for example, it’s because your brain is *outputting* a warning signal to you about that area for some reason. Pain is therefore not an input from your tissues to your brain – it’s an output from your brain to your tissues!

PAIN SCIENCE FACT #3: We’ve already covered (in a very simplified way) the fact that pain is an output FROM the brain, not an input TO the brain.

We used to believe that all pain experienced in the body was the result of tissue damage somewhere inside of us – in other words, we thought pain was always the result of some structural problem. But we now understand that tissue damage is just *one input* that the brain considers when deciding whether to emit a pain signal. In addition to tissue damage, the brain considers inputs like past memories, emotions, expectations, beliefs, one’s environment, things that health professionals say, and more when deciding whether to output a pain experience in any given moment. All of this information processing happens unconsciously, and in just a fraction of a second.

PAIN SCIENCE FACT #4: We often believe that our body is naturally vulnerable in certain movements or postures, like lumbar flexion, forward head posture (“text neck”), etc. We believe that these positions will injure our tissues and create pain, often blaming someone’s low back or neck pain on these “bad postures”.What this viewpoint (that I used to share too!) overlooks is the fact that the tissues of our body are adaptable and become stronger when they are loaded (as long as the load isn’t too high). Any movement that you desire to do is a “good” movement as long as your tissues are adapted to withstand its loads.

In Yoga, there is also Karmic pain. In his article, “Do Postures Have To Be Painful?” Gregor Maehle, Ashtanga teacher and author of Ashtanga Yoga Practice and Philsophy, talks about Karmic pain.

This form of pain is more difficult for Westerners to understand, as it involves the concept of karma. Through our past actions, words, and thoughts, we have created who we are today, including, according to Patanjali, the type of body, span of life, and form of death we will experience. When Patanjali stated that future pain is to be avoided, he did not elaborate about past pain. Past pain in this context is the pain that we have created through our past actions. It may be experienced now or in the future. We cannot change our past actions. Once the seeds of our actions have sprouted, the karma associated with those actions cannot be intercepted, and the pain resulting from them needs to be endured — not grudgingly endured but willingly accepted as ordained. If it is willingly accepted, it will lead to a karmic purification, to a burning of the old karma associated with that pain.

Occasionally in life we have to go through letting-go processes, and they are not complete without painful sensations. Grief is an example of such a process. Nobody will doubt that a possibly lengthy grieving process, during which we learn or come to terms with letting go, follows the death of a loved one. These processes can come to a conclusion only if we willingly and consciously enter into them.

Karmic pain in asana is that pain that cannot be removed by anatomical inquiry and attention to detail. If you have done everything in your power to correct the posture and the pain still persists, it may be necessary, karmic pain, something you may have to go through. It is very challenging for a yogini to know that she has done everything in her power and yet continues to suffer. Many people at this point will stop practicing because they feel unfairly treated. If you manage to continue your practice, you are fostering tapas, the ability to sustain your practice in the face of adversity. If you refuse to work through karmic pain and simply endure it, your yogic progress may stagnate.

Yoga in this regard is similar to a marriage. When you get married, you commit to sticking with your partner through good and bad times. The same unwavering commitment is necessary in your asana practice. However, it needs to be an intelligent commitment. You need to be able to clearly identify whether the pain is the avoidable result of faulty technique or whether it is caused by demerit accumulated in the past. You can achieve this by doing everything in your power to make sure that you perform asana correctly and are therefore sure beyond doubt that avoiding the pain that you experience is not possible.

A word of caution: If you do not correctly identify your pain, you may make matters worse. Again, the overwhelming majority of pain experienced during asana is unnecessary and due to faulty technique. Never accept that your pain is karmic until you have ruled out beyond doubt that it is caused by poor alignment. This point shows the importance of anatomical inquiry. If your understanding of the anatomical principles of the body and the posture under discussion are sound, you will know whether you have done everything to avoid the pain. Anatomical knowledge must be used to determine whether pain is karmic or not.

The instruction given in the previous paragraphs may easily lend itself to abuse. Often students are only too happy to believe that their pain is necessary, as this way they don’t have to take responsibility for changing their approach to asana. For the correct identification of pain, consult a qualified yoga instructor steeped in the study of anatomy and alignment. This section in no way constitutes medical advice. If you experience any ongoing pain, consult your physician.

In the same article, Gregor talks about Samskaras,

  Patanjali states in Yoga Sutra, “heyam duhkham anagatam,” which means that new suffering needs to be avoided (Yoga Sutra II.16). The reasoning behind this injunction is simple. Every experience you have forms a subconscious imprint (samskara). Every subconscious imprint, whatever its content, calls for its own repetition.

One more important aspect, of the mind/body injury connection, is the placebo effect.

pla·ce·bo ef·fect (Google Dictionary)
pləˈsēbō əˈfekt,ēˈfekt/
noun
  1. a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment.

Does the pain go away during workshops or activities you are excited about? How about in Mysore or around Sharath? Does it go away for Yoga pictures or while you are teaching? Does it go away during demonstrations? Has the doctor done sufficient tests to prove it is gone and you still feel it? This could be an indication that it is a samskara.

Because the pain is created by the mind, it does not mean you should push into it! If you believe it is there, this will make the pain worse. Because you believe it, the brain is going to send you that signal.  Also, your body reacts to stress and it can show up in your tissues as something more concrete.  According to Yoga philosophy, all suffering is created by the mind. That does not mean we can magically stop it.  That is why we have Yoga! The process of Yoga was created to get rid of Samskaras. In my personal practice, I have found deep breathing and redirecting to be the best way to to get the mind to let go of pain.

Breathing calms the mind and body creating a sense of well being that may undo the samskaric knots.

re·di·rect (Google Dictionary)
verb
gerund or present participle: redirecting
ˌrēdəˈrekt,ˌrēˌdīˈrekt/
  1. direct (something) to a new or different place or purpose.
    “get the post office to redirect your mail”

I also use redirecting. When I redirect, I shift the focus to another part of the pose. During the first part of my trip to Mysore, I was super excited. All my phantom pains went away. Once I settled into the day to day routine, they came back. When my knee hurt, I shifted my awareness to my hamstrings, my hips or my breath, depending on the pose.  By the end of the five breaths, my knee felt fine. This does not always work. When it does not, I don’t push. I know that I will get relaxed enough to let it go at some point. No rush.

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