The three of us have been knocking around ideas on how to share more of our message within the Yoga community. Social media and blogging is hard for us, with kids and clinics to manage. But we have made a goal to produce more. We thought that a good one out of the gate would be sharing an article originally shared on Yoga International. We will share it in two installments. This article outlines some or our core beliefs and reasons for teaching.
Diana, Helen and Emily
The Issue: A knowledge gap exists between what yoga teachers know of anatomy and how to apply it to prevent and address injury among a rapidly expanding number of yoga students.
The Solution: An asana-based movement assessment rooted in science to uncover suboptimal movement patterns in relationship to applied anatomy and kinesiology.
A growing focus on yoga-related injuries and the use of yoga to rehab injuries spotlights the knowledge gap between a typical yoga teacher and one who can detect, assess, address and prevent injuries.
Improved yoga teacher education will heighten awareness and deepen knowledge of applied anatomy and kinesiology in order to detect root injury causes and design optimal asana movement patterns.
1. Ask about the history and presentation of the student’s injury
Yoga teachers have become the frontline for a student when they have an injury. Often, a student’s yoga teacher is the first person they ask about their injury and how to address it.
In order to give appropriate and intelligent guidance and recommendations, the teacher should ascertain certain essential information. First, inquiring about the history and nature of a student’s pain can provide valuable information about the type of injury and whether continuing to practice yoga is appropriate. These questions include: when did the pain start? Is the pain better or worse with exercise? What is the nature of the pain (i.e. sharp, achy)? Are there any pins and needles associated with the pain? What is the intensity (1-10) scale?
From these answers a knowledgeable teacher can advise the student whether they should avoid all asana, go right to the doctor, or take it easy in class with some specific modifications.
For example, if a student complains of worsening hip pain that started 3 months ago, is sharp in nature and doesn’t improve with movement, it's possible the student may have an injury to the joint itself or the surrounding cartilage and soft tissue. Understanding the severity, intensity and nature of the pain is essential. In this case, the student should be advised not to participate in asana practice and see a physical therapist or physician. Not only can this shorten the overall duration of injury, but improve the student/teacher relationship. It is vital that the student can trust the teacher’s opinion when asked for advice about pain or an injury while practicing.
2. Be able to explain what is happening when common yoga injuries occur
As yoga has become a significant player in the world of movement and wellness, it is essential that the yoga teaching community upholds a working knowledge of common yoga injuries. Currently, most RYT 200-hour certifications include only 20 hours of anatomy and physiology education, with only 10 of those hours considered “contact time.” That’s just enough to cover the basics. Basic anatomy and physiology without application is difficult material to incorporate into classes and 1:1 sessions.
Given that student injuries are common, it’s imperative teachers become familiar with the pathophysiology of injury, i.e. what common yoga injuries are and how they are caused. In order to fully appreciate the injury and healing process, the teacher needs to understand how the human body actually links together; how muscles contract to move joints; how the shape of a joint dictates which movements are possible and safe (and which are not); and how joints can be affected from movements and restrictions elsewhere in the body.
Whether or not your students tell you this, many yoga students feel discomfort or, sometimes, pain. Students may intentionally push through pain or be told to go to their limit, breathe, then go further. There is ‘good’ and ‘bad’ pain. Sometimes it’s hard to differentiate. Pushing through bad pain almost always leads to injury. The sensation of muscle elongation is different than that of ligament or joint capsule stretching and also different from scar tissue restriction. These sensations may feel very different to one another. To address this globally, teachers should be encouraged to take a step back, investigate, and understand the injury before giving intelligent cues and modifications. Also being cautious about long holds and repetitive postures is essential.
Pain is relative, individual and complicated. In addition to mechanical complication that may elicit pain, other contributors can include emotional stress, nutritional status, a ‘type A’ personality, and other social factors. When a teacher has awareness of this and is asked advice about a chronic pain or injury it brings an opportunity for the student not only to get advice for their asana practice but also to be referred to other healthcare professionals that can work together to fix the problem by diving deeper into the biopsychosocial factors of the issue.
3. Assess movements that may contribute to the musculoskeletal cause of injury
Most yoga teachers by virtue have a keen sense of body awareness and are great at teaching optimal, safe movement.
Using an evaluation tool for the assessment of movement patterns may assist in picking up any dysfunctional and suboptimal movement (we are in the process of investigating our tool's reliability). With appropriate training in anatomy, biomechanics and kinesiology, teachers could use this tool to assess movement that may contribute to injury. Many injuries are the result of repeated stress to an area. If the body is moving in an aligned, supported and fluid way, injury would be less likely to happen during yoga class.
However, if there is a breakdown in movement, a dysfunctional pattern or improper alignment and load, some areas will be exposed to less than ideal mechanics. If loaded irregularly and repetitively this area may become injured.
For example, in high lunge, if the foot is over flat or pronated, the knee tends to move inward toward the midline, which may draw the hip forward and internally rotate the femoral head. If we continue to follow this up the chain, we may see a subsequent twist in the pelvis and upper trunk. Repetitively loading in this pattern is likely to result in a part of the chain eventually breaking down. In this instance, the hip.
A smart asana-based assessment to highlight dysfunctional movement patterns will include an examination of a student’s ability to stabilize during movement. The entire kinetic chain (the joints above and below the injury) must also be observed and tested for possible contribution to misalignment, dysfunction and muscle recruitment.
When assessing hip pain, a student that has sharp pain and finds limitation in pigeon pose may have a bony variation or osteophyte at the joint, either on the ball or the socket, which causes pain by impinging on structures such as the hip labrum. This bony variation can cause restriction in the movement of the joint, often felt as pinching. If this student deepens in a hip opening pose, the chances of causing injury increase. The best course of action in this occurrence is to start by referral to a physical therapist or physician.
The same complaint of sharp pain and limitation in pigeon could be a direct result of a rigid foot and ankle in the presence or absence of direct hip joint damage. The role of the foot and ankle is to sense where we are in space (proprioception) and send information to rest of the body via receptors in the joints, soft tissue and skin, as well as provide a stable but mobile foundation to our lower limb while standing, walking and running. With a rigid foot/ankle proprioception is reduced, the bony structures in the lower leg may become stiff as the musculature around them compress instead of lengthen. This restriction can result in compensatory movement occurring higher up the chain in the hip and lower back. A stiff ankle or foot may cause the femur to be held more forward in it’s socket and therefore more likely to repetitively impinge or bump into the hip labrum during functional movements. This shows that hip pain may be caused from a direct issue in the hip, OR, from an issue further away in the chain, in this case, the foot and ankle. Therefore It is essential that the whole chain is assessed and addressed along with any local hip treatment.
*If you want to learn more, including how to use our asana based movement assessment, join us this Fall in NYC for the 100-Hour advanced YTT*
** Our next blog will outline 2 additional approaches yoga teachers can take with injured students, stay tuned**