WHAT’S WITH THE INJURY? (Part Two)

“All injury is the result of bad breathing,” Ashtanga master  Shri K. P. Pattabhi Jois used to say. Rooted solidly in the breath rather than alignment school, this is exactly what we would expect him to say. But I have pondered the depth of this remark over the years, even as I continued to acquire more and more knowledge of anatomy.  And I think he’s right. If we stop breathing or allow our breath to become shallow, irregular, or labored, we are energetically “off’—trying too hard or not giving enough to what we are doing.

“All injury is the result of greed or inattention,” opined another teacher. This also strikes me as true, for the very same reasons. If we are “greedy,” in a rush to push our practice along, we are bound to strain or pull something sooner or later. A friend once told me that when he was young, he tried growing carrots from seed in a little pot. When the first green shoots started to sprout up, he was so eager to help the plant along that he tugged and tugged at it, eventually ripping it right up out of the soil.  A lot of us have done the same thing in practice. I have strained and even torn muscles trying to build strength I didn’t have or openness beyond my means--most embarrassingly, of course, when I was doing so to earn the teacher’s attention and respect.

Inattention is just as dangerous as over-efforting. When we check out, space out, unplug from what we are doing, we sail into the open seas of mishap and misadventure. Yoga asanas are intricate, whole-body endeavors that require a high degree of awareness. If we cannot muster and sustain the “many-pointed” attention required to ensure that each part is doing its part, something’s gonna give! This same divided awareness makes us trip on uneven pavement, slip on ice, bump fenders, or shut the car door on a finger.

Being generally stiff Americans (in contrast to the genetically more supple Asian and Southeast Asian body types), we collect many of our domestic yoga injuries  by stretching muscles and joints beyond their current capacities. This well-intended striving has roots in the common Western misconception that yoga is about flexibility, “stretching in Sanskrit” as my philosophy teacher sardonically calls it. Whereas yoga is traditionally about cultivating and channeling the flow of energy, and in today’s modern anatomy about creating strength, flexibility and balance, many still feel that only morphing into human noodles will make them good yogis. So we tug and we pull on the tender shoots of our often mature limbs, forcing the growth to happen a little faster than God wills. Being culturally short on santosha (contentment), the second of yoga’s ethical precepts, we strain against the walls of what is.

Of course, some yoga injuries also arise from falls, knockdowns, and collisions. I have seen students tumble out headstand or handstand. I have seen others knocked over by someone  else kicking up into handstand in a crowded room. I know of more than a few teachers who have been kicked—in the head, in the eye, in the chest-- by enthusiastic yet undisciplined students. These sorts of injuries, while no less physically damaging, have I feel less to teach us beyond the common sense of clearing adequate personal space around you so that you are a risk to no one beyond yourself.

But the vast majority of injuries on the mat are not one-day blowouts but creep up on you. Not “one false move,” these afflictions arise from doing the same moves or postures over and over again in poor alignment. My teacher often says that even one-quarter of an inch off is enough to cause harm.  The medical world calls these injuries “Repetitive Stress Injuries, “ or RSIs, and off the mat they include everything from tennis elbow to handmaid’s knee (inflammation under the kneecaps from prolonged kneeling on hard floors) to today’s seemingly ubiquitous Carpal Tunnel Syndrome, evil offspring of hours hunched over computer keyboards.

As with their RSI forebears, yoga’s repetitive injuries now comprise a taxonomy of their own. Among the most common:

• Rotator cuff injuries from dropped and rounded shoulders trying to support the weight of the body (think chataranga, the yoga pushup, and “jump throughs” and “jump backs,” transitions from down dog to sitting and back)
• Shoulder tendonitis, same causes
• Carpal tunnel and other wrist  irritations, inflammations and cysts, which also arise from poor shoulder alignment when placing weight on the hands (down dog, chataranga, up dog are common scenes of this crime)
• Meniscus strains and tears: damage to the cartilage of the knees from aggressively externally (and sometimes internally) rotating the joint when the hip is not yet open enough
• “Yoga butt”: a strain or tear of the hamstring at its attachment to the sitting bone; also a strain/inflammation of the hamstring tendon or the bursa at the same spot, usually the result of aggressive forward bending while the muscles are slack
• Groin (adductor) strains or tears from opening the legs wider than God intended
• Bulging or herniated disks in the lower back, from pushing forward bends when hamstrings are tight
• Sometimes “receding” vertebrae in the low back from using this part of the spin as the hinge for backbends (instead of the more stable upper back)
• Neck injuries from putting weight on the head/neck with improper neck curvature (too flat or too curved), usually in headstand and shoulder stand

I’ve had my share of these, including rotator cuffs (at least twice!) and wrist compression (dropping back from standing into wheel), and some others more related to my specific anatomical type. I have made outside injuries worse through yoga: in 2001, following a bike accident that damaged the ligament on my inner right knee, I aggravated the problem through excessively internally rotating the knee. This combo of injury and misalignment then generated a Baker’s cyst behind the knee that made it impossible to fully fold the joint. Eight years later I’m still nursing a finicky knee.  In 1996 I fell off a steep curb in Mysore, India, smack onto my bent my right ankle. Continuing to practice lotus and other variations through the pain, I further stretched the already strained ligaments, eventually destabilizing the entire joint. Along with the ligament damage came nerve damage, so my foot and ankle could no longer sense changes in the surfaces beneath me. For months afterward my ankle would “buckle” under me while walking on uneven pavement, painfully reinjuring the ankle as well as making me look like a drunken clod. Years  and hours of physical therapy later, I will still cross the street rather than walk on bricks, cobblestones, or other “risky” surfaces. Just this past summer, I strained my infraspinatus or teres minor (small rotator cuff muscles at the back of the shoulder) lifting a heavy bag across my carseat. This in turn caused my chest muscles to contract in the front, pulling on the biceps attachment. As usual I practiced away, thinking yoga would help, to no avail. Then one day I caught my reflection in a mirrored studio as I lowered into chataranga—oh, dread humiliation! Shrugged shoulders, bowed elbows, sunken belly—could this be me?! Whether I was unconsciously trying to avoid injury-related pain or whether this sorry alignment contributed to the injury, I’ll never know. But here I am now, 16 years into daily yoga practice, doing “girl’s pushup” style chataranga, lowering to my knees first and going super-slow like a beginner.

WHATS WITH THE INJURY?

Yoga is widely touted, historically and today, as a miraculous holistic path to physical, energetic, mental, emotional, and spiritual health.  The scriptures are full of extravagant promises: illnesses and aging will disappear, we can live forever! And they don’t stop there. We can cultivate paranormal powers like inflating to the size of the universe, shrinking to the size of an atom, being in two places at once, seeing into the future.

If yoga is so good for us,  why are so many getting injured? And how?

How  is the easy part.  As a “science” in the Western sense, yoga is in its infancy. Ayurveda, the Indian traditional medicine, did not begin its study of the body by cutting it open. Dissections are a Western inspiration. Instead, Indian doctors explored the body experientially, learning what they could from visible markers like complexion and build and more subtle indicators like the pulse one can feel by pressing on someone’s wrist. The yogis of the past looked for similar signs, only on an even higher degree of subtlety. They explored with they experienced as internal energy flows, which they categorized as 10 forms of prana or the life force. These included upward flows and downward flows but also pranas devoted exclusively to sneezing, burping, and other spasmodic eruptions. The yoga postures we know began as attempts to direct, redirect, and channel energy—not as a spiritual form of physical fitness.

Thus, the yogis did not know about muscles and bones, the central nervous system, the cerebellum. Yogic “anatomy” instead mapped out 72,000 nadis (energy pathways similar to the Chinese meridians), chakras (spinning wheels located along the central nadi that govern everything from posture to personality), the pranas, and three bandhas (locks that direct or stem the flow of prana). It was only in the late 20th century, thanks to the singular, tireless, and exacting empirical research of Indian teacher B.K.S. Iyengar, that we came to view yoga asana from the perspective of Western structural well being. Iyengar, though trained by master Indian yogi Krishnamacharya, also served at one point in his youth as a medical model. He stood on stage in only a loincloth while a medical professor pointed out bones and muscles and their actions to his students. Iyengar picked up this knowledge and applied it to asanas, especially to the frustrations and limitations that many of his students were encountering in trying to fold in half, touch their toes, open their chests, or stand on their heads and hands. He created props (see “Props: Who Needs Them?”) like blocks and straps and blankets that would allow students to do modified forms of the poses safely and effectively while moving toward the happy day when their hips, shoulders, hamstrings, pecs, and hip flexors would open or their hands, arms, and upper back would grow strong.

Sadly, much of the yoga practiced today remains ignorant of Iyengar’s breakthroughs, or perhaps sees them as irrelevant. After all, the postures were initially created to facilitate the flow of prana, not to stack bones, and many yoga systems continue to see breath, not alignment, as the essence of yoga. The breath traditions view alignment as secondary at best, at worst as a mental preoccupation that distracts students from deep breathing. Even old photos of Iyengar doing asanas with wildly hyperextending joints and other anatomical distortions seem to contradict the very alignment instructions he gives students!

So, many of us continue to practice perilously ignorant of both the physical benefits and the risks of asanas. As in most fields, it’s how rather than what you do that matters. The same pose in optimal alignment can build strength, lengthen muscles, and improve balance—or feed old unconscious patterns that continue to weaken and destabilize the whole.

And even if we receive good instruction, applying the science of yoga is an art that can take a lifetime to refine.  Indeed, the yogic texts of the past frequently admonish us not to practice without the guidance of a skilled teacher. Don’t try this at home! And the more subtle the practice, the greater the danger: pranayama, or breathwork is especially dangerous. Yoga teacher trainings often reinforce these fears. I have heard more than one story of some poor soul who had a psychotic break while experimenting too freely with the various breathing practices and never made it back from the ashram. Even applying physical alignment principles to our own bodies is tricky business; we think we have it right, yet it’s damn hard to know, as none of us can see ourselves clearly. I’ve injured myself more than once playing the role of self-teacher. A teacher or fellow yogi can often steer us clear of imbalances, torques, dropped shoulders, collapsed waistlines, protruding thighbones, and other distortions.