Injury in Yoga

If yoga is such a gentle practice, why are so many people getting hurt?
By Carrie Schneider

Even though your hamstrings are aching, you approach the first Sun Salutation of class determined to keep your quads lifted and legs arrow-straight, all the while ignoring an internal warning to shelve that ego. You wince: "Uh-oh, this is going to hurt," and push on through your pain, believing our competitive culture's myth that pain means progress.

For many American yoga practitioners, it takes an injury to learn how to advance at a safe and comfortable pace. The learning curve was precipitous for Robin Aronson, associate publisher of Tikkun magazine in New York, who wandered into a yoga class at her gym two years ago and fell in love with the sweaty, Ashtanga-inspired practice being taught there. "It was a competitive environment, and I became fairly aggressive in it. I wanted to be really good," Aronson says. "So if something hurt a lot it didn't stop me from trying to do it. I was excited and just wanted to go for it—that's the culture of the gym I was in."

Within six months Aronson had begun to experience the debilitating hip pain that eventually drove her off the mat and into the office of an orthopedic surgeon. The journey, with stop-offs at a variety of alternative and traditional health-care practitioners, was excruciating. "When walking home after a long day, there were times I would be in so much pain I could not breathe," Aronson recalls.

As an MRI confirmed, the source of Aronson's pain was not tendonitis or soft tissue problems—the misdiagnoses of a movement therapist and rheumatologist, respectively—but a torn labrum, the band of fibrous tissue that surrounds the socket of the hip joint. Two weeks after the test, Aronson underwent arthroscopic surgery to repair the tear.

According to Aronson's orthopedist, Dr. Bryan Nestor of the Hospital for Special Surgery in New York, "We can't be sure yoga is what caused it, but the extreme positions of the hip she assumed with yoga postures likely contributed to the injury."

Aronson is less equivocal about where her practice failed. "Some teachers at the gym really encouraged pushing yourself. I learned a lot about my body from them. But it was the movement therapist who said, 'Don't push; the point of yoga is not to do it until it hurts, but to find where it's right for you.' And I thought, 'Well, how about that?' That was not the instruction I'd received."

If there's no single definable answer for how Aronson got injured, one thing is certain: By disallowing her observations, by doing yoga rather than being it, she arrived at the zone of potential injury all practitioners enter when asana practice supersedes yoga.

Are You Pushing It?

The psychology of injury has long interested psychotherapist Stephen Cope, M.S.W., L.I.C.S.W., scholar-in-residence at Kripalu Center in Lenox, Massachusetts, and author of Yoga and the Quest for the True Self (Bantam) due out this fall. In his 10 years of teaching and studying, Cope has observed practitioners from beginners to considerably adept students striving for perfection. These days, as more and more guests arrive at Kripalu Center demanding vigorous practices—a departure from Kripalu's slower, mindful style of yoga—Cope finds himself urging a return to clarity about the intentions behind practice.
"Classical yoga is crystal clear about the goal for practice—attenuation of the kleshas [causes of suffering]," he says. "But in its transmission to this culture, it became about achieving: altered states of consciousness, the perfect body, perfect health, perfect alignment, perfect stretch. The paradox is that all that striving and clinging and holding on tends to intensify kleshas; it intensifies attraction, aversion, and ignorance. And it increases our chances of hurting ourselves."

Stop by a health club yoga class and you may see a fair amount of competitiveness and physical exertion. Many of these students—and teachers—will tell you that what they are doing is Ashtanga Yoga. But to watch Ashtanga master Richard Freeman practice is another thing entirely. The very definition of slow, deliberate movement, he defies laws of velocity, weight, and gravity as he melts through the series of poses. Yet he acknowledges that Western practitioners of Ashtanga continue to hit speed bumps.

"One tendency of people in Ashtanga Yoga is to become obsessed with advancement and physical fitness, often completely losing touch with the intention of the practice: self knowledge and liberation," says Freeman, who teaches in Boulder, Colorado.

Preoccupation with the external experience, Cope explains, triggers what in Western psychology is known as the "false-self complex," when highly charged ideas about how we should be, look, and feel create a deep disconnection from the body, leading us to be out of touch with how we and the things around us really are. In asana practice, this false, disconnected self uses external instead of internal references to "achieve" postures, measuring oneself against other people, photographs in books, and even how the posture felt yesterday. This prevents us from being here now, Cope points out.

Donna Farhi, an international yoga teacher and registered movement therapist based in New Zealand, also laments the desire of students and teachers to be "perfect."

"During the early days of Iyengar Yoga dominance in the United States, teachers bombarded their students with detailed mechanical instructions as if they were talking them through a bomb defusion," says Farhi, who was originally trained as an Iyengar teacher. "This kind of heady overload and overemphasis on alignment causes people to shut down or ignore their feeling function, leaving them more prone to injury."

Farhi stresses the importance of giving students "permission to explore and discover without the pressure of failure." She includes experiential anatomy inquiries in her classes where students can learn to feel rather than think about their structure, not only their musculoskeletal system, but also the organs that support integrated movement. By "reawakening healthy-feeling function," students are able to find their own alignment, something they're fully capable of doing, she insists. In this way, Farhi says, "students are less likely to injure themselves because they will be able to feel the sensations that signal trouble."

Sage Advice

Cope, Freeman, and Farhi offer what may be unpopular injury-prevention tips in the face of the current sweet tooth for ever more challenging, nearly aerobic-style practices. Cope champions "slow, deliberate movement," which he calls a key way to promote optimal learning and unlearning. "When muscles are moved slowly and consciously," he says, "that movement is brought under the control of the most refined aspect of the brain, the neocortex, and away from the more primitive second layer, so we're less and less driven by regression to aggressive behavior and involuntary reaction."

To prevent injury, Freeman encourages incorporating the principles of alignment, meditation, and pranayama into the practice of the postures, keeping you close to the present moment and lowering the chance that you'll injure yourself.

Farhi's particularly wise advice is to back off-and she practices what she preaches. While she always sensed that extremely deep and repetitious backbending was not healthy for her body, Farhi recently discovered the reason: congenital weakness in the lumbar region of her spine where vertebrae have not fused. She has stopped pushing it.

"By outside standards, it would appear my practice is not as good as it was 15 years ago," Farhi says. "But my body is much better integrated than before. The standard for me now is about feeling good all the time, having a back that can sit at the computer for hours, garden, lift, sustain meditation positions-not necessarily a back that can bend like a noodle. If we used these kinds of standards rather than be dictated to by competition and pressure to do amazing postures, I think there would be far fewer injuries."

Pure Intentions

Yoga students should ask themselves why they were drawn to yoga in the first place. Most practitioners would agree that it was not the desire to compete. And the ancient yogis most likely didn't intend for yoga to become an intramural sport. "When asana is taken out of its original context—part of an overall process of transformation at every level—and into a context of performance, where people measure their progress by how many asanas they can do, competitiveness and force arise, and so can injury," says Gary Kraftsow, author of Yoga for Wellness: Healing with the Timeless Teachings of Viniyoga (Penguin,1999) and head of the American Viniyoga Institute on Maui, Hawaii.

A 25-year student of T.K.V. Desikachar, Kraftsow continues the teachings of Viniyoga, which stress adapting yoga to the individual. Some people have "the ability to do backbends to die for as a result of genes as opposed to their practice," says Kraftsow, while others have congenital limitations. Adapt the form of the posture to the person and anyone can receive the pose's functional benefits regardless of structural limitations, he adds. This is the guiding principle at the Krishnamacharya Yoga Mandiram in Chennai, the clinic in southern India where Desikachar's staff treats hundreds of people individually each week.
However, it is often difficult for an American yoga teacher, faced with 50 students at the local YMCA, to give such personalized attention—which means that most students have to educate themselves and take responsibility for their own practices.

"You're the one experiencing what's going on and to that extent you're the best judge of where to go and when to stop," says David Life, cofounder, with Sharon Gannon, of New York's Jivamukti Yoga Center. On the other hand, "most people don't listen to the inner guru, they listen to the inner ego, which does not want them to change. I don't know how many times I've heard people say, 'I don't do that posture.' But who is this one who 'doesn't do this?' That's when the outer guru has to urge you on."

"Without effort there won't be change in a positive direction," allows Kraftsow, a most cautious yoga teacher. "But in asana practice, 'no pain no gain' may not be intelligent. If you push yourself beyond what you think you can do, it builds self-confidence. If the pain in the body is muscle soreness, developmental pain—sort of like it hurts but it hurts good—that's great. But 'uh-oh' pain...that's nerve pain, and it's potentially damaging to the system."

Sizing Up Your Teacher

Teachers and practitioners alike grapple with the borders of responsibility when it comes to injury. At its very roots, the study of yoga is based on a strong, long student-teacher relationship. But the current high demand for teachers has sometimes resulted in the "worst combination: beginning teacher, beginning student," says Judith Lasater, P.T., Ph.D., cofounder of the California Yoga Teachers Association in 1973 and author of Relax and Renew (Rodmell Press, 1995).

Lasater says that since she began teaching 28 years ago (she inherited the yoga curriculum at a YMCA in Austin, Texas, just 10 months into her own practice) "there are a lot more kinds of yoga than ever before, some of them quite vigorous. Some students are not ready for those vigorous styles, and some teachers are not as well trained as they could be."

What makes it hard for beginning students to scout out talented, safe teachers is the fact that there is no national, regulated certification program for American yoga instructors, unlike in the United Kingdom, where certification is awarded after a nationally decreed five-year course of study. While similar measures have long been considered in the United States, currently choosing a teacher can be haphazard at best.

"With yoga classes being so popular," surmises Aronson, "a lot of people are going through training classes and teaching really quickly."

With poor or misguided instruction, you can get injured. This is when it's important to listen to your body. "Occasionally what you're being told doesn't make sense and seems to contradict all your intuitions about how your body works," says Freeman. "That doesn't mean it's wrong; it means you should throw up a red flag and inquire as to what the teacher really means. Because often, the teacher is describing something with a new vocabulary for people, and people don't really understand what's being referred to—especially when you're talking about different anatomical parts."

At Jivamukti, teacher training is a rigorous one-year course of study that includes study of Sanskrit texts, anatomy, and asanas. Life is adamant about what he expects his trainees to deliver. "Whether they're teaching in an old folks home or a gym or a nursery school, it should be 'What do you need?' not 'What do I have to teach you?'" The approach that leads to injury, he says, is when teachers learn a certain thing and think they have "the beginning, middle, and end of knowledge. The teacher must be the perfect disciple to serving the student. When teachers come with preset ideas of what they're going to teach and there's no allowance for the needs of who is there to take the class, that's when injury occurs."

Because students are usually the most competitive with themselves, Lasater says the "best thing a teacher can do, besides being well trained, is to create an atmosphere where everybody pays attention to their own limits, where the teacher talks about her own difficulties, offers alternatives, and makes it all right to do them—not just in words but deeds, by honoring people for doing less sometimes."

One teacher who is able to talk about her own limits and offer alternatives is Carol Del Mul, who three months into her teacher training at Jivamukti discovered that she had osteoarthritis in her cervical spine. Surgery was recommended, Shoulderstands and Headstands were forbidden.

"I was so tied into my practice, in a way that was very prideful," she says. "We get attached to the things we can do really well. So it was 'Oh my god, I can't do this, I can't do that,' until I realized I wasn't doing yoga anymore; I was shrinking instead of expanding."

Noting how she involved her neck in asanas where there was no reason to, she rebuilt her approach to each one. "Plowing right through life and leading with my neck like a turtle is how I've gotten a lot of things done," says Del Mul, director of production at an advertising agency. "So I had to rethink everything: how I walk and sit and talk with you." The most important thing she has done is to modify her practice and her understanding of yoga.

"Coming to terms with these physical limitations has made me more inventive about how to circumvent them and still keep challenging myself—using judgment, using discrimination," Del Mul says. The prime directive in both her practice and her teaching now (she completed her training) is sthira sukham asanam—steady, comfortable seat—from chapter II, verse 46 of the Yoga Sutra. "I don't have to do something if it doesn't work for my body. And if there are alternative ways, I don't feel less-than or lazy for doing them."

Dealing With Injuries

Ever heard the saying "everything happens for a reason?" Perhaps your injury is telling you to slow down. "When we're injured, we think, 'Now I can't do my practice. This is not real practice, not what I want,'" says Cope, "and by then we are miles away from what it's about: Being with injury as much as being with practice when it's humming, and learning to embrace the fact that part of the embodied state is injury, pain, displeasure, getting what I don't want."
To work intelligently with your injury, become an expert on it. Extend the attention you exercise during your asana practice to life in general. Get an anatomy book and read about the area where you're injured "so it's not a mystery," Life says. "You need to be able to visualize it. Then observe all your habits: the shoes you wear, how you carry your bags, how you walk down the street. You have to mentally be aware of habits you form and start changing them. Because it isn't just something that happens in asana practice; the practice just kind of pulls it out and says, 'Hey, you better pay attention to this.'"

Studying with a yoga teacher who has a thorough understanding of asana and anatomy is the ideal when you're injured. If you feel that insufficient progress is being made with a trusted and respected yoga teacher, seek a second or third opinion—either within yoga or in another healing discipline. "Perhaps the basic assumption about what is wrong should be questioned," says Mary Pullig Schatz, M.D., author of Back Care Basics: A Doctor's Gentle Yoga Program for Back and Neck Pain Relief (Rodmell Press, 1992). "And always remember that traditional medicine does have much to offer when used appropriately, just as other healing arts do."

In 1979, Schatz became engrossed in what B.K.S. Iyengar was doing therapeutically, "not only with muscles and bones, but with the nervous system and organs—seeing yoga as a total health maintenance system," she says. Since then she has become ever more convinced of asana practice's efficacy as a tool to prevent and heal injury, through her use of it for her patients and for herself.

"People who do poses without knowing where their areas of vulnerability are can create injuries," Schatz notes. "But if you know what your vulnerabilities are, you can use similar poses or the same poses, modified, to make those problems better."

Unfortunately, injuries are not uncommon even among long-term practitioners with supple bodies. "Muscles are the guardians of the joints," Schatz explains, "so people who are really stiff with muscle tightness actually benefit. They may be holding the joints in a less-than-perfect position, but they're not letting the joint support structures get overstretched, which is what happens with very flexible people." When the stretch moves into the ligaments and the tendons—the supporting structures of joints—the joints become more unstable and disorders like fibromyalgia (chronic pain in muscles and soft tissues around joints) can develop.

Life, who has suffered from meniscal tears in both knees, eschewed surgery, opting instead to accommodate the condition in his practice.

"The choice of surgery vs. no surgery depends on one's tolerance for discomfort and level of patience, viewed in the context of the degree of disability created by the problem," says Schatz. One has to "weigh the desire for quick relief against one's aversion to being cut open and to the risks of anesthesia, infection, and a poor surgical result."

Yoga therapy for such an injury might take a very long time, Schatz adds, and consists mainly of trying not to irritate the area.

The bottom line: Like anyone using their body in a regular, strong physical practice, yogis get injured. "That is an absolute fact," Lasater acknowledges. "Asana practice asks people to do things that are unusual and sometimes uncomfortable so that they can learn about themselves and a new way of being in the world, experiencing their own resistance for a variety of psychological, emotional, and physical reasons. And when you do that, there's always risk."

One of Lasater's prescriptions for injuries is Savasana (Corpse Pose), which she calls the most advanced of yoga poses. "When we learn to do nothing 20 minutes a day, it's powerful, not only physiologically—improved immune function and reduced blood pressure—but because we imbue ourselves with an understanding that we are more than our bodies, more than what we do. When you have that knowledge, you learn it over and over again and carry it with you into your next practice. And that's the ultimate injury prevention: to love yourself and to know your connection to the whole."

Carrie Schneider is a writer and yoga teacher in New York City.