Wednesday, October 24, 2012

Coping with Injuries: Some Practical Suggestions, by Michelle Ryan

Sometime last month, I invited readers of this blog (that includes you :-)) to submit guest posts about practicing with injury and using the practice to heal from them. I'm very pleased to report that Yoga in the Dragon's Den now has its very first guest post. In response to my invitation, Michelle Ryan has very generously written a long guest post, which you will have the pleasure of reading below.

But first, a few things about Michelle. Michelle is the owner and director of Florence Yoga in Northampton, MA (I just realized I actually don't know how to spell MA in full...). She has been practicing Ashtanga since 1997. Among other things, her studio boasts a big beautiful Ganesh statue. I have yet to see it, but I hope to someday go there and practice in front of it; I have a good feeling that my practice will improve by leaps and bounds when I do so :-) If you are ever in the area, please think about stopping by her studio to practice.

I guess I've said enough. I should let you read what Michelle has to share below. She combines her knowledge of the Ashtanga practice with an intimate knowledge of Ayurveda (especially the Ayurvedic concept of Dinacharya, or "daily routine") to fashion a comprehensive path towards greater well-being. Enjoy!

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Coping with Injuries: Some Practical Suggestions
by Michelle Ryan

So, you’ve gone to Ashtanga class, and at some point in the practice, you forgot to breathe, lost your concentration, or pushed a bit too hard and you feel a sharp pain. Or, you were chopping wood, or raking leaves, or walking an overzealous dog, and you go inside and notice "something" hurts. You’ve pulled or strained something, and you are unsure if you should do your practice.

Approaching your practice with an attitude of self care is vital at all times, but especially when you are injured. The practice is a brilliant means of bringing you health and wellbeing, a way to clear and revitalize your mind and body, when approached wisely and compassionately. You should feel buoyed and energized, not depleted and discouraged, by your practice. A compassionate, non-striving approach goes a long way.

But, we have bodies, we can use them rigorously, and sometimes we get hurt. Here’s what I do when this happens, and it’s based on the Ayurvedic concept of “dinacharya” or “daily routine.”

(A couple of disclaimers: with any injury or pain in yoga practice, especially if it’s chronic, it’s best to talk to a healthcare professional to determine whether or not the pain is something more serious. Yoga can help and even heal the body, but you must be certain your injury is not something more serious, that may require Western medicine. Also - I am not an expert on Ayurveda. I have had this post fact-checked by one of my students, Kim Jorczak, who is a trained Ayurvedic Consultant - and I owe much of my original information to my friend and teacher, Christine Hoar, who has shared these strategies with me over the years.)

Very succinctly, Ayurveda, the “sister science” of Yoga, was developed in India over many centuries to help us put our bodies into harmony with nature’s rhythms. The easiest way to think about these rhythms is to imagine that our bodies are like clocks, where every system of the body has a time period of optimum function. Aligning your choices with the optimum times of when and what to eat, when and how long to sleep, when to do mental work, and when to be physically active, and then following the regimen regularly, on a daily basis, along with awareness of the season, is the basis of Ayurveda. It can have a profound effect on maintaining and even enhancing our health and wellbeing, especially as it gives us the means to do so naturally, without resorting to panaceas that only mask or treat the symptoms.

Our bodies like routine - and rituals. Just as doing a daily asana practice becomes something we begin to look forward to and benefit from, dinacharya - daily routine - will also be something your mind and body will benefit from, too. Dinacharya follows the Ayurvedic tenet that as long as we live in harmony with daily and seasonal rhythms, our body and our minds will respond by being more healthy and well as a result, giving us the means to live in balance.

My personal dinacharya helps me manage those aches and pains that inevitable arise through the rigors of the practice. Besides my 5-6 days of asana and pranayama practice each week, I practice the following methods of self care every day:

  • going to bed and getting up at the same time 
  • scraping my tongue 
  • using a neti pot 
  • dry brushing before I shower 
  • doing uddhiyana kriya (not necessarily ayurvedic, but it really helps your digestion to do this) 
  • sesame oil self-massage (especially ears, hands and feet)

In addition, I eat moderately and healthfully, according to my ayurvedic constitution, at optimum times for my digestion. I also drink warm water or herbal tea throughout the day, and have cut way down on fats, sugars, wheat, and most animal products.

If this seems like a lot to do, it’s not, really. It only takes me 30 minutes to get ready every morning, including my daily cup of chai, before I head out the door. It has become my way of managing my health every day, and the results have been very positive. I began doing these dinacharya practices, in addition to my yoga practice, 7 years ago, with Christine's guidance. While I had a daily asana practice, I wasn’t fully healthy: my blood pressure was considered “borderline” high, and my cholesterol was above 200. I was overweight by about 15 lbs, had chronic back pain, debilitating allergies that were leading to asthma, and Reynaud’s syndrome, an auto-immune related disorder that effects circulation, and is a pre-cursor to more serious autoimmune disorders.

I just went to the doctor a few weeks ago for a complete “work up,” and every test fell well within the “normal” range. My Reynaud’s is gone (it disappeared about 5 years ago); I fortunately never developed asthma; my weight and BMI are within normal range, and my cholesterol and blood pressure are excellent; I still have some seasonal allergies, but they are not as debilitating or year-round as they once were. I no longer suffer from back pain. I am very healthy - and I attribute it to these dinacharya practices that I have added to my Yoga asana practice.



This may sounds very self-satisfied, but I am very humbly grateful to my dinacharya routine, and thank Christine for her kindness and wisdom in sharing it with me. Your routine may be different, and I highly recommend that Ashtanga practitioners meet with a qualified consultant to have their own Ayurvedic evaluation, and be given a dinacharya routine specific for you and your body type.

Now, some additional things - some Ayurvedic, some not - that I do when I am injured - My mantra is “decrease inflammation, increase circulation.”

  • Ice the injury to decrease inflammation. 
  • Put sesame oil on the affected area at night, before you sleep. Gentle massage brings stimulation and circulation to the injury, which ultimately speeds up the bodies natural healing process, and doing so before you go to bed is very effective, too, as you sleep more deeply, which helps promote healing.

  • If you have worked particularly hard in a class and know you’ll be sore later, take an Epsom salt bath that evening, before the oil massage. Epsom salt has long been associated with helping to decrease muscular pain and inflammation. You will sleep like a baby after this warm bath, which again, promotes healing. Follow up with a bit of sesame oil massage on the affected area before you go to bed (wear old clothing, as the oil can stain.)

  • Consider trying an interesting “hybrid” homeopathic/herbal anti-inflammatory ointment called Traumeel. It’s also available in an internal “tincture” form. It includes arnica and a variety of other herbal anti-inflammatories. It’s effects are helpful in decreasing muscle and joint pain. I have had success with Traumeel in the past - and know of many other students and friends who have had the success with this product as well. (My mother, who suffers from Fibromyalgia, swears by it.) It’s good to put it on right after you injure yourself, so keep some handy when you practice, just in case!

  • If you are not allergic to ibuprofen (as I am - and I kind of dislike suggesting this), but it may help to take some for a limited time to help with the inflammation. Do not become dependent on it, however, as it is only a panacea - and can wreak havoc on your liver if you take it for long periods of time.

  • Reduce caffeine, alcohol, sugar and fats in your diet. This can be hard, but it’s necessary. For me, a vegetarian diet is best for promoting healing and renewal - you may be different. 

  • Eat more pineapple - it is great for reducing inflammation. Juicing is great, as well, since the micronutrients you get from one 16oz. glass of freshly juiced veggies and fruits are concentrated and easier to consume than eating the original large amount of veggies.
  • For old injuries where there is scar tissue, hot castor packs work wonders. (I used these on my C-Section scar about 5 years post-partum, and it dissolved the scar tissue from the incision.)

  • If you can afford it, get good body work from a qualified professional. The modalities I personally prefer for injury are acupuncture, shiatsu and deep tissue massage. Do what makes your body relax and renew. It’s worth the cost to give this gift of to ourselves. 

  • Talk to a qualified Ashtanga teacher to see what else you can do in your practice to promote healing. Modification of postures is preferable to re-injury, and it’s the wise yogi who does this. Also, study the anatomy of the affected area - I have found this is very helpful in giving me a greater understanding of what I should do in my asana practice to prevent further damage, and also future injury.

Although there may be an understandable desire to “take a break” from practice to heal the pulled muscle, I’ve found that after a short rest of a day or two to let any swelling subside, it’s better to continue my practice, albeit, carefully. In general, it’s also better to practice for shorter periods of time, but more regularly, because you will feel less sore and depleted when you practice gradually, adding a little more every time you practice. 
 

I use the asana practice to promote healing. I listen to my breath and intuition even more as a guide and make sure to explore alternatives and modify postures that would exacerbate the injury. Following Primary series carefully, moving through the postures and ending my practice if a posture is not working or feels like it exacerbates the injury, is wisest. The next day, I go through the series and only add a posture when there isn’t pain associated with it. If it hurts, I close my practice. Each day, I do a little more, adding postures as they become comfortable. I may get “stuck” on a posture for some weeks before being able to move on.

Patience is key to this slow and steady approach. It can feel like you are going back to square one - you may only be able to do Suryanamaskar at first - but this method can work to resolve longstanding issues in your body. You have your whole life to practice and explore - what’s the rush?! Pushing to “fix” yourself with the practice by doing it as you “think” you should be doing it, or as you were doing it before the injury, is counterproductive. Trust the practice, because it’s healing, but trust your intuition too. If something hurts very badly, or makes you feel worse afterwards, STOP. Don’t keep doing it. Close your practice for the day. Take rest. The Ashtanga Police will not arrest you for taking good care of yourself.


Finally, see this amazing  man and definitely watch this amazing woman's story; both of these videos offer a refreshing, inspirational perspective on the Ashtanga practice and the potential of our minds and bodies.
Injuries can be humbling and frustrating, no question. But, I suggest, you will find greater clarity, depth, humility and acceptance of what “is” when they do happen to you. It's then that the true yoga practice can begin.       

10 comments:

  1. Thanks for the great post Michelle, and thanks for publishing it on your blog Nobel :) Being a woman dealing with an autoimmune thyroid disorder, as well as chronic sinus and respiratory challenges, I found a lot here to think about and come back to. Dealing with autoimmune issues is a delicate balancing act. I want to practice and get stronger, but it is so easy to deplete my energy if I get overzealous. With respiratory issues the question becomes, do I still practice when I can barely breath?? Ha ha....these are all very personal and highly individual questions and reading about your experience is very helpful. I am learning to be more gentle with myself even as I get stronger.

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    1. Thanks for sharing, desperate yogi. Some years ago, I did some yoga regularly with a friend who was suffering from an autoimmune disorder, although we didn't practice Ashtanga (at that time, I hadn't become a "full-time Ashtangi"; I was still a dabbler). But I think the key is to modify; maybe do less vinyasas and jumpthroughs and jumpbacks (I'm guessing you already know this...), and generally, do whatever your energy level allows you to do on any given day.

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  2. Yes, that's the key, although I also believe in sticking to a full+ practice 6 days a week, so therein lies the challenge. If the ideal practice week happens once out of every 4 weeks I'm happy :) When the sick days, and 'shit happens' days make their appearances....I'm learning to say "Welcome!".

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  3. Thanks, desperate yogi, for your comments!

    I think there can definitely be a "one size fits all" attitude about Ashtanga - i.e. it must be done every day, quite rigorously, in order for it to be "correct" and effective - that can make Ashtanga practitioners just crazy! Consider that what we are doing is on par with Olympic athletes, and it puts things into perspective. It takes a long, long time, working slowly and patiently, to bring our bodies to a place where we can do some of these amazing asanas. So, because we are all not blessed with perfect, healthy bodies, the dogma we inflict on ourselves can engender a lot of self-ciriticism along the way - i.e. "Even though I am injured (or ill) If I don't do full Primary today, I am not doing my practice. Therefore, I suck at this."

    That harsh voice in our head is so loud, and we are so hopeful for improvement, that we actually make things worse sometimes.

    After a once decent practice, where I was cruising my way happily and steadily through Second Series, one day I woke up, and was wracked with pain. So, I tried to "fix" myself by doing my practice even more - even though my back was screaming in agony and it only made things worse. Eventually, I had to stop practicing. For over a year. No asana, not even Suryanamaskar, because of the pain. I was depleted and depressed from the pain, and from my efforts to fix myself. I had to turn to other forms of practice to manage the pain (mainly meditation), and used many of these Ayurvedic and holistic means to help, too. It took a long time to return to my old, relatively pain-free practice. And, when I say pain-free, I mean without the debilitating back pain I had suffered - the normal, everyday "aches and pains" of practice are more of a temporary discomfort, I believe, something that must be endured to help strengthen and open the body, to bring healing. I've learned the difference.

    There's pain, and then there's pain, in other words.

    Practicing intuitively, with a deep awareness that comes through pratyahara, seems to be what helps me heal and evolve, more than trying to do the asana "perfectly." I turn inward and discern the difference between what my mind is telling me and what I know to be true. The true self speaks quietly, compassionately, honestly to me, like a really good teacher would. And like any good student, I try to be quiet and just listen and learn.

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  4. I appreciate your words Michelle. I definitely agree that Ashtanga can bring out the best (courage, dedication, faith, commitment) and the worst in us (dogma, highly critical attitude, non-acceptance...etc.). Yet for me that's also the magic ~ it brings a confrontation with the self ~ the good, the bad and the beautiful. Hearing about your injury that kept you away from practice for so long is very sobering. Thankyou for sharing that. So far I have avoided injury (at least anything requiring more than a day off practice), but I realize I'm treading a delicate line and will have to deal with it eventually. For now my other health issues are keeping me very busy :) I am very inspired to hear that your autoimmune condition disappeared, as I constantly hear that all autoimmune diseases stick around for life, and are in other words incurable.

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  5. Very interesting discussion.

    Michelle: Yes, there's pain, and then there's pain. A couple of years ago, I had this twingy pain in my lower pain that would come on whenever I moved my back through a particular range of motion; my teacher in Milwaukee believed that it was triggered by the emotional upheavals that moving to a new place brings up (I was in the process of moving here to Minnesota when this pain started), and he believed that I should have switched to doing primary only or even just half-primary during this difficult period (I wished he had told me earlier, but oh well...).

    Anyway, this twingy pain lasted for about six months. At one point, it got so bad that I could even feel it in the transition from updog to downdog during vinyasas and surya namaskars. The wisest thing to do at that time would probably have been to stop practicing and not try to move through the pain, but I was one of those crazy stubborn Ashtangis that are the stuff of bad jokes about Ashtangis in the yoga world :-) Anyway, I continued to practice and somehow, after experimenting with this and that and looking here and there, I came across this video by David Garrigues on how to lift up and float forward and back in Surya Namaskar. I know this sounds crazy (I mean, I couldn't even move into a backbend without pain, and I'm thinking of floating back?!), but I saw the video, and I intuitively felt that whatever technique he was using in that floating action (in particular, the bandha engagement involved in floating) would help my back pain. So I tried it, and my back actually got better! It took another couple of months for the pain to actually go away completely, but it worked.

    So... I don't know what the point of this story is; I know Yoga Journal definitely won't want to publish a story like this :-) But I think this fits into my view that Ashtanga is very much a mind/body practice; both the causes and the cure of the pain is in your own body and mind. Especially with back pain; some years ago, a doctor called John Sarno actually published a book on the mind-body connection that is involved in back pain. He's not saying that back pain is all "in your head"; what he's saying, I think, is that the physical pain is the body's reaction to some kind of emotion that the mind/psyche is repressing. This being the case, addressing pain purely on a physical level isn't going to do much good. I sense that Ashtanga practice is also based on the same insight; it's basically an ancient technology that is based on the premise that the mind and body are really one entity.

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    1. It's really interesting how we get these epiphanies in practice, isn't it?! Experimenting, testing, with awareness and compassion, over a long period of time, maybe just trying something different, approaching the asana with curious exploration, leads to healing. Sometimes it can be a very long process, so it's difficult and frustrating. And, yes, I've found in the past that with some "injuries" there were absolutely some emotional "issues" that needed to be released, too, in order for the "injury" to heal.

      Dena Kingsberg has a great quote about this in the book, "Guruji":

      "Repetition is the key. We go back to the same place over and over without expectation or judgment again and again in both the practice and the cleansing until eventually catharsis, either subtle or dramatic, occurs as some stubborn or trapped part of us breaks free. A grief, a fear, a trauma, a secret, a sadness. Once it settles, there is clarity or lightness, a freedom of movement or a breakthrough in the practice that was not there before. That illumination and transformation inspires faith in the wisdom of the method. Days, weeks, months, years pass, and slowly the mind settles and the window of perception clears." - p. 290 of Guruji

      The practice teaches us how to persevere in the face of great challenge.

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  6. Desperate Yogi: Thanks for sharing so much here. I've seen my friend (the one I practiced yoga with some years ago) work with autoimmune disorder. There are lots of ups and downs, and the healing is definitely not a linear path.

    I really don't know if autoimmune diseases stick around for life. There are so many variables involved: Every individual's constitution is different, medical science's understanding of the disease is still rather limited, and it's also increasingly difficult to know what counts as "objective" medical knowledge, given that even articles in medical journals have been known to have been ghost-written on behalf of pharmaceutical companies who obviously have some vested interests... But all this is neither here nor there. I think I can at least say that regular yoga practice can help greatly in managing the condition and improving one's overall quality of life. So... keep practicing :-)

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  7. I'm really enjoying this discussion too. I also intuit that very often (not always of course) the practice is exactly what is needed to heal and regain strength. If practice is done with mindfulness and full breathing it does restore energy. Blood, oxygen and nutrients get to the injured area, difficult emotions are processed and released, the practice is reaffirmed as the constant rock you can depend on to get you through whatever life throws at you. I have had days when I've felt like I've overdone it, depleted myself, pushed to hard...etc. But then I just think back to the days before yoga and remember that whatever discomfort, stiffness, fatigue I deal with because of practice is hardly anything compared to my life in the Dark Ages before I started practicing.

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