Working With Injuries Workshop: Reference Guide Introduction Welcome to the Working With Injuries Workshop, where we will develop skills that helps us investigate pain and injury in a yoga practice. Of course, ideally, we would avoid all pain ​ ​ and injury when practicing asana! However, the reality is that practicing asana is a physical activity. Like other physical activities, when we are doing asana we are moving a body that has a whole past history of patterns. We most likely do not arrive on the yoga mat with an even, balanced body. We have muscular patterns in the body from activities we currently do. Those patterns can come from simply commuting to work and sitting at a computer for numerous hours a day, sports that we play, or accidents and injuries we’ve sustained in the past from sports or any other activity. When we start moving our body in new ways doing yoga postures, all of these patterns that we’ve retained in the body influence how we are able to move and the sensations that we feel from those movements. Each one of us arrives on the yoga mat with a unique set of muscular/body patterns, genetic body structure, and attitude about working with new movements. Even when aches and pains arise during our practice, we have to understand that sometimes the effect of repatterning how we move brings these things up. After all, your body has probably spent a decent amount of time adapting to existing patterns. New patterns are not always welcomed even though they may be good for you in the long run. The new patterns might ask muscles to be longer, shorter, stronger, or more flexible than they previously were. Of course, muscles are attached to the bones and by their nature, when muscles change in tension and length, that has an impact on the musculoskeletal system and how it functions. Context and approach is very important. There is no one-size-fits-all method of avoiding pain and injury in any physical activity and asana practice is no different. All content © copyright 2017 David Keil (DBK 108 Inc.) Working With Injuries Workshop: Reference Guide Pain does not necessarily equal weakness! I often get asked questions about pain in a way that assume pain or even injury, is the result of weakness. The question is often framed as: “What do I need to strengthen now that I have this pain/injury?” While gaining strength might reduce pain at times, strength is not necessarily the solution to all sensations of pain or injury. In the same way, stretching tissue although the answer at other times, is also not always the solution. The right balance of strength and flexibility for your body is probably closer to the truth. What I hope to offer you in this course is a method of assessing what you or a student is experiencing during a yoga practice and a process for modifying the practice to continue evolving the postures without injury. At the most basic level pain is the body’s warning signal. What do we do when we experience pain in asana practice? I hope to provide you with some useful tools to answer that question in a thoughtful way. My intention in this course is to walk you through a number of the most common injuries I come across while traveling and teaching. Along the way, I will share tools and a process to evaluate what is going on and make intelligent decisions about how to proceed. I want to help you develop a way of thinking, rather than a one size fits all answer, which rarely exists. With this in mind, it’s my hope that these tools will help you navigate each unique situation that comes up. The key here is to help you investigate by asking the right questions from the beginning. As you get answers to the questions, you can formulate an educated guess about what is going on. From there, you can modify, test, and then investigate with more questions until you get as close as possible to a solution to reducing or eliminating pain during practice. This reference guide will give you a place to review the thought-process for working with injuries and make some notes for yourself regarding situations that are most relevant to you. In this document, you will find an outline of the overall process for working with injuries. Where we explore specific areas of the body where pain and injury are common in yoga, we have also included a list of some of the many questions that might be relevant for working with injuries in that specific area of the body. Remember that these questions All content © copyright 2017 David Keil (DBK 108 Inc.) Working With Injuries Workshop: Reference Guide are just examples of questions that you might ask as you begin working with someone who is experiencing pain or an injury. It is our intent to provide enough examples to help you understand how to work with the process. Every situation is unique however. Adapt the process as it is relevant to you and/or your students. Definitions and Context Let’s start with some definitions so that, as we move forward in the course, we’re clear about what we mean by “injury” and “pain”. Definition of injury The medical definition of injury according to Merriam-Webster (http://www.merriam-webster.com/dictionary/injury) is: “hurt, damage, or loss ​ ​ sustained”. For example: A sprained ankle would cause hurt and damage to tendons around the ankle: this is an injury. Signs of inflammation (redness, heat, and swelling) that would likely accompany a sprained ankle are indications that an injury might have occurred. Symptoms like ​ ​ sensations of pain or discomfort are also indications that an injury might have occurred. ​ ​ Definition of pain a : usually localized physical suffering associated with bodily disorder (as a disease ​ or an injury); also : a basic bodily sensation induced by a noxious stimulus, received ​ ​ by naked nerve endings, characterized by physical discomfort (as pricking, throbbing, or aching), and typically leading to evasive action b : acute mental or emotional distress or suffering : grief (Merriam-Webster, ​ https://www.merriam-webster.com/dictionary/pain) For example: All content © copyright 2017 David Keil (DBK 108 Inc.) Working With Injuries Workshop: Reference Guide Sharp, throbbing sensations that would likely accompany a sprained ankle are examples of sensations of “pain”. What factors lead to injury while practicing yoga? Our ideal is to avoid injury at all. While this may not be possible all of the time, being mindful of the factors that can contribute to injury can help us reduce our chances of injury. ● Our history, which I refer to as “converging histories”: body patterns that predispose injury that may come from: ○ daily repetitive tasks that set patterns in our body (sitting at a computer, driving a car, picking up children, or possibly the kind of work-related activities that we do) ○ activities that we participate in frequently like sports ○ accidents we have been in ○ genetic body structure (bone shape, ligament/tendon length, tendency to acquire either flexibility or strength more slowly or more quickly than average) We are often unaware of what our converging histories are. ● Competition (with ourselves or with others) The way we approach our practice ● Wrong ideas about what yoga is for (we’re trying to get somewhere or “get the pose right”) ● Using videos to teach oneself and trying to make it look like the video ● Not being ok with who you are and how your body works ○ Trying to look like or be like someone else can lead to injuries ○ Even using alignment that works for one body may not work in yours All content © copyright 2017 David Keil (DBK 108 Inc.) Working With Injuries Workshop: Reference Guide ● Fatigue (just a generally tired day OR too much practice too soon) ○ Not honoring how you feel in the moment ○ Not adjusting your practice to energy level and circumstances ● Common Western postural patterns including tight hips and contracted front of chest ● Distraction: paying attention to anything other than what you’re feeling in a pose can leave potential for injury How can we avoid these factors and reduce chances of injury? ● Stay present ● Stop being so competitive—be OK with where you’re at. That includes competition with yourself. Just because it was working for you yesterday doesn’t mean it’s going to happen today—every day is different. ● Aim for a balance of effort and ease ● Learn your body—get interested in your own postural patterns and what things feel like generally, so you are more able to tell when something feels “off” to you ● Be consistent with practice—better to do a little bit most days, than a weekend warrior style 2-hour practice once a week ● Listen to your body! It’s cliché, but true. When something feels “off” or “not quite right” in some way, Stop! and reassess the posture. ● Assess how a posture feels. All content © copyright 2017 David Keil (DBK 108 Inc.) Working With Injuries Workshop: Reference Guide ○ Is there a sense of groundedness? ○ Is there a sense of lengthening? ○ Avoid trying to make yourself fit arbitrary alignment cues (e.g. lining up the heels in revolved triangle pose often results in students feeling ungrounded in the pose because their hips are not open enough yet for that alignment cue to be appropriate or beneficial.) What are the sensations that we feel in the body? If you or your students are newer to practicing yoga or even to movement in general, then all the sensations that come up in the body during practice may be unfamiliar as well.