om gam yoga

Melbourne yoga instruction by Sophie Langley

Tag: yoga injuries

Yoga and tendonitis in the shoulders, elbows and wrists

Over the last few years, I’ve had a few students with varying degrees of tendonitis in their shoulders, elbows or wrists. It’s painful, and has the potential to really restrict what you can do with your arms. But you can still do yoga with tendonitis, and it can, in fact, help to relieve the symptoms and prevent it from occurring.

What is tendonitis?
Tendonitis is an inflammation of the tendons. Tendons are strong tissues that join muscle to bone and help to keep a joint stable. Typically, tendonitis is an overuse injury. If the tendon is repeatedly strained, small tears can form and the tissue inflames. Shoulders, elbows and wrists are particularly prone to this type of injury. Symptoms include pain, swelling, stiffness or restricted movement, and muscle weakness in the area. Often, mild tendonitis will heal itself, but there are some simple yoga exercises you can do to encourage this process. Of course, if your symptoms persist, or if they are very painful to begin with, it’s a very good idea to see your doctor.

Causes of tendonitis
But before we get to the exercises, let’s take a look at what causes tendonitis. These are some things you should either avoid or be careful with.

  • Overuse through repetitive actions
  • Any activity that requires lots of running, jumping or other sudden impact movements
  • Lifting weights that are too heavy
  • Not warming up properly before activity, exercise or sport
  • Poor technique, like holding a tennis racquet incorrectly (which is where the term ‘tennis elbow’ comes from)
  • Exercising in the cold
  • Holding awkward positions for a long time

Essentially, relying too much on the joint, without making proper use of the muscles that surround that joint, puts pressure on the tendons, and can lead to tendonitis. In yoga, poses like Downward Facing Dog, Plank, Chaturanga (and any other poses where you’re holding your weight in your hands) can leave you at risk of tendonitis if you’re not conscious about using the muscles in your hands and arms to hold you up. I often see students who dump all their weight into their wrists in Down Dog, and don’t use their hands at all. Take a quick look at your hands next time you do Down Dog — if your fingers are lifting up off the floor, you’re probably not really using your hands.

Simply pressing the whole hand into the floor and lightly gripping the mat with your fingers really helps to build up the strength of the muscles in the hands and arms, and that strength will protect take the pressure off your joints and tendons, thereby reducing the risk of developing problems like tendonitis.

Relieving tendonitis
The first and most important step is to stop whatever activity triggered the pain or swelling. If that’s a particular yoga pose, then stop doing it, at least for now. More generally, resting the area is also important. But total immobilisation can actually aggravate the problem, so carefully maintaining at least some normal movement in the area is vital.

Suffering from tendonitis in the shoulders, elbows or wrists does not necessarily mean you can’t practice yoga at all, but it does mean you need to be careful. You will probably find you need to be especially careful with weight-bearing poses. As a general rule, if it hurts, then stop. Some discomfort is probably okay (and inevitable), but pain is a sign of acute distress.

Exercises to help relieve (and prevent) tendonitis
Again, with each of these exercises, it’s important to be patient with yourself, and stop if the exercises prove painful.

  • Stretch for tendonitis of the shoulders, elbows and wrists: Interlace your fingers and reach your palms away from you, out in front, lengthening out your arms. Moving slowly, begin to lift your hands up towards the ceiling. Keep your shoulders relaxed down, and your arms lengthening out. Go only as far as you can without pain, and make sure you can still breathe. Hold for a minute or so. Interlace your fingers the other way (with the opposite forefinger on top) and repeat.
  • Strengthening to relieve/prevent tendonitis of the shoulders, elbows and wrists: Stand about thirty centimetres from a wall and place the palms of your hands on the wall, shoulder-width apart. Spread your fingers. Relax your shoulders. Press your fingertips into the wall, as if you’re trying to get a grip on it. To go further, you might also begin to push into the wall with the palms of your hands, as if you’re trying to push the wall away from you. To go further still, you might also begin to bend your elbows, keeping them tucked in line with your shoulders, then straighten them again — essentially Plank and Chaturanga against the wall. This exercise is especially good if you find it difficult or painful to hold yourself in a regular Plank on your mat.

Further treatment
If your tendonitis is severe or if your symptoms persist, see your doctor. Severe pain might need to be managed with painkillers, and in some cases, very severe cases of tendonitis will not heal on their own, and might require surgery. And, as with any injury, make sure you tell your yoga teacher about it before class starts, even if you feel the injury is only very minor.

On Yoga Injuries and the Ego

Last week the New York Times ran a story entitled ‘How Yoga Can Wreck Your Body’. A number of different people sent it my way, asking for comment. To be perfectly honest, my initial response was to roll my eyes. Of course you can hurt yourself doing yoga — just as you can hurt yourself running, walking, rolling over in bed. To move at all is to risk injury to a certain extent.

The problem, I think, lies less within the system of physical yoga practices and more in the expectation that’s placed upon them. Yes, yoga asana can improve your wellbeing, it can make you feel amazing, but it isn’t going to fix everything. And yes, it may in fact cause some injury. But yoga is not just the physical poses. It’s about finding balance between opposing forces — sometimes those forces are just within the physical body, but more often they’re in the interplay between our physicality and our thoughts and emotions. We think or feel we should be able to do something — or that we shouldn’t — and sometimes that’s in direct opposition to the abilities of our physical body. Our ego rears its ugly head; sometimes pushing us further than we should go, sometimes holding us back.

That’s part of the practice though, as far as I’m concerned. When you’re on a yoga mat, it’s just as much about testing and observing your own ego as it is about watching how your body works. The two are, really, inextricably linked.

The very first part of Patanjali’s Yoga Sutras (one of the seminal ‘how to’ yoga texts) says, ‘yogash chitta vritti nirodahah’, which translates as ‘yoga is calming the fluctuations of the mind’. Some people interpret this as ridding oneself of ego, but I find it more helpful (albeit more complicated) to think of it as stepping away from the ego (and the body) in order to witness their activities. And it’s in the witnessing that the calmness lies. The ego itself is not a problem; blindly following it can be.

All that said, as a teacher, I do worry about my students injuring themselves, and it’s a very real possibility that they will. It’s absolutely vital that I keep learning more about human anatomy and physiology so I can create a space that’s as safe as possible for my students to practice in.

In fact that word, ‘practice’, is a really important part of how I plan and conduct my classes — and how I think when I’m on the yoga mat for myself. It’s in taking our practice — practising, in other words — slowly but surely that we learn about ourselves. Slowing down enough to notice the breath, and to notice the physical sensations in the body is at the heart of a physical yoga practice. The body gives warning signals if you’re coming too close to injury; it tells you to back off by giving off the ‘pain’ message loud enough that your breath becomes laboured. But you need to be moving slowly enough to notice those signs — and to have practise recognising them.

In no way am I suggesting that yoga injuries are all the fault of the student — it’s a shared responsibility between student and teacher. What I am saying is that, as yoga teacher Bernadette Birney points out, yoga is a therapy and the risks are similar to the risks in any other type of therapy, physical or otherwise. It’s perfectly valid to be concerned about those risks and an excellent idea to talk about them. Slowing down will help, but my advice to anyone concerned about the risks is to talk to your teacher/s about them. Tell your teacher/s about your injuries, and about anything that doesn’t feel quite right, even if it’s not exactly painful. I’m certainly interested in building a relationship with my students so they can get the most out of my classes, and I think you’d be hard pressed to find a teacher who isn’t.

I should also add that yoga teaching in itself is a yoga practice. I certainly do not have my ego all figured out — if I did, I wouldn’t be interested enough in yoga to be teaching it. Keep this in mind if you talk to your teacher, just like you would if you were talking to your doctor or other healthcare professional about a treatment. Your yoga teacher is a person too, and they are not infallible. Chances are they’ve also had injuries — I know I’ve had my fair share, some from yoga, some not. Injury can actually be a fantastic opportunity for learning how your body does (or doesn’t!) work, and to observe your internal response to the injury. Of course, I’m not suggesting that we should all injure ourselves in the name of learning. But human bodies break sometimes, and they definitely wear out. We will not necessarily be able to do things today just because we were able to yesterday, injury or not, and, at least in part, the physical yoga practices are designed to help us find that elusive sense of calm regardless.

If you’re interested in reading some other responses to the article, look here and here.

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This is cross-posted on my writing blog.