General Advice for Long Term Yoga Practitioners with Acute or Chronic Injuries of the Musculoskeleta

The following letter is the response to a friend with an injury of the spine diagnosed via MRI asking for advice. When I wrote the reply I only had limited information about the issue which makes it less specific and applicable to many problems of the movement apparatus (not only regarding the spine) that may arise because or despite a dedicated long term practice.

Hi —- ,

Generic MRI scan

I can certainly share my observations and experiences in this area. First of all, I think it’s important to know that, to a certain degree, a degeneration of the spine is quite normal and can be found in most people at any age. I remember doing an x-ray of my lungs at the beginning of working in the hospital and I compared my x-ray with other colleagues; we all had some strange looking spines with slight bends in the frontal plane and sometimes less than optimal distances between the vertebrae.

I mention all of this because the diagnosis “spine degeneration” can create the impression that from now on you will always have problems and pains, however, a completely healthy spine is somewhat unrealistic and there are people having multiple hernias without even noticing them. Spine abnormalities can be found very frequently on X-rays or MRIs without people ever reporting problems.

In terms of treatment of the musculoskeletal system, I believe the most important quality to develop is strength. Many people (including me) tend to automatically associate flexibility rather than strength with youthfulness, health and perhaps even spirituality, but a reading through scientific literature and studies shows that the main component to develop in regards to long-time health of the musculoskeletal system is strength. Flexibility is more of a luxury.

Consequently, if you are having a look at non-surgical orthopaedic treatment protocols for ailments of the musculoskeletal system, the emphasis is most often on building strength; stretching is, if at all, a very minor part in the path of recovery.

The tricky thing is that most Yoga practitioners, especially Ashtangis, think they train strength and flexibility in equal measures, which is simply not the case. I remember a session with a physiotherapist where she told me my back and my core is quite weak. My perception was different. I thought that after many years of Ashtanga Yoga, I am very strong, but according to the problems I had with my back and in the light of my widened knowledge regarding the needs of my body I now know her assessment was right.

As wonderful as Yoga is, there are many areas where the body, potentially and quite likely, over the years develops in a not-so-balanced way and there are some postures I certainly do not do anymore and would not recommend. We (Charlene and I) stopped practising leg-behind-the-head postures. These asanas put shear forces on the spine which the spine is not made for and if a person does not have rather extreme hip flexibility, it will most likely create problems over time. The amount of hip flexibility necessary to comfortably move into leg-behind-the-head postures without creating problems to the spine will likely lead to other issues if not met with an equal amount of strength which is unlikely to develop in a Hatha Yoga practice alone. The common sight of flat bums of those practitioners who move into leg-behind-the-head postures easily strongly suggests that this balance of strength and flexibility is more illusion than reality (and relatively few practitioners and teachers are aware of how to actually assess if strength and flexibility of any area of the body is expressed in equal measures).

Other postures we see as problematic and have no interested in anymore are headstands.

Muscles of the upper back are usually very weak or even atrophied in long term Yoga practitioners, creating all sorts of minor or major neck problems that people learn to live with or they might even think they need to do more Yoga to “stretch it out”.

However, very often the solution is to add some training with weights outside of the Yoga mat as well as letting go of certain postures. I think during the evolution of the human body over thousands of years it was the most natural thing to have a strong physical interaction with the environment, meaning simply lifting and manipulating heavy objects around us on a frequent basis which is not necessary for most humans only since relatively recent years.

As you have mentioned hanging (I was evaluating on the potential benefits of hanging in regards to shoulder health in the article ‘From specialists to humans‘), this can be tricky, as it is indeed very much a natural activity for the body, but not necessarily a familiar activity for most spines, meaning that although downward dog is somewhat similar, hanging can be quite upsetting for a spine not used to it and I would recommend a cautious approach to begin with, i.e. not hanging with full weight the first time, but it is certainly an important as well as fun activity. However I am unsure if it will be of great help with your issue at the moment.

I don’t know how bad the problem is and how much you are able to move at the moment, but generally in addition to a physiotherapist who has experience with working with that problem, I would recommend to you (and to every passionate long time Yoga practitioner) to perhaps find an excellent personal trainer and do weight training with kettle bells, barbell, etc as well as some pulling (bar or gymnastic rings).

Charlene had some issues with her upper spine as well, strained muscles as well as vertebrae moving out of place which even resulted in numbness in the hands. A chiropractor was only a temporary help, but since she included strength training (gymnastic rings, rowing machine, some weights) about two times a week in addition to her asana practice, her spine and upper back is well again and her general sense of “feeling well” in her body increased.

The second thing worth mentioning is the psychological layer of your problem The med school I went to adhered to the biopsychosocial model of health and disease, meaning that health and every disease is the result of the interplay of biological, psychological and social factors. Although that model has some flaws, I do believe in it more than ever.

I would like to give an example from my own life explaining what that means to me: since about two years I have some slight discomfort at times in my right shoulder that I felt for example when I lifted my arms during the sun salutes as well as in Chaturanga. In the last months, although I thought I am having a diverse movement practice beside my Yoga practice (weights training, some gymnastics as well as Martial arts, running) it got worse, and I actually got quite worried that it develops into a serious chronic rotator cuff issue or even tear of a muscle. I did a lot of research about physical therapy in relation to rotator cuff injuries and included that into my practice.

However, it did not really help, so I addressed to the psychological layer in simple asking myself in a quiet moment why do I have this problem. After some time, something answered in my that the shoulder is a symbol of power and my problem in this area shows my perception of not being powerful, that I am to some extent at the mercy of outside sources (I know this might sound quite New Agey, but I want to honestly and openly share my observations and what works for me).

When I did my therapeutical shoulder exercises the next time a few days ago I simply included the feeling of being powerful. With imagery, I fabricated and created in myself the emotional feeling of being powerful. The influence of imagination and self perception on physiology is simply amazing and had a very strong influence on my shoulder, now being almost completely fine again.