Anyone who is suffering from chronic pain is already saying “what is this idiot talking about?” Having suffered my own fair share of severe pain, I must say I would gladly have murdered that friend and buried it at the bottom of the garden. In this article we will focus on acute pain, the type of pain that may arise during your practice or within the subsequent day or so. We will endeavor to explore the common situations that may give rise to pain and the course of action you should follow.
When you experience pain it is in effect your body trying to talk to you. Perhaps it’s saying that it’s not happy with the aberrant alignment it finds itself in, the damage that has been done to it, the tension patterns that are building up, or on a positive note that structural change is taking place. More often than not it is saying ‘’back the hell off bitch’’.
When doing yoga (the physical practice) it’s easy enough to come across pain, either during the practice, straight after or several days later. For a pursuit focused on balancing and opening the body in a gentle and controlled way, it sometimes seems we are instead putting our bodies through the wringer.
I spend six months every year in Goa helping yogis with their injuries, and fair to say I find it hard to find enough time to see everybody. Many people come to yoga with existing injuries aiming to use it as a therapeutic modality, but unfortunately a fair number of us manage to hurt our bodies with our practice. Hopefully as yogis we are more sensitive to what’s going on in our bodies, noticing more easily imbalances, tension patterns and pain, but this is only useful if we take heed. It is very easy to get caught up in wanting to take our practice to the next level, ignoring what our bodies are trying to tell us.
Pain during the practice
Every time we go on the mat we are asking our bodies to move into positions that may present the potential for soft tissue damage. At particular danger of injury seem to be shoulders, low back, wrists, knees, ankles and neck (not much left). We may place strain on the joints and their supporting structures (ligaments and cartilage) or particular muscles or groups of muscles (e.g. hamstrings). So how do we interpret what our bodies are saying?
Padmasana is the quintessential yoga pose and as such our eagerness to achieve a semblance of the posture seems to fill our ears with cotton wool. If you are not open enough in the hips for this pose, you are more than likely to experience pain in the knee (either medially or laterally) and/or the ankle (normally just below the front edge of the lateral (outside) ankle bone). This pain is due to the ligaments being stressed too much, and your body is saying ’keep going and damage will occur”.
Ligaments are only mildly elastic, allowing for perhaps only a 6% stretch before tissue damage happens, and they do not mend readily due to a minimal blood supply. Unless chronically shortened due to some prior trauma, there is nothing to be gained by over stretching ligaments. Their job it is to provide structural integrity to joints by restricting movement in undesired directions, by loosening them you are not becoming more flexible just undermining their function.
So if you find yourself in this situation don’t hang it out in the posture thinking that by suffering the pain you will eventually open that area, you might hurt yourself before you get there. Instead leave it, go open the area with other postures and revisit the pose a number of weeks later to see if it is more comfortable. This is not the same situation as purposefully placing mild stress on the joints to elicit a positive response such as with Yin Yoga.
Another area of common injury and pain is where the muscles attach to the bones by way of tendons (their origins and insertions). In this instance the pain if felt as sharp, its exact location is easily determined. Repeated stretching near your limit of flexibility may stress these areas causing damage to the tendon fibers, resulting in inflammation. Due to all the forward folding in yoga, a frequent site for this type of pain is where the hamstrings attach to the ischial tuberosity (sit bone).
If you ignore this pain which may start out as more of a niggle, the injury is likely to worsen, become chronic and start to hurt not only when forward folding but when sitting and walking. In these instances you must modify in order to allow the inflamed area to recover. If you are feeling pain in a posture you need to back off until it does not hurt. This may seem like common sense but I bet that at many times during a yoga class there are people just trying to ignore some pain or other, hoping that the later repercussions will not be too bad.
So what about when we feel a sudden sharp pain whilst practicing, the offending limb or area then hurting to move (to varying degrees)? Do we plough on hoping that it will ease out? I would say no, the longer you go on the more likely you are to make things worse. It is easy for the presence of endorphins and the distraction of the practice to mask the true extent of the damage.
The best course of action is to stop and initiate the RICE protocol (rest, ice, compression, elevation) as soon as possible. If you didn’t need it no harm will be done but if you did you will benefit from the prompt action. The icing in particular will reduce inflammation in the area and help lessen the amount of damage done, and the sooner it is applied the better.
When icing never put the ice directly on the skin unless you are going to keep it moving (such as with an ice massage) and restrict the time of application to 20 minutes for more fleshy areas (e.g. thighs) and 10 minutes for bony areas like the feet and hands. You may ice frequently just allow a gap of at least 30 minutes between applications (a good indication that it is safe to reapply ice is that the skin and tissue has returned to normal temperature). Just remember icing for too long can cause tissue damage itself with particular ease on the fingers and toes, think of frostbite.
Pain after the practice
OK, you have a nice practice and then the next day or the day after that you get that feeling like you’ve aged 10 years over night. Muscle soreness, tenderness and stiffness pervade your body and you feel like anything but a bendy yogi. The sensation may very localized, restricted to one or two muscles or may cover a larger area. When the offending areas are in the resting position no pain is felt, it is only when the muscles are contracted or stretched that you experience the full glory of what is happening.
This body response is called DOMS for short and stands for delayed onset muscle soreness. If you have really given yourself a going over it may last 5 to 7 days but normally 2 to 4 sees the back of it. The reason may be that you are new to yoga, but this experience is by no means restricted to the novice. If you have had a prolonged break, amped up your practice, or started doing some poses that use more strength than normal, you may well endure a little suffering.
So what’s the cause and what can you do about it if it happens? A few of you might now jump in with, ‘a buildup of lactic acid’ and I will say, ’err no’. It is now currently accepted that lactic acid build up may help produce the fatigue pain associated with intense activity but is not responsible for DOMS as the level of lactic acid in the muscles has been shown to return to normal within 1 hour of exercise termination.
As a double no, lactic acid is associated with anaerobic exercise. Due to the intensity of the exercise and high energy requirement of the muscles, the body is forced to produce energy without using oxygen, lactic acid lands up being synthesized as a consequence of the metabolic waste produced by this means of energy production. Sprinting ok, yoga no (well alright you might feel this type of burn in Titibasana B, C, D if you have tight hamstrings and are working hard with your quadriceps to straighten your legs, that’s a yes for me).
There is still much disagreement as to the exact cause of DOMS but it seems to boil down to a combination of factors (e.g. inflammation, increased sensitivity of nerve receptors) resulting from micro damage suffered by muscle fibers and the associated connective tissue. This damage is more likely to occur during eccentric muscle contraction (working against a load whilst lengthening). For example the triceps are working eccentrically when lowering down in Chataranga.
This pain is not necessarily all bad though, DOMS is a sign that your body is adapting to the new stresses to which it is being subjected. It should not be confused however with repetitive strain injury, which is a much sharper pain and represents damage being done rather than adaptation.
DOMS may in certain circumstances even be used as a barometer of practice intensity. I remember many moons ago in my gym days that if I didn’t get DOMS the day after training I would consider that I hadn’t trained hard enough on that session, motivating me to work harder next time. Luckily I used a split routine (different body parts on different days) which allowed me to avoid reworking the area affected by DOMS for several days.
I am not suggesting here that you should set out in your yoga practice to experience DOMS but occasionally it’s not a bad thing. As DOMS is felt only in the muscles that have been worked hard (either by contraction or stretching) it can actually tell you quite a lot. Say for example you have decided that your practice has been neglecting you quadriceps and you add in some postures that you think might hit the spot.
If you experience DOMS in that area you can be assured you have got It right. On the other hand your teacher may have advised you to try and engage a certain muscle when doing a particular posture, DOMS may indicate that you were doing what you thought you were (of course if you use this muscle a lot already you may not experience DOMS). On the flip side you may sometimes get an indication that you are using certain muscles too much e.g. trapezius.
So a little DOMS can be nice (were still on the topic of muscle soreness here not S & M!) but too much and we need a remedy. It hurts to move the muscles involved but actually that’s exactly the thing to do. Light exercise such as gentle cycling will help ease out those uncomfortable feelings, light stretching is also good so a gentle practice is also fine. Remember much like the gym training if you want to still practice strong that’s also fine you just need to switch around the asanas you do so that you are not working the affected area strongly.
If you like the nasty medicine course of action an ice bath will help for sure. Top athletes often have an ice bath straight after a hard session to try to minimize the effects of DOMS and promote a quicker recovery. As much as I would like to say otherwise, massage although very useful for treating many injuries, may give temporary relief from DOMS but will not speed up the duration of the symptoms.
I’m aware that I have probably babbled on for far too long already, but here’s just one more thing. Sometimes you get a feeling of stiffness and soreness the next day that seems a bit like DOMS, but maybe restricts your range of movement a bit more and probably also aches when resting. Common sites for this type of feeling would be the neck and low back, and what you have probably done here is to stress the ligaments in that area. What your body is doing here is tightening up the muscles surrounding the area that you have over stressed in an attempt to splint and somewhat immobilize the area.
Unlike DOMS where you might be willing to think no problem change is under way, in these instances you need to take stock and look at what you are doing in your practice and make adjustments. It might be that you are being too aggressive in your forward bends, or perhaps having too much pressure on your neck in Shoulderstand or Headstand, or maybe using a little head flick in the infamous Chakrasana. Whatever the cause take time to figure out what you need to do to remove the strain you are placing on these areas.
It is often said that as yogis we can mend many of our injuries on the mat. I would say that this is great advice but only if taken the right way. What it doesn’t mean is to keep on with what you have been doing, waiting for the pain to go when somehow yoga magically sorts it out. In my mind what we are talking about is using every sensitivity you have developed in your practice to determine where the problems are arising from and then making changes as necessary. Focus on opening those areas that may be causing stress to be experienced in others. Above all listen to your body and let it guide you.
Great article Stuart – thank you! Jane