sleeping-in-symmetryHere are my favorite home remedies for routine tweaks and twinges–and a word on the psychosomatic factor.

RICE (Rest Ice Compression Elevation)

Rest. The best and simplest remedy is hardest for me to comply with. When I notice a twinge or tweak, what do I do? I might ratchet down, but short of full R&R.

When I attend class and the teacher says, “Does anyone have anything to report?” I tend to underreport. Then, instead of forgoing the class sequence, I adjust my intensity accordingly; there’s a big difference in doing a pose at 75% versus 85% versus 95% capacity. I admit that an individualized modified practice might be much wiser.

liz-koch-constructive-restTo “justify” rest, I sometimes recall a position (and turn of phrase) that my first yoga teacher called “constructive rest.” Yes-sir-ee, rest is constructive. No need to feel lazy or guilty about resting.

Ice is bracingly effective to me, but also messy and inconvenient. Non-ice substitutes are ideal. (Long ago I found an ice pack composed of small gel-filled plastic pillows (like ravioli). Magically, they keep cold for several hours. Today I can neither identify the brand nor find anything remotely as effective.)

Compression and elevation make sense, but I find these options cumbersome for non-limb muscles and joints. Compress and elevate my hamstring origins?!

OTC drugstore remedies

I have no qualms popping two Advils (Ibuprofen) when I’m hurt. To me, it’s important immediately to reduce inflammation and the sensation of pain. Otherwise, acute pain from a legitimate injury can become chronic pain, due not to tissue damage but to misguided neurologic activity.

Atul Gawande’s New Yorker article “The Itch” disturbingly explains the brain’s effects on sensation: what we think we feel through our senses might well be “made up” by our brain. I don’t want to give my brain a chance to cling to pain!

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Besides ibuprofen, I’ve tried the herbal arnica remedy Traumeel, which I found ineffective, perhaps because I’m skeptical of homeopathy and it’s “Law of Infinitesimals.” More recently I’ve tried Voltaren Emugel (Diclofenac; available only by prescription in the USA). On a whim I tried the gel last year for mild plantar fasciitis. Soon, my feet felt fine. Due to Voltaren? Due to stretching my soles and Achilles tendons? Without a control, who can know?

My favorite home remedy harks back to my childhood: Salonpas. Maybe every Japanese kid remembers the unmistakable camphor-menthol smell of a grandparent’s Salonpas. The smell alone could cure (or so it seemed). Wake with a stiff neck? Slap on one of these patches… Ah!

Stress

The year before I first tried yoga was turbulent: breakup, landlord clash over harboring cat in no-pets apartment, move across town. I suddenly felt inexplicable back discomfort, primarily while sitting. Strangely, the pain was inconsistent, flaring up at work (despite ergonomic chair) and vanishing at home. A yoga classmate recommended that I read Mind Over Back Pain by John Sarno.

mind-over-back-pain-coverSarno hypothesized that pain is subjective based on mental state; tenseness disrupts circulation, reduces blood flow to specific areas (especially the back), and causes pain. He had studied patients with actual spinal-disc injuries: some felt excruciating pain, others felt nothing despite similar physical abnormality. Thus pain can be a function of the mind. The cure: change your mindset.

Note: Sarno has written two follow-up books, Healing Back Pain and The Mindbody Prescription. I happened upon the latter and found it over-the-top in its crusading claim that all illnesses and injuries are “in the mind.” Read a clear-eyed review here.

Massage

Undoubtedly, my favorite antidote to aches and pains is massage. It is both preventive and curative. Sometimes my body simply craves deep-tissue massage and, if I book an appointment, my mind also relaxes in anticipation.

I do wonder whether my craving for massage signals Sarno-type tension. Do people exist who are truly tension free? People whose muscles are strong and firm, yet uniformly pliable and smooth? Sarno might conclude that massage, while soothing, is only a Band-Aid.

Or maybe it’s more like a prop: with massage, I can feel more myself while working on myself.

GO TO PART I

Image: Liz Koch in “constructive rest” position

Last month, eight colleagues and I faced our Intro II assessment for certification as Iyengar yoga teachers. Before commencing, the assessors asked us about injuries or health issues: “Do you have anything new to report?”

When my turn came, I said, “Nothing new to report.” I entered the exam “healthy.” Secretly, however, I knew my real answer: “Nothing new, except the usual stuff.” In other words, even 100%, I’m always aware of my potential trouble spots.

In the past decade, I’ve sustained one major injury (rotator cuff tear) and a bunch of little tweaks and twinges. I tell myself that active people inevitably sustain minor injuries. But is this true?

bizarro-yoga-comicWhy are some people “injury-prone”?

Have you noticed that some people are inexplicably “injury prone”? Among yoga students, one might report new problems every other week, while another might never mention anything. (This tendency does not correlate with ability or flexibility, by the way.)

My first idea is mindfulness: Do injuries result from preoccupied or scattered behavior? Do people invite accidents? An acquaintance once said that when she finds herself stubbing a toe or stumbling on stairs, it’s a sign that she must pause, take deep breaths, and gather herself.

Next, I wonder if some people are hypersensitive to pain. The same tweaked knee might bother one person more than the next. After all, people vary in tolerance levels for deep massage, intense aerobic training, invasive surgery, freezing weather, and hot chili peppers. Regardless of your sensory awareness/tolerance level, perhaps the main thing is be sensitive during the activity, not after, when it’s too late and damage is done.

The likeliest reason might be overzealousness. Possibly, intense students end up injuring themselves because they willingly, eagerly push to their limits. They never allow R&R, and they ignore warning signs.

Are injuries preventable?

So, can people be intensely active and yet prevent/avoid injuries? My injury history (very abridged sample below) indicates yes:

  • Rotator cuff tear A few years ago, I tore two rotator-cuff tendons by slipping and falling on my shoulder. What was I doing? Walking around photographing fall leaves. Instead of bracing myself, I held onto my camera; my shoulder took the hit.
  • Hamstring strain Six months post-op, I resumed yoga classes full force. I also volunteered as a student in an Intermediate Junior II assessment (and did more Utthita Hasta Padangusthasana than ever). Soon I felt twinges at my hamstring origins. Too much, too soon.
  • Neck/upper back stiffness post Sarvangasana Last month, in the run-up to my assessment, I suddenly tripled my usual Sarvangasana hold, doing recorded timed-practice sequences. Again, intensifying a pose should be done incrementally.

And so forth. Of course, you might be more mindful than I–and still end up injured. I’m not implying that we’re always the perpetrators of our aches and pains! We’re also ruled by genetics and chance. Even fully mindful, stuff happens.

Next: when faced with injury, what do you do?

GO TO PART II

Image: Bizarro comic, The Peace Lily

Acknowledgment

This post is dedicated to my colleagues in Vancouver. We all passed our Intro II assessment in April. We couldn’t be more diverse, in body type, age, profession, personality, and birthplace (spanning four different countries!). But we all, in one way or another, have dealt with pain.

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I need not introduce How Yoga Can Wreck Your Body, the New York Times article that’s gone viral. My first response upon reading it: These anecdotes are outliers! Who sits in Vajrasana for hours daily, tears Achilles tendons in Downward Dog, or pops ribs in a spinal twist?!

My second response: No Iyengar yoga teacher would intentionally push students too hard, beyond safety. Salamba Sarvangasana without a stack of blankets under the shoulders? Unheard of! If a novice tries a headstand or an Upward Bow backbend before she’s ready, the teacher would immediately say, “Stop! Come down now!”

My third response: Uh, I’m sitting here with a strained piriformis (or something), probably from yoga. My body isn’t “wrecked,” but since taking my first yoga class over a dozen years ago, I’ve occasionally sustained asana-related injuries. Examples:

  • Overflexing my neck I’ve tweaked my cervical spine in Halasana and Salamba Sarvangasana, typically when pressing my chest too forcefully toward my chin. Lesson: Ground my elbows (and rest my ribcage in my palms) to lighten the weight on my neck. Cultivate a sense of repose in shoulderstand and its kin.
  • Unexplained knee pain after Virasana In early 2010, I felt pain in the back of my right knee after exiting Virasana. A doctor conjectured that my meniscus had micro tears and would heal by itself over time. Indeed, my MRI results were normal and the pain eventually subsided. Lesson: Work on stretching my quadriceps and gradually increase my Virasana hold time. Expect “mystery” conditions to appear now and then.
  • Strained hamstring attachments About four years ago, I practiced too much Utthita Hasta Padangusthasana and began to feel twinges at my sitting bones. I made the typical mistake of assuming I needed to stretch more. Suddenly forward bends weren’t easy and relaxing, but challenging and humbling. Lesson: Moderate and vary my practice to allow for recovery. Tone down rajasic energy. Accept change. (“Easy” and “hard” can suddenly reverse.)

That said, I blame my injuries on my own overzealousness and momentary attention lapses. Asana, no matter how strenuous, is not inherently risky. It’s not speed skiing or tow-in surfing! Asana is controlled movement in a controlled setting. Chances are, I could have prevented my injuries.

While the serious cases mentioned in the NYT article are inexcusable, occasional muscular strains are perhaps inherent in a vigorous asana practice. If I’d done only restorative yoga and never attempted to move beyond “level one,” I might be injury-free today. But isn’t yoga about exploring our perceived limits? If I do a pose and feel absolutely comfy, I’m probably merely going through the motions. I should feel strong sensation (which, by the way, isn’t synonymous with pain) during practice, but not after. And if I do injure myself, I must determine why—and learn from it.

Additional reading: Insight from Injury, Carol Krucoff, Yoga Journal

Image: Michael Fleming via the Lighthouse Keeper’s Cat

Note: Blog post title owes a debt to Mary Oliver‘s poem “Wild Geese.” from Dream Work (Atlantic Monthly Press, 1986)