Yoga Spy

Several months ago, Terry, a yoga student, felt pain in her left hip flexors. She saw a physical therapist who recommended several exercises. When that seemed ineffective, she tried forced rest for two weeks. Then she did two or three private sessions with her longtime fitness trainer. Still in pain, she saw another physical therapist who recommended glute-strengthening akin to my Sit to Stand. A couple of weeks later, she asked me about yoga poses for hip pain.

Waitaminute. How long did Terry do each protocol? Is her pain constant or variable? Has she received an accurate diagnosis?

Our conversation got me thinking. What’s the best way to deal with injuries?

RICE (rest, ice, compression, elevation)

The conventional RICE protocol has its critics, but it can help with new, acute injuries—and possibly with chronic inflammatory conditions. If I were to fall, hard, on my kneecap, I’d probably ice it ASAP and limit activity that day. But the RICE modalities are short-term treatments—use them only when you can barely move.

MEAT (movement, exercise, analgesia, treatment)

Nowadays, the MEAT protocol is touted as superior to RICE. But to me they just apply to different stages. MEAT replaces RICE once you’re past debilitating pain.

The main takeaway here: Move the injured body part sooner rather than later. Movement flushes fluid to and from the injury site—and also prevents stiffness. Incrementally ramp up gentle movement into actual physiotherapy and exercise. (See below for more on analgesia and physiotherapy.)

Drugs

Some people are loathe to take prescription painkillers and even OTC analgesics. That can be misguided. For severe pain, strong drugs, including narcotics and steroids, can be warranted—to prevent nerves from getting stuck in a chronic pain cycle and firing even after the injury has resolved.

In The Brain’s Way of Healing, the opening anecdote describes how a physician (who happens to be a pain specialist in the San Francisco Bay Area) fractured a femur bone and experienced “level 10/10” pain. When paramedics gave him a dose of morphine, he saw the dose and requested more, to prevent that potential pain cycle. So, avoiding painkillers might sound safer when it’s actually not.

For less-severe pain, OTC drugs including non-steroidal anti-inflammatories (NSAIDs), ibruprofen and naproxen, are commonly used. I pop a couple of Advils if needed, but I’ve recently been reading that NSAIDs might inhibit the healing process. Inflammation is part of the body’s response to injury and some believe that interrupting this stage delays healing. Some suggest acetaminophen as a better option (although dosage must be monitored to avoid liver damage).

What about “natural” remedies such as curcumin (turmeric) and glucosamine? They’re not scientically proven, but probably safe to try. Note: Anecdotally speaking, vets often prescribe glucosamine for joint maintenance; it has shown more efficacy in dogs and cats than in humans. My healthy 10-year-old dog and my sister’s 17-year-old cat are prime examples, anyway!

Rest

Although R&R has been debunked, it can be worth a try. By R&R I mean taking a break from your work and exercise routine. Maybe you’re unknowingly, habitually causing injury to your body—sitting in an unergonomic chair at work, wearing the wrong running shoes.

Whenever I travel, my routine is disrupted: I do much less yoga and strenuous exercise. Interestingly, I often feel better after a trip. Maybe taking a break gives my body a rare chance to recover. So, don’t assume that rest is bad for you. (Don’t rest for longer than a couple of weeks, however.)

Physical Therapy

Physiotherapy comprises wide-ranging modalities, which I’ll divide into two overarching categories: passive (therapist manipulates client’s body) and active (client learns exercises and performs them at home). The former is warranted for major trauma, such as post surgery. But I don’t trust physical therapists who do only in-office treatments (especially if they merely hook you up to a device)—and who never prescribe home exercises.

PT exercises are the key to recovery (and also to prevention). The New York Times recently published an informative piece on exercises geared for tendons versus ligaments versus joints.

It might go without saying, but it’s important to do PT exercises as prescribed. Some people conclude that PT “didn’t work.” But did they actually do the homework? Also, as discussed in my post “Lifetime Physiotherapy,” you probably should continue PT exercises indefinitely.

Seek medical diagnosis

During one of my first Lonely Planet projects, I had a big write-up, the entire first edition Kaua‘i book. I worked at my computer for hours. Eventually it was excruciating to move my right thumb and wrist. I initially went to my workplace health clinic, got misdiagnosed with carpal tunnel syndrome, and was told to limit typing.

The pain persisted, so I saw my GP, who immediately diagnosed de Quervain’s Tenosynovitis and referred me to a hand orthopedics specialist. I got a cortisone shot that almost immediately (and permanently) resolved the pain. If I hadn’t see my GP, I would’ve suffered for much longer.

If you’re like me, you’re always self-diagnosing your maladies. But we should know our limits (and the limits of Google searches). For example,  your hip-flexor pain might be osteoarthritis. Your calf pain might be referred pain from a herniated disc. Bottom line: Find a GP who’s an excellent diagnostician. Get an accurate diagnosis. Get imaging (X-ray, MRI, CT) done.

Yoga

After I had rotator-cuff surgery fifteen years ago, I could barely move my arm. I initially needed manual physiotherapy, but soon did home exercises using a pulley. Once I graduated to strength building with TheraBands and eventually dumbbells, I returned to yoga asana.

Both PT and yoga improve mobility and strength, but yoga restored my pre-injury range of motion. If I hadn’t done yoga, I wouldn’t have regained my innate full range of motion.

That said, after decades of yoga practice, I’ve learned that some poses simply aren’t beneficial for my body and, in fact, might be injurious. Poses that push toward extreme joint angles or maximal flexion or extension might work for your body—or might not. You must learn from experience and not assume that all asana is right for your body.

General Health

If you have a lingering injury, consider your general health. You know the usual suspects: poor diet, lack of sleep, extreme stress, weight gain or loss, recent or chronic illness. Such health issues might delay healing. Don’t focus exclusively on your injury. You might benefit from improving your overall lifestyle habits.

Time (and Patience)

Give each protocol sufficient time—a couple of months, I’d say. If you keep changing from one thing to another, you don’t give any enough time to work. It would be an experiment in which you keep changing the variables.

Also, if you’re trying multiple protocols—for example, PT exercises, ice-heat therapy, and swimming—ideally try only one new thing at a time. Otherwise, you won’t know what’s making a difference. Here, it would be an experiment with too many variables.

Stick to your protocol(s), keep an open mind, be patient, and see what happens. Note: It’s not uncommon for pain mysteriously to alleviate over time. I’ve heard people describe pain from various conditions—sciatica, tendonitis, lumbar strain. But after weeks and months they stop talking about it—and appear quite functional. Pain is not necessarily constant; it can become manageable over time.

Acceptance

What if you’ve tried everything? Months, maybe years, have passed, and something is still off. Or you’ve undergone surgery and rehab, but haven’t regained your former abilities?

Sometimes injuries cause permanent change. Your knee or shoulder—maybe your entire body—might never feel as smooth and easy as it once did. If so, we have no choice, but to accept the “new normal.”

Images: Stella with telephone pole, Kitsilano, Vancouver, October 2019, Luci Yamamoto.