But I Thought All Yoga Was Therapeutic?

As we were moving slowly and consciously through a series of poses in a yoga therapy session last week, a 69-year-old client of mine who had practiced asana off and on for 40 years noted the difference between yoga therapy and the typical group classes she'd been to in the past, exclaiming, “No wonder I don't attend classes anymore! It doesn’t make sense for me to do what they are doing. And I thought all yoga was therapeutic!”

What we came to understand in her session was that many of the poses, instructions, and approaches to fitness that she was encountering in her local yoga classes were aggravating her conditions rather than alleviating them. Was this just because she was no longer 25? Not at all—I've seen the same kind of overuse and repetitive strain in people in their twenties, and even in teenagers. But for some reason, it's a common belief that yoga is exempt from the rules of cross-training and diversity of movement.

Injury has now become so much a part of yoga practice that it is widely accepted as inevitable. I recently came across a Facebook post written by a self-described “yoga teacher/mentor” this week that illustrates this prevalence perfectly. Her words (directed to her students) were, to this effect: “We’ve been through so much together, so many changes. I’ve seen some of you become mothers, others retire, we’ve ripped hamstrings and blown shoulders…” My mouth fell open. Since when are torn hamstrings and injured shoulders a normal, accepted part of the yoga experience? Memorable, yes, but something to look back on with nostalgia?? Somehow I don’t think that sages of yoga would agree, since yogis ascribe to the same rule of ahimsa as do medical doctors—first, do no harm.

Injury has now become so much a part of yoga practice that it is widely accepted as inevitable.

More and more, doctors are offering referrals to yoga classes, and teachers and students alike must be aware of what that means. Within the medical community, there is a growing sense of trust in yoga and in yoga teachers. My classes at a hospital, and my private lessons and therapy sessions, were full of doctors, nurses, physical and occupational therapists, and their families. Many of these medical professionals even chose to go through yoga teacher training programs so that they would have new options to offer their patients.

The issue is that to most people, a “yoga class” means a “follow the leader,” and includes the same 20 or so poses in every class. Some of them might feel good, like the reclining bent-knee-over-straight-leg twist that makes your back pop every time. This type of twist is actually destabilizing for your lumbar joints and can lead to later arthritis or sciatic nerve issues. Is it really worth it then? And while it may be momentarily empowering to kick up into headstand so you can say “I got that pose," what about the nagging neck pain the next morning? Or maybe you love the achievement of full lotus but are noticing knee pain. Thankfully, there are other poses out there—poses that may make you stronger and more flexible. But discovering those poses takes time and demands attention to the specific needs of your body.

To see why a "one-size-fits-all" approach to yoga can be problematic, let's look at the outline of a standard yoga class. A standard yoga class starts with some kind of warm-up. This, in my opinion, is the most important part of the class. Exploring your tightness du jour, breathing into a more supple ease in the morning, or de-stressing at the end of the day is why most students say they come to class. If left to our own devices, many of us might choose to spend anywhere from 20 minutes to an entire class doing cat/cow variations and all the core work and delicious hamstring and shoulder stretches we want. But the next thing we know, we are up and into sun salutes (or a comparable vinyasa) because the fitness class model demands that unless we sweat, we aren’t “doing yoga.”

In my private work, more than three-fourths of my diverse clients are unable to benefit their current physical state very much by doing “sun salutes” as they know them. Their backs are rounded in forward folds, their knees locked in downward dog, and their heads flung back as they grasp for backbends by straining upward. A chaturanga is a belly flop with shoulders wailing in misery, and stepping forward from downdog is an arduous and pretty embarrassing process. They hate these sun salutes but have done them religiously—thinking they were required in yoga practice and therefore must be good for them. With new or untrained teachers especially, sun salutes often take up a good amount of class time, as they may not be aware of other ways to generate heat.

In my private work, more than three-fourths of my diverse clients are unable to benefit their current physical state very much by doing “sun salutes” as they know them.

Next comes standing poses. Despite the fact that even students who have practiced for years have alignment epiphanies when they raise the surface at which they practice, in your average class, modifications with a chair or other high surface are almost never offered for standing postures like triangle. If the agile teacher and the other students are using no props, it could be embarrassing to pull out a chair—especially if the student is young, or older but wanting to appear strong and healthy.

After a few standing poses, many yoga classes include some sort of inversion, often much too difficult for those lacking core and arm strength. More experienced teachers will give some helpful modifications, since falling out of an upside-down pose can look pretty scary (as are lawsuits). Poses like legs-up-the-wall (or legs-up-a-chair) are wonderful, accessible inversions. And for those with more arm strength, a handstand or forearm balance is actually less risky than a headstand or unsupported neck-smashing shoulderstand. But even so, practitioners often eschew the simple poses in favor of more dramatic or "classical" postures. While inversions can be very beneficial for the body and mood, keeping your head and neck safe is an essential part of the practice!

The backbending part of class is excellent for many people, and a well-aligned bridge or locust can be quite strengthening. But when the other students start jamming stiff arms into full cobras, or teachers lift students into full wheels so that everyone "gets there," many practitioners feel pressured to do things for which their own bodies will suffer (both now and later).

Twists can be the most subtle and luscious of asanas when approached in an informed and exploratory fashion. But a ”get it done” mentality takes much of the sweetness out of the twist. Going for a popping “adjustment” or squeezing excessively to “wring out toxins” promotes an aggressive approach to the spinal movement. In actuality, it is the breath that promotes the "detox," not the twists “flushing the organs with new blood.” Of course, gentle twisting can help to calm the nervous system and keep the spine mobile. Popping is not always a good thing, though, and may set you up for joint problems down the line.

In many classes, there tends to be a similar approach to forward folds, which should be calming, soothing, strengthening, and lengthening poses. The “If you are more flexible, do ____" cue becomes a punishment to those whose natural suppleness (or lack thereof) may not meet their own expectations. They begin pulling and tugging themselves forward with rounded lumbar spines. When you consider the sitting that most of us do all day, why would collapsing and squeezing our spinal discs be a good plan? 

Along the same lines, you'll probably also find the ubiquitous “hip opener” in most classes. These are beneficial to a degree and may feel good to tightly clenched buttocks—but when overpracticed without good core strength and a countering squeeze from the outer thighs, they can cause instability of the hip joint. My motto is “Don’t feed the pigeon,” especially if it’s a fat spacious pigeon with way too much entitlement. In other words, if the pose feels too easy, the student needs to strengthen the muscles around the joint rather than increase a passive stretch. Loosen what’s too tight, tighten what’s too loose.

Along with warm-ups, shavasana relaxation has the opportunity to be a particularly healing part of yoga class, especially when attention is given to diaphragmatic breathing. In fact, some really great teachers add a sprinkling of “stop, breathe, and pay attention” practice throughout their classes, or start class with a centering resting pose. It is in the moments of resting that our minds and bodies download what we have practiced. Without the stopping and resting, the autonomic nervous system can’t assimilate the deeper benefits. Conscious rest provides a training ground for keeping us calm in all of life’s stressful situations.

What I’m talking about is yoga as a healing modality—not just for weight loss or "detox," or to firm buttocks or perform impressive postures. I had one yoga therapy client who really understood the difference. She said, “I am here for the therapy, the process that happens in the breath and mind and body. I also do fitness yoga, a vigorous power flow, because I don’t like running!” She practiced yoga as therapy, along with yoga as fitness, and did not confuse the two.

If a healthy person with a clear mind and good joints and muscles takes vigorous classes to stay fit, good for them. But they need to vary their movements and be aware of the pitfalls of some repetitive actions too. A repetitive strain injury (RSI) like carpal tunnel syndrome is an "injury to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions." How many awkward positions do we assume repeatedly in yoga classes, especially in vinyasa? (Think weight supported on hands, neck thrust back.) How many times per week? Or if you are a teacher, how many times per day?

If you are unsure about how to practice therapeutically, it may be good to visit a well-recommended yoga therapist or experienced teacher who can map out some areas where you need strength practices, and others where you need to focus on flexibility. Consulting with the International Association of Yoga Therapists (IAYT) for trained therapists in your area may be helpful. Most importantly, a trained professional can observe how you breathe during yoga and help you to modify the speed and intensity of your practice accordingly. This type of help will give the prospective or long-term yogi more confidence in how to practice in general. Remember, the poses and breathing techniques we choose to practice may lower pain levels and help with range of motion, but it's how we practice them that can change our lives.

I’m not offering these thoughts to frighten students or keep them away from classes they love. But how many times must we ignore the pinches we feel around the tops of our thighbones, or the lower back twinges in straight-leg forward folds? How many times must we continue to lower to chaturanga when it hurts our shoulders? When we "do it anyway" (just like going for a third cocktail or chocolate pie bender), we will pay for it sooner or later.

If you attend classes because you love them, consider trying the simpler "beginner’s" options for awhile. Go to your knees in plank pose, or skip the deep backbends even if you think you can do them—then add gradually from there. Ask yourself: Is this uncomfortable? Is my breath ragged? Am I stressed or anxious when I try this? If a teacher pushes you to ever-harder movements that result in pain, or won't let you modify a pose, look for a new class.

If a teacher pushes you to ever-harder movements that result in pain, or won't let you modify a pose, look for a new class.

My personal preference is to let my yoga be sweet yoga, and take a long walk (with attention to alignment!) if I want fitness. My “sweet” practice includes different strong asana every day, along with plenty of TLC. My body has been at this awhile and rewires well with some intense focused poses; this may be the case for you as well.

The home remedy I suggest for anyone is to be more playful in your practice—to breathe and stretch in joyful ways that generate a sense of openness in your body. Historically, before the development of asana as we know it, yogis simply moved to link the circuits in their energetic systems. They would then "breathe life" into these shapes. In fact, Tandava (Indian sacred dance) and Qigong both evolved out of playful, wise, joyful movement combined with breath.

Start on the floor on your belly or back and just see what your breath is doing; then move your way into cat-like stretches—not necessarily a yoga pose, but stretching to feel better and to connect with deeper breathing into tight areas. And when you discover the yoga postures that give you space, allow you to breathe deeper "into" constricted areas of your body, and leave you feeling refreshed, practice them! Practice them in a spirit of exploration.

Swami Rama of the Himalayas, a spiritual scientist and remarkable scholar of the mind/body connection, likewise encouraged his students to be like scientists in exploring the body and energetic system. But no good laboratory research is done without variables or by allowing oneself to damage the equipment. Explore and learn your strengths and weaknesses, and vary what you are doing physically. Only a mad scientist does the same thing over and over and expects a different result.