Q & A

While it is essential to get professional help for painful, chronic problems, post your questions here about problems that you are experiencing in your yoga practice and get suggestions on

  • How to approach your injuries,
  • Which kind of medical professional may help you most
  • Ways to modify your yoga practice.

If you would like to contact me via email, you can do so using the form below

 

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22 thoughts on “Q & A

  1. Hi Niki

    I have been practising ashtanga yoga for about 20 months I am a 39 year old female and I felt and heard something spring or twang in my left side under the breat bone and around the shoulder when I pushed up into my 3rd backbend in mysore class 2 weeks ago I rested for a week no practice at all but have done a gentle modified practice 3 times last week it felt much better. For no apparent reason the injury site is blasting with pain today and I dont know what to do? I really want to practice or find another form of stimulating yoga that is as exciting and benficial and spiritual. Any ideas?

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    • Hi Karen

      That doesn’t sound good at all. From what you describe, you have either strained or torn a stabiliser muscle in your shoulder girdle and I think it would be a good idea to get it seen by a physiotherapist or sports practitioner. Those kinds of injuries generally require at least 3 weeks of rest and you should avoid any yoga poses involving the upper body, especially vinyasa, because exercising with pain often leads to the development of muscle imbalances that will take a lot of work to correct later.
      Exercise is beneficial for healing as it increases blood flow and tissue repair, but you must take care not to stress the injury further. Saunas are also useful, for the same reason, so Bikram yoga can be helpful while the injury is healing if you can tolerate the heat.
      If Ashtanga is what you love and it’s not causing you any other problems, take a 3 – 4 week break and practice any other Hatha yoga form but avoid vinyasa, backbends, arm balances, tolasana, headstands or anything else that requires arm and shoulder strength. You could also focus on Pranayama practice while you give it time to heal. Although you are a yoga practitioner, if the synchronisation of breath and movement in Ashtanga is what appeals to you, then you might like to try Tai Chi or Chi Kung practices for a while – they are not stressful to the shoulder girdle. Even if such practices aren’t exciting to you, it’s not permanent. Start with gentle stretching of your chest muscles and then ease back into your Asthanga practice slowly.

      Impatience with healing processes only prolongs the healing time and it would also be a good idea to investigate why you had that much tension in your shoulder girdle stabilisers to have caused this injury. I strongly recommend that you consult a sports practitioner. Ashtanga practice can cause a lot of upper body problems and it’s often helpful to perform pulling exercise in addition to your practice if you are prone to shoulder problems but only after you have recovered from this injury – do not try this now. A qualified person can prescribe the right kind of supplementary exercise to correct muscle imbalance and keep your shoulder girdle free of the kind of tension that causes injury.
      Once your injury has healed, work especially at strengthening your shoulders: Tolasana, Pincha Mayurasana, Makrasana & Sirsasana and lifting from Sirsasana to Pincha Mayurasana but only if you don’t feel pain otherwise, more rehab exercise is required.

      Please ask if you have any further questions.

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  2. Hi Niki
    I have been practising yoga for the last 18 years or so, teaching for the last 14. Have explored various styles, all fairly dynamic and strong, started off with Ashtanga, then into ‘Shadow Yoga’, now Vinyasa-flow style, but have adopted a much more gentle approach over the last few years in response to student needs.
    Started having problems last year…….and physio diagnosed the classic Si dysfunction and unstable hips that seem to be a characteristic problem with this type of practice. Am seeing an excellent physio who is gradually helping me restabilise and retrain my stabilizing muscles, but it is a very challenging time for me – I have done none of my own practice since January (from someone who had a six days a week self practice!), but am still teaching and have had to completely change and adapt my teaching style. It’s been a huge learning curve for me, having to unlearn a lot of the ‘classic’ way of doing things and a lot of what I was taught. Obviously I want to bring as much of my new movement awareness as possible into my teaching and future personal practice, so that others can benefit from my experience. But I am just questioning everything I have been taught and my whole yoga and teaching foundation feels very ‘unstable’ at the moment – like feeling my way around in the dark! All part of the process of yoga and ongoing change with which we have to learn to flow, I guess!
    Anyway, one of the changes I am gradually going to introduce is doing a lot more core work and side body strengtheners and my question in this regard is to do with sequencing. How would you tend to sequence post-standing asana floor work which included core and/or side strengtheners, backbends (gentle eg salabasana, and more strenuous like bridges and dhanurasana-types), forward bends/stretches and twists? I used to attend a lot of Shiva Rea workshops and did her Vinyasa flow teacher training…and she always maintained never do backbends after core work…………but as I said, I am questioning absolutely everything I have learnt so far!
    Your blog is great, so glad I found it (very timeous!) and look forward to your reply. thanks a mil.
    Bronwen

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    • Hi Bronwen
      I’m glad you find my blog helpful
      I think that backbending after core work depends on the state of the Psoas: many yogis have weak butts and an overactive Psoas and if you are doing the kind of core strength that works the Psoas hard – Navasana and supine leg lifting and lowering – this can cause pain in backbending because the pelvis doesn’t want to tilt backwards on the heads of the Femurs and directs force into the Lumbar spine. Core work that strengthens the butt and lower abdominals will make backbending easier.
      A good guide for core work is to do equal amounts of front, back, sides and butt using yoga core-strengthening postures rather than Pilates style abdominal exercise: Pilates is very heavy on the Psoas.
      I’m also not a believer in the ‘relax your butt’ school of thought. Although it is undesirable to clench your butt, engaging Glutes to support and tilt the pelvis backwards in bridging and backbending protects the Lumbar spine from hyperextension.
      My opinion is that backbending after core work is not problematic in a properly balanced body.
      Let me know how that works for you
      Niki

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  3. Hello,

    My experience with yoga is limited to once a week, a “functional fitness” type class. I am not very familiar with the proper names for poses.
    I’ve taken this class for 6 year along with causual walking and some strength training classes about 2x a week that focus on balance and functional fitness. My Mom and sister have hypermobile joints and I am not as flexible as they are, but I think I am a bit more flexible than average. I am nearly 50 and I have never been pregnant. My job is sedentary, but I have been experimenting with a standing desk for the past few months.

    About 2 years ago, I fell while roller skating. I fell almost perfectly straight down onto the base of my spine. Since then, my left hip is not as flexible as my right. Also, and this problem may have pre-dated the fall, I think my left glute does not “activate” as much as the right.

    I worked on increasing the openness of that hip and succeeded but I think perhaps that was a mistake. I now think it may be a pelvic stability and/or SI joint problem. If I rock my hips from side to side or front to back, there’s often clicking, clunks – disconcerting noises. Not painful, more of a discomfort, especially at night when I lie on my right side. However, pain tolerance also runs in the family. My mother, who is a red head, has had extensive periodontal work with no pain relief at all. I also have pain in my left hamstring during bridge particularly if the right leg is raised. I also have a possibly related torn left rotator cuff injury from 2009. I think yoga and a lot of rest has led to a full recovery, except for minor discomfort when sleeping on my left side, but I suppose it could be a factor in all this.

    I have started using the “constructive rest position” and I believe it may be helping. My chiropractor seems to think that everything is lined up and I do have good and bad days. I think I may need to consult with some sort of trained professional, but I haven’t a clue where to start. I am currently in Tennessee with occasional work in Florida.

    I would appreciate your suggestions about consulting and perhaps a plan of action to further define the problem. Do I understand correctly that I should avoid twists and hip openers for now? Is it ok to do these poses very gently? I think they feel good and perhaps have been overzealous.

    thank you for a very helpful website
    NGE

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    • Hi NGE

      I would concur with your sense that you have a pelvic stability problem, definitely related to the fact that you can feel that your left glute isn’t firing properly. Strength differences between the right and left hip will produce the clicking sensations that you describe because the muscles aren’t providing adequate force closure of the Sacroiliac joint. The fall that you mention could have contributed to that because pain in the lower back inhibits deep spinal stabilisers, which in turn inhibits correct hip-muscle function. The pain that you feel in your hamstring when bridging is an indication that the glute isn’t working as it should.

      I would recommend that you consult a rehab-specialist who can do muscle testing and movement assessment to pinpoint the problem muscles. A good professional is someone who works with you for a couple of sessions to make sure that you are moving correctly – not someone who sees you once and sends you home with a list of exercises. Ask your Chiropractor if they can refer you to someone reputable in your area.
      Getting your butt working properly should be your first priority but also have your shoulder function assessed because that may or may not be playing a part. It’s unusual for the left hip to be weak in a right-handed person (I’m assuming that you are) and previous injury to the hip or opposite shoulder is often a cause.

      Clinical Pilates or Feldenkrais classes might be a useful addition to rehab work on your hips. A large part of hip stability derives from correct use of the lower abdominals and the pelvic floor – these muscles can sometimes use a little re-education: even if the muscles aren’t weak, their stabilising function may be poor and a better awareness of how you use your pelvis when you move might be helpful.

      With regards to yoga practice I’d say that the main poses to avoid are lunging poses of all kinds, these stress an unstable pelvis in unhealthy ways. Hip openers are important and necessary – these poses only become problematic if they are practiced excessively and you feel pain or stiffness during or afterwards and don’t investigate the causes. Avoid them if they cause pain.
      The same applies to twists – if your upper back is stiff, you will twist into your sacrum and misalign the SI-joint but if your bandha use (read: pelvic stabilisation) is good and your shoulders and thoracic spine are flexible, twisting is good for you. Don’t do twists if you experience clicks or clunks in your lower back and hips that cause pain. Focus on twisting your upper back.
      Practicing back extensions (strengthening exercises, not backbending) may also help to control the clicking.

      Learning different movement strategies and balancing your left and right hips should eliminate most of the symptoms that you you describe. Your joint may always tend to click, but this shouldn’t be frequent or uncomfortable.

      I hope this helps you, please ask if anything is unclear

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  4. Thank you very much. I’ve made a list from your comments and it a great relief to have a plan of action. This is my project for 2013. Happy New Year to you!

    Like

      • one year update – a month of physiotherapy, followed by a month with a rehab pilates/structural integration and then several months of the pilates rehab. (I was very lucky to find such a talented practitioner.) I am still taking pilates instruction with the occasional integration “intervention” but only about once a month. The idea is to keep working on some problematic movement patterns to ward off future possibly injuries such as another rotator cuff tear. Also to improve my technique so that I could take pilates mat classes and actually be doing the moves correctly, consistently.

        So, after a few months, this summer, my SI joint started to “slip” – YEE-OUCH! But I suppose this was progress, as it means that it wasn’t stuck all the time. Shortly after that, about 5 months ago, I got the ok from her to try a kettlebells class (SFG, ie Strong First) and this has turned out to be a huge help with large strength and flexibility gains. My ability to roll my spine has improved tremendously. Even better, my hip/lower back often feels perfectly stable/solid. It feels great! It is hard to explain how much calmer and relaxed I feel, to be so comfortable. She insists that I “keep doing what I am doing.” I do enjoy the kettlebell classes and think it is the kind of thing that I could do for a long time.

        Now, my next goal is one full week with no slips. I am very close to this and have even taken long car rides with minimal issues, up to 500 miles. Also, I’ve been working on stretching my hamstrings and that seems to help reduce the “clunking” noises. I was thinking about you at Thanksgiving; I so appreciate your help. I was willing to put in the work, but didn’t know where to direct my efforts. Thanks and if you keep count, put me in as a success!

        Here’s to a great 2014!

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  5. Hi Niki,

    I am writing because I have recently injured my back and I suspect the injury is the result of how my practice has evolved over the last few years. I was having my morning coffee seated in a chair when I felt the urge to stretch so I brought my arms over head and arched back. I felt a sharp pain on the right side of my lower back and lay down on the floor and was not able to get up. If I remained flat there was no pain, if I tried to get up my back began to spasm. The more I tried to move the worse it got. After about two hours I had the ambulance come and get me because I was in agony.

    The X-rays showed a healthy spine, and at that time I did not have any unusual sensations anywhere other than what felt like muscular pain in the sacral area. I was told that it was an acute sprain. It took 3 days for me to be able to put weight on my legs and sitting was an impossibility. By the 7th day I was standing and sitting but still felt tremendous pressure on the spine in area of the sacrum. When the muscular pain in my back subsided I began to feel pain in both buttocks, in my hip joints mostly the right, tingling down my thighs, and sore calf muscles. My right hip has always been less flexible than the left.

    It has been two weeks now and I feel fine, except that my muscles are locked. I tried to bend down and touch my toes yesterday and my torso is parallel to the floor where previously I could sit my chest on my thighs and hug my legs. Can this happen if I am doing to much forward bending and not enough work to strengthen the glutes, hams and lower back? I have been practicing gentle hatha for 2 years- this school believes you should relax any muscle not directly involved in the posture. During these two years I have lost a lot of muscle mass and tone, six months ago I transitioned back to practicing the Ashtanga half primary. Help. Where do I begin figuring out what has gone wrong. I’m afraid to start practicing again.

    Your blog is fantastic, thank you so much!

    C

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  6. Hi Cris
    That sounds like a hellish experience. I suggest you see a chiropractor who can mobilise your pelvis and Sacroiliac joints: the muscle spasm in your lower back has probably left you with restricted movement in your SI joint which might be why you can’t bend forward at the moment. The other hip symptoms you describe could also be from your Sacroiliac joint, although there are other possibilities. Get it checked out to be sure.

    Ashtanga isn’t kind to hips and I think your sense that you have been doing too much forward-bending without strengthening the hip and lower-back area is correct. The Primary Series can leave people with a very tight psoas, a forward-tilting pelvis and a lower back that is prone to going into spasm.
    Right now it’s probably a good idea to stop yoga and get a referral from a chiropractor to see a movement and exercise specialist who can assess your muscle strength and prescribe suitable exercise, since the doctors have ruled out a spinal problem.

    Personal experience has taught me that yoga alone is frequently unsuitable for general strength-building, I believe in doing more conventional exercise to strengthen my body and yoga for focus and relaxation. Although the yoga-is-everything approach appears to work for some people, it doesn’t work for me – and quite a few others, judging from the responses to this blog. A suitable yoga practice for your body depends on your physical activity and your body’s strengths and weakness.
    It is a good idea to educate yourself about the effects of exercise on the body and what constitutes a balanced exercise plan. Attend classes that have a balanced approach and open-minded teachers. While set formulas sound great in theory, one size does not fit all and many hatha teachers bias their classes towards standing postures and abdominal exercise, which can also cause problems in the hips.
    For now it may be best for you to do a varied hatha practice focused on flexibility and all-round core strength and find other ways to build hip and leg strength. What is ultimately suitable is a trial-and-error process for most of us and also changes over time.

    I hope you feel better soon
    Niki

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  7. Just an update – I saw a physiotherapist 10 times in January. Almost immediate improvement in terms of the discomfort level at night. I caught up on my sleep and they gradually added additional exercises and “therapeutic activities.” They also monitored the range of movement in my left hip, primarily the extension. By the end of the month, it was very close to the right leg’s range and I now have a list of corrective strengthening exercises using resistance bands to pursue on my own for at least 2 months. I usually can now do bridge pose without that sharp pain in my hamstring and I can do a pilates ab move with double leg lowering. I think I couldn’t do that before because the pelvis was just not in the right place.

    I I am very glad that you mentioned there would still be clicking noises, because if anything, there’s even more than before. But it all sounds and feels much more benign. I have not found a clinical pilates option that is very close by but I hope to add that soon after re-arranging my schedule a bit.

    Thank you!!

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    • That’s good to hear.
      I suggested the clinical pilates because if you learn to work the pelvic floor, lower abs and spinal stabilisers properly, the clicking should improve as you get better pelvic stabilisation from the deep core. Those muscles all stop working properly if the hip is dysfunctional.
      When you have one weak hip, the weaker hip tends to rotate forwards and the stronger one backwards. As the whole area gets stronger, they should line up better and click less, but it often doesn’t go away entirely

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  8. Hi Niki-

    Thank you so much for your awesome website. I’ve been doing tons of internet research about yoga/anatomy and yours is most helpful by far. I hoping that you have some suggestions that could help me with my current problem.

    About two months ago, I started practicing Ashtanga regularly (5-6 days a week). Three weeks after I started, my wrist began hurting. I saw my primary care doctor, who told me it was likely mild tendonitis and advised that I stay off it. So, I wore a wrist brace and practiced with forearm modifications until this past week (that’s ~1 month with the brace). A day or so after I got back to the mat, my knee began hurting– it hurts at the side, not by the kneecap, so I don’t think I crushed the meniscus. I’m going to see a knee specialist next week to make sure nothing is torn.

    Are there any questions you would recommend I ask the doctor I’m going to see? Is there any about my practice that I should be sure to bring up? (for that matter, do you have any ideas/suggestions about why I keep getting injured? I am trying to be very careful and not push myself into poses). Everything you have said about muscular imbalance sounds relevant and I want to find out how to prevent future injuries, not just be told to stay off my knee for a month.

    Thanks so much for your help!

    Emily

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    • Hi Emily

      Thanks, I’m glad you find my website helpful. Ashtanga is very heavy on the wrists – especially a daily practice – the only thing that seems to help prevent pain is body-weight pulling exercise. Your wrists may always be sore, regardless of what you try and any injury which causes swelling at the wrist is going to take months and physio before it stops hurting.

      Some other problems with knees apart from meniscus damage are:
      1. Knee ligaments sometimes slip out of position during Lotus or adjustments in Lotus and will need treatment
      2. Some people have scar-tissue in their knees from old injuries – this can be painful and may always be
      3. Pain at the sides of the knee are often due to imbalances in the hips and you will be told that either the Sartorius muscle or the ITB is tight, which is probably a result of yoga-practice. You should ask the doctor to assess your hip-function: knee pain can be the first sign of developing Sacroiliac trouble if there is no specific knee injury. See if it improves with rest but if you start to experience lower-back pain, reconsider whether Ashtanga is the right practice for you (I’m not sure whether you have only just started practising yoga, or if you have switched to Ashtanga after practising some other form of yoga)

      Despite what many true-believers say, you can injure yourself in yoga no matter how careful you are and then there is also the not-so-little matter of poor adjustment from teachers or injuries from partner-stretches. My personal experience and opinion is that Vinyasa practices are inherently problematic, especially a daily vinyasa-practice. If a practice doesn’t work for a student, it’s common to blame the student, but in fact, there are many aspects of yoga that are inherently injurious or cause muscle-imbalance and chronic pain.
      I think it’s perfectly ok to blame the practice and put your body’s needs first and explore other options if this is your experience.

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  9. When doing certain poses, such as warrior III, the hip of my standing leg becomes incredibly sore instantly and sometimes feels as though it has locked. It is a cramping sensation. This goes if I bend my standing leg. In poses such as half moon pose however where the top hip rolls on top of the bottom this is not an issue.

    Any suggestions on why this is occurring?

    Like

    • Hi RJ

      Can you tell me exactly where you feel the pain in your hip: there are a couple of possibilities so I would need to figure out which muscles are cramping, then I can make some suggestions

      Niki

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  10. Hi Niki,

    The pain is in the inside of the hip. As in I feel cramping in the actual hip joint.

    Sorry I’m not amazing at describing pain 🙂

    RJ

    Like

    • Hi RJ

      One possibility that suggests itself is that your Gluteus medius is not engaging to stabilise the hip when it should so the smaller stabiliser muscles (Piriformis, etc) are trying to do the job and going into spasm (cramping). Bending the standing leg helps because then you are involving your hip flexor muscles – mainly the Tensor Fascia Latae, which work to stabilise the hip. If you also tend to feel pain at the outside of the knee, this is a definite sign that your hips are too weak and not stabilising correctly. This is a very common issue in yoga which can affect one or both hips.
      It would be wise to see a physiotherapist who can help you strengthen your hips where they need it and restore normal muscle recruitment patterns.
      Yoga tends to cause weak hips by a process of reciprocal inhibition. When practicing yoga, make sure that you are doing enough bridging, especially one-legged bridging and that you keep your pelvis level when you are standing on one leg.

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