 This is part of a series about Injuries In Yoga. Last month we wrote about the common shoulder injury Shoulder Impingement. The other common injury to the shoulder happens in the front, where the short head of the biceps muscle attaches to the shoulder blade, a biceps tendon strain. This injury is most common in Ashtanga Vinyasa and subsequent 'flowing' yoga styles that incorporate a lot of Sun Salutations and chaturangas. The shoulder can't do this action very well, and the biceps become strained before too long.  Pectoralis major ("pec") To understand this injury, we have to talk about shoulder mechanics and the muscles that move the arm. PECTORALIS MAJOR & ADDUCTION One of the biggest and most powerful muscles of the shoulder is the pectoralis major, commonly known as the 'pecs' or just the 'chest muscle', pictured to the left. It connects the arm (humerus) directly to the middle of the chest. Its main function is to pull the arm toward the chest in an action called adduction. Try it: hold your arm out to the side (as pictured below, labeled adduction), then bring your arm toward the center, so you end up with your arm pointing forward. As you do this, you will feel your 'pec' engage. When you apply this motion to something like a pushup, the arms need to be away from the body, so the pushup motion will be pulling the arm inward toward the chest. Simply put, this means keeping your elbows away from the body. This is the safest way to do any pushup motion.   BICEPS & FLEXION
In contrast, if we start with our arms down by the sides and lift them up until they point forward, this is called flexion (pictured above, labeled flexion). When we lift the arm like this, the pec doesn't get activated much, so the work is done by much smaller muscles like the anterior deltoid (the front of the shoulder cap) and the biceps. The biceps cross two joints; they bend the elbow and also flex the shoulder. But they don't have the power to move the body's entire weight. When we do pushups or chaturangas with the elbows close to the sides of the body, we are essentially moving the shoulder in flexion. This is not a powerful nor particularly healthy way to move so much weight. When we do this repeatedly, the bicep tendon (usually the short head at the attachment with the coracoid process of the shoulder blade) will often be damaged. This manifests as pain or soreness in the front of the shoulder. There is a common belief that keeping the elbows close to the body uses the triceps more than if the elbows were wider. This is not true for the simple reason that the triceps straighten the elbow, and the elbow is doing a similar action in both versions. The big impact is on the shoulder and what muscle group you use when doing a pushup or chaturanga motion. IN CONCLUSION There is nothing inherently wrong with keeping the elbows close to the body and flexing the shoulder. The problems arise when we do this with our entire body weight and do it repetitively. This is how injury usually happens. Consider making the elbows wider, which will strengthen the huge pectoralis major muscle as well as be safer for the smaller muscles of the shoulder. Happy, healthy practicing!
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 This is part of a series about Injuries In Yoga. Two common injuries in yoga happen in the shoulder. One is in the front of the shoulder---the biceps tendon---which we will address next time. The other is in the top of the shoulder, called impingement. It happens when the arm lifts up high; the arm bone can bump against the edge of the shoulder blade, called the acromion, and damage the tendon there.
 HOW THIS CAN HAPPEN In yoga, this happens most often when we force the arms overhead. Think of any time you link your hands together and then try to straighten your arms using force. As pictured below, it happens in Half Moon Backbend, Half Moon Sidebend, Balancing Stick and Half Tortoise, among others. (It also happens in Downward Facing Dog.) When we force our arms to straighten overhead, we usually use the triceps, a muscle mainly of the elbow, to compel movement in the shoulder. This is where we get into trouble and impingement can happen. You will feel a 'pinching' sensation in the top and outside of your shoulder. This is the bones bumping into each other, damaging the soft tissue. If the shoulders become injured this way, they will be painful whenever lifting the arms sideways, and the breathing exercise pictured at the top will cause pain.
 HOW TO HELP The simplest and most effective way to avoid this injury is to not link your hands together. Just place them side by side without interlacing the fingers. Interlacing the fingers and forcing the arms straight overhead is the easiest way to create the injury. Or don't lift your arms overhead (pictured below left). Most postures can be done quite effectively without the arms overhead. All of the positions pictured above don't require the arms to get the primary benefit. Alternatively, you can lift your arms forward and up (pictured below) instead of out to the side. This will help the shoulder blades move into the proper position and keep the shoulders healthy. In the breathing exercise, pictured at the top, you can keep your elbows lower, not lifting them higher than the shoulders. This will prevent further irritation of this area. To build strength in the area, postures like Full Locust will help (pictured below right). By pulling the shoulders back and together, we build strength in the back of the shoulder to help stabilize and balance the joint.
CONCLUSION
The moral of the story is that we should be aware and careful when lifting the arms overhead, especially if we are gripping the hands together and straightening with force. If there is a 'pinching' sensation in the top of the shoulder, back off immediately. There is nothing there to 'stretch', and it is likely that we are impinging our supraspinatus tendon. Try adjusting your approach to the posture and using your shoulders a little differently. Happy, healthy practicing.  This is part of a series about Injuries In Yoga. The second most common injury we see in the yoga world is of the hip. The damage happens when the hip bends (flexes) significantly. The thigh bone can bump against the bone of the pelvis and hip socket, crushing the cartilage there. This is called hip impingement. The injury generally happens in three progressive stages that may take months or years to develop. In the first stage, there is a slight or moderate pinching sensation as we pull the leg into the chest or rest the body onto the leg with gravity. This pinch is not the result of muscular engagement or tissue stretching, but of bone resting on bone and squishing the cartilage between. (There is a somewhat common instruction to 'feel a pinching sensation in the hip' in some postures. We recommend against this, for obvious reasons.)
If we continue to damage the cartilage beyond the second stage, in the third stage it can actually tear and pull away from the hip socket. This is called a labral tear, because the cartilage ring around the hip socket is the labrum. This injury can be quite painful, making it excruciating to do something as simple as walk. Like in the second stage, not only will the hip joint itself hurt, but the muscles of the thigh will struggle to function properly. Common postures that are in danger of causing this injury are those that involve deep hip flexion, which is bending of the hip joint. These include Wind Removing (pictured above), Bikram Triangle, Standing Bow, Half Tortoise, Separate Arms Balancing Stick and Spinal Twist (Ardha Matsyendrasana). Look at the position of the hip in all these postures. Notice that the deep flexion can cause the thigh bone to bump into the pelvis.
How can we avoid, prevent or heal this injury? As with most things, prevention is the most effective method, as it will keep the body healthier and pain-free. To prevent this injury, pay close attention in any of these postures where your hip is deeply flexed. If you feel a pinching or pressure in the top/front of your hip, back off a bit. It can be challenging to separate this sensation from a stretching or engaged muscle, but the differentiation is quite clear once you notice it.
Anytime we use the arms to pull the leg deeper toward the pelvis, use great care! This is taking the hip joint past its normal range of motion, and is a common way to injure the hip. In most (perhaps all) situations, pulling will increase the risk of injury. Healing damaged hip cartilage is difficult. If you are only in Stage 1 or Stage 2, backing off of the postures will likely allow the body to heal. You will need to be conservative with the hip for awhile, at least six weeks. If you have a torn labrum, the conversation gets more complicated, as most will recommend surgical repair. The cartilage doesn't have a great blood supply, so it has trouble healing on its own. There are some stories of non-surgical success, but they are few and far-between. For us, the moral of the story is to be careful and gentle. Most people practice yoga to improve their health, and injury is the exact opposite of that.   This is part of a series about Injuries In Yoga. The single most common injury that we see in the yoga world is a hamstring attachment injury. It happens due to over-stretching the hamstrings. Since so many postures and exercises target this muscle group on the back of the thighs, what often ends up happening is we over-stretch and the tendon that attaches the hamstrings to the sit bones gets damaged. Quite often, we mistake this new, intense sensation for a "deeper" hamstring stretch, so we continue to push (or more often pull). This makes it worse, and many of us don't realize there is an injury until serious damage has been done. Stretching the hamstrings has become central to many styles of yoga. Like many other physical elements of modern practice, this emphasis comes from gymnastics, contortion and dance. In any given class, we may stretch the hamstrings from numerous positions: standing, seated, legs together, legs split, one leg, both legs, etc. This injury creates pain at the point where the hamstrings attach to the sit bones (ischial tuberosities), at the base of the pelvis in the back, pictured to the right and circled in red. It can be painful in forward folding positions, and may be sore after class so that it hurts to sit down. It is sometimes called "yoga butt". This injury is so common that almost half of yoga practitioners---men and women---have it currently or have had it in the past. Common postures that could strain the hamstrings are: Hands to Feet, Standing Separate Legs Stretching (pictured above), Standing Bow, Standing Splits, Stretching, Separate Legs Stretching and Tortoise, etc. Take a moment to notice the similarities in these positions, pictured below. They all tilt the pelvis forward with relationship to the femur (thigh bone). This makes the hamstrings long, which is why we feel the "stretching" in the back of the leg. The deeper these postures are, and the harder we push them, the more likely it will be to damage the attachment of the hamstrings.
HOW TO HELP
First and foremost: rest. I know you don't want to hear this, and resting can be a real challenge for the mind and ego. This injury can take months or years to heal, and the more we aggravate it the longer it will take. Avoid forward folds for several months. Seriously! You can still do lots of other exercises and postures, but avoid forward bending of the hip for awhile. DO NOT STRETCH YOUR HAMSTRINGS! Second, don't overstretch the hamstrings, even after you're healed. The natural range of motion of the hamstrings only gets the femurs (thigh bones) to about 90 degrees with the pelvis when the knees are straight. This means that the vast majority of contortion-influenced yoga postures that "stretch" the hamstrings take it too far, which is why injury is so common. You might not be able to do Standing Splits with the same picturesque beauty, but you will be able to walk and sit without pain. Third, strengthen and shorten the hamstrings. We did a whole blog on this, where we explain a handful of postures and exercises that will make the legs strong and help prevent injury. These include Balancing Stick, Squatting, Bridge and Jastiasana. IN CONCLUSION The most important thing to take away from this is that you can get hurt from yoga practice. If you have pain at the back of your hip, the top of your hamstrings, at or near your sit bones, and this is exacerbated when you do forward folding postures, STOP IMMEDIATELY! It is very likely that you are damaging the upper attachment of the hamstrings. Take the time to let it heal, and then perhaps adjust your approach to the physical postures so that they have less likelihood of injury.  Over the past few months, we have heard increasingly loud calls for talk about injury in yoga. So many students are hurt or have pain, and they don’t know what it is, how it happened or how to fix it. Some are even told by their teachers to push through the sensation to continue deepening the physical postures. After all, these exercises and postures are supposed to be healing, right? When we describe the common yoga injuries, students are both 1) shocked that you can get hurt doing yoga, and 2) surprised to hear us describing the pain and difficulty that they experience.
Yes, yoga can hurt you. It’s true. If you’ve practiced the physical forms of yoga that are popular in the West for more than a few months, chances are you’ve been injured or know someone who has. This is not to say that physical yoga practices are inherently dangerous or should be avoided. The same risk is present in virtually any physical activity: basketball, running, bowling. Anytime we use the body in a repetitive way and push it to go farther and farther, the risk of injury is quite high. We generally don’t know the limits of our capabilities until we go too far! Yoga is mostly thought of as a healing, healthy and therapeutic form of exercise, not to mention safe. Since most of us approach the practices thinking they will help us, we overlook the possibility for injury until it’s too late. It is especially true in the yoga world, where we want to believe that it only has the ability to make us better, more open, happier, peaceful versions of ourselves. The idea that any of these practices could injure our bodies, nervous systems or minds feels foreign and even contradictory. So all too often we disregard it. Until we get injured. Even then, we may think it was our fault, that we weren’t doing the practice right, because a “healing” practice couldn’t possibly be dangerous. But injuries are quite common in yoga. And each style has its own tendency toward certain imbalances, as the stress and repetition in each practice are a little different. We are going to do a whole series of posts about Injuries In Yoga. We will go into some depth about the most common injuries we see, which include hamstring attachment strain, hip impingement and labral tear, meniscus tear in the knee, supraspinatus damage in the shoulder, bicep tendon strain in the shoulder, sacroiliac instability in the low spine, and neck pain in the base of the neck. All of these can be created or exacerbated by physical yoga practices. For now, we want you to know that yoga can injure you, especially if you think it never will. Always take care and try to understand what you’re doing and why. Some intense sensations are safe and even beneficial, while others are not. Use caution and ask your teacher if you’re not sure. If they tell you that you won’t hurt yourself in yoga, get a new teacher. If you have an injury or had one in the past that you’d like to tell us about, please comment or message. Let us know your experience!  Hardly a day goes by when someone doesn't ask us, "Is Bikram Yoga the same as Ghosh Yoga?" It is a valid and interesting question, as plentiful yoga systems seek to separate themselves from the competition with novel methods and attributes. The two methods are closely related, since Bikram Choudhury learned at Ghosh's College. But there are some fundamental differences that keep the two systems from being synonymous.
First, let's look at what they have in common. THE POSTURES Most of the exercises in Bikram Yoga are recognizably from the Bengal region of India, where Ghosh's College is located. The previous students of Ghosh taught these same postures and exercises like Half Tortoise, Rabbit and Standing Head to Knee. And several of the postures, like Stretching, Cobra, Locust, Bow and Corpse, are traditional yoga asanas found in older texts. Notably missing from both Bikram and Ghosh yogas are exercises like Up-dog, Down-dog and Warriors One and Two which come from South India and have made their way into most vinyasa yoga styles. STILLNESS Another element shared between Bikram and Ghosh yogas is the alternation of effort and rest. Each posture is held in stillness for a brief period and followed by an equal portion of relaxation. While standing, the practitioner simply stands still, though some of the older Ghosh students insisted on lying down between exercises. During postures on the floor, relaxation happens by assuming the Corpse posture. This is a distinctive element of these styles, setting them apart from the popular flowing methods that link stationary positions with fluid movements and Sun Salutations. THERAPEUTIC INTENT It can seem obvious, but both Bikram and Ghosh yogas are fundamentally designed to help the student be healthy. This is similar to all the yoga in Bengal, where the postures are done to help the organs, circulation, digestion or some other element. They generally have a therapeutic purpose. This intention can be contrasted with many vinyasa styles of yoga that originated in the performative gymnastics of Mysore. Those styles, like Ashtanga Vinyasa and its descendant "flow" methods, have become more therapeutically focused over the ensuing decades. But the origin of flowing yoga was performative. Now, let's look at what is different between Bikram Yoga and Ghosh Yoga. SET INSTRUCTIONS The method of Bikram's yoga is largely defined by its style of instruction, the rote utterance of prewritten commands. Teachers of the style can be judged by the quality of their "dialogue." Many paraphrases and copycats have popped up, but Bikram's original is still considered by most to be the gold standard. This rote instructional style is nowhere present in the teachings of Ghosh Yoga, where the majority of verbal instruction is simply counting the duration of each exercise. HEAT Also central to Bikram's style is a heated room, a characteristic that finds no expression in other manifestations of Ghosh's style. In India, they turn on fans or air conditioning when the day gets hot, or they forego the scorching parts of the day altogether. A SET SEQUENCE The two differences above are somewhat peripheral to the essence of the methods. The irreconcilable difference between these two systems is Bikram Yoga's unchanging set of exercises. The same 26 postures are "prescribed" for every student no matter their age, ability, experience, goals or ailments. Central, indeed fundamental, to the Ghosh system is a unique prescription for each student. It would be unheard of to assign the same practices to different people, especially without learning their strengths and weaknesses. Because Bikram Yoga is defined by its specific and repeated set of postures, and Ghosh Yoga is defined by its attention to the individual, it is impossible to conclude that Bikram Yoga and Ghosh Yoga are the same thing. They certainly share several key elements, namely their postures, the alternation of effort and relaxation, and therapeutic intent. But the defining characteristics of Bikram Yoga like rote instruction, added heat and especially a single unchanging set of exercises separate it substantially from Ghosh Yoga.  "Locking the knee" is a concept in yoga that was popular in the 60s and 70s, including the styles of BKS Iyengar and Bikram Choudhury. It originally comes from weightlifting, where full extension of the knee joint and concerted contraction of the quadriceps are paramount. You will still hear weightlifters talk about "locking out" to refer to the full straightening of a joint that is under stress.
For the most part, this concept has dwindled in the yoga world due to the confusion it causes. There are at least 3 different meanings to the phrase "lock the knee," depending on what position you are in and who you're talking to. An anatomist has a different definition than a Bikram Yoga teacher. These are the three meanings: 1. CONTRACT THE QUADRICEPS This is the original meaning of the term as it comes from weightlifting and bodybuilding. Used in quadricep-heavy exercises like squats, "lock the knee" meant to straighten the knee as much as possible by squeezing the quadriceps with great force. In the yoga world, this has also become a way to relax or stretch the hamstrings, since engaging the quads naturally causes the hamstrings to disengage. In addition, it is sometimes believed that engaging the quadriceps, which causes the kneecap to lift up, will protect the knee joint from hyperextension. (It won't.) 2. RESTING THE FEMUR ON THE TIBIAL SHELF Anatomically speaking, a normal knee has the ability to hyperextend by a few degrees. It can go past the 180 degrees of a straight leg by about 4-6 degrees. When we are standing and our legs are bearing weight, we have the ability to hyperextend the knees and "rest" them on the tibial shelf. They settle back and the muscles of the leg relax, allowing us to stand for long periods of time without using much energy. When the knees are resting in this manner, they are "locked." To unlock them, there is a specific muscle (the popliteus) that unlocks the knees before they return to normal function. This definition of a "locked knee," which is essentially slight hyperextension, is often conflated with the first: contracting the quadriceps. Unfortunately, the combination of hyperextension and contracted quadriceps will accentuate the knee's tendency to hyperextend and possible create instability. 3. ENGAGING ALL THE MUSCLES AROUND THE KNEE Normally, the contraction of the quadriceps is accompanied by a relaxation of the hamstrings, and vice versa. It allows for effortless movement of the knee back and forth. But this relationship can be overridden with conscious effort and control, contracting both sets of opposing muscles simultaneously. In yoga parlance this is called a bandha, a "lock." When opposing muscle groups around a joint are consciously contracted together, the joint does not move. On the contrary, it becomes immobile and quite stable. This is often done to create stability and pressure gradients that effect the blood and heat flow in the body. IN CONCLUSION As you can see, the phrase "lock the knee" can mean a handful of different things. And it is important to note that the interpretations can conflict with one another. The first involves engaging the quadriceps while relaxing the hamstrings; the second involves relaxing both the quadriceps and the hamstrings; and the third involves engaging both the quadriceps and the hamstrings.
With the forthcoming translation and publication of Labanya Palit's book from 1955 (please support the project here), we have instruction from yet another of Bishnu Ghosh's students. Much of the information is similar to the other instructors in the tradition, reinforcing our understanding of the goals and practices.
Some practices that Labanya instructs are less common, and it is illuminating to place them in the context of history. One of these peripheral postures is Standing Hand to Toe, pictured above. This posture involves balancing on one leg and holding the toe with the hand. It is a relatively less difficult version of the popular Standing Head to Knee, since Hand to Toe allows the body to be more upright and only one hand needs to reach forward. This makes balance a lot easier. In 1938, Buddha Bose (pictured above, right) instructed the posture with a little twist, holding the foot with the opposite hand. This adds an element of crossing the body, which can make balance more difficult. But it allows a little twist, so it doesn't require as much flexibility in the lifted leg/hamstring. Now, Labanya (pictured above, left) has a version where the toe is held by the hand of the same side. This is similar to the yoga traditions of South India like Krishnamacharya and Iyengar. It doesn't cross the body but requires a little more flexibility in the lifted leg. As mentioned above, either of these positions is useful for anyone who struggles with the full expression of Standing Head to Knee. They require less strength and control, so they are great for beginners and older students. Please support the Kickstarter campaign to translate and publish Labanya's book, as well as research the forgotten women of yoga.  "Suck your stomach in!" goes a common instruction in yoga class. This cue is present in a lot of different lineages and styles, and goes to the heart of an important conversation in the yoga world: What are we teaching? Let's explore the meaning of this instruction, beginning with the elements involved. Namely, the "stomach" and "sucking in." What is the stomach? It is an organ in our digestive tract. It is high in the abdomen, just below the ribs and diaphragm. It is the first place our food goes after we chew and swallow it. How do we suck the stomach in? We don't. We can't. The stomach itself has muscles that help us in digesting and passing food through our system. But they are involuntary muscles that we can't consciously control. This instruction, "Suck the stomach in," refers to the stomach in a much more general and imprecise way, where "stomach" actually means "abdomen."
The muscle that pulls the abdomen in is called the transverse abdominis. It wraps around the belly like a corset, helping us breathe and stabilizing the spine when needed. If you are wondering what if feels like, exhale your breath forcefully and feel the sides of your abdomen. They will be tight and contracted. This is your transverse abdominis.
What are we actually teaching? That brings us back to the instruction, "Suck your stomach in." If we take the instruction at its word, it is impossible. The stomach's position cannot be changed consciously nor can its muscles be contracted consciously. The only way that this instruction makes sense is if we interpret "stomach" to mean "abdomen" and proceed to contract an abdominal muscle that "sucks in." Also, if our students take us at our word (which I hope they do), they are learning that the stomach is something that can be "sucked in," which it is not. This is worrying, essentially teaching an inaccurate and incorrect concept to unknowing students. The easiest of fixes This instruction can be modified ever so slightly to become an effective cue. "Pull your abdomen in" or "pull your belly in" are both anatomically sound and they accomplish the desired result: contraction of the transverse abdominis. They remove the danger of propagating false information to our students and encourage them to learn the correct way.  Put your forehead on your knee!
We've all heard this instruction thousands of times. The phrase and its variations have become synonymous with correct practice of "head to knee" postures. The problem is this: the forehead touching the knee should be a result of the correct muscular usage, not the end goal. This may be a surprise, but there is little to no benefit in touching your head to your knee. Unless you are making the argument that the head benefits from its contact with the knee (which it might, due to a nerve plexus or gland), or the knee benefits from its contact with the head, it becomes obvious that the value of the position lies somewhere else, even if the well-known signifier of the posture is the famous "head on the knee." The distinct benefit comes from using the abdominal muscles (rectus abdominis) to bend the spine forward, compressing the organs, glands and intestines; and from forward- bending the neck, compressing the throat. These two foundational elements are then accentuated by what the rest of the body is doing, whether balancing on one leg as in Standing Head to Knee, maintaining external rotation of the opposite hip as in Seated Forehead to Knee, or kneeling as in Rabbit. Sometimes the cue---to put the head on the knee---and the posture work together. Great! The muscles in the neck and abdomen engage, the spine bends forward, the throat and abdominal contents get compressed, and the head touches the knee. But often the instruction and the posture don't work together. Our head may be able to touch the knee without the valuable engagement, bending and compression. We get the end result of the cue, so we think we are benefitting from the posture. But the important parts of the posture are left undone. Those that struggle with "head to knee" poses will get great benefit in finding their abs and contracting them as best they can. Will their head get close enough to touch their knee? Maybe, but maybe not. Those that are stronger should try to get their head closer to their hip than their knee. This will continue to develop their abdominal strength and compression past the point of their head on their knee. "Touch your forehead on your knee" can be a great visual cue. However, as practitioners and teachers, we need to remember cues are attempting to make an action happen in the body. They are not the goal in and of themselves. |
AUTHORS
Scott & Ida are Yoga Acharyas (Masters of Yoga). They are the head teachers of Ghosh Yoga. This blog is about their experience with yoga practice, study and teaching.
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