Pathophysiology, Inflammation, Injury & Recovery

Question 1

What other precautions or risk factors would you consider when facilitating a yoga class?

Answer 1

Yoga is Non-Competitive
Encourage your students to be aware that Yoga is non-competitive. For some this will create liberation in their practice particularly if the person they are competing with is themselves. It is imperative that as Yoga Teachers we intertwine the Yama and Niyama in our teachings, as this is when these teachings really come alive. Remind the students of Ahiṃsā (non-violence, non-harming) by providing the space for them to learn to be gentle with themselves as they progress on their yoga path.

Roger Cole, Ph.D. indicates that the lower back, knees, and neck as the most prone to injury, followed by the sacroiliac (SI) joint and the origin of the hamstring muscle (where it joins the sitting bone). Spinal and Sacroiliac Joint (SIJ) injuries are commonly linked to forward bends since they can place strain on the intervertebral disks and ligaments at the base of the spine.

Some risk factors may include yet not limited to:

1. Teaching to meet the needs of the individual as well as the group class considering the level, pace, experience and physical capacity of your students.
2. Teaching within the limits of your training, qualifications, and experience. For example, a student presents with a medical condition outside your knowledge. Always choose to either seek expert medical advice or refer your student to the appropriate medical health care practitioner or GP.
3. Ensure your student/s take responsibility for their themselves.

Question 2

How does SIJ injury impact on a students’ Yoga Practice?

Answer 2

• As previously mentioned, the most common cause of dysfunction are postures where asymmetry occurs.
• Pelvic asymmetry causes tightness in the hip flexors, avoid postures that create asymmetry of the pelvis such as Gomukhāsana.
• Include postures that increase symmetry such as Caturaṅga Daṇḍāsana and Adho Mukha Śvānāsana, Utkaṭāsana.
• Ensure weight bearing postures place equal weight across the pelvis vs just on one side. This includes, standing, seated and supine postures.
• Build strength in the hip extensors and external rotators including gluteus maximus and medius, piriformis, superior and inferior gemellus, obturator internus and externus, and quadratus femoris.
• Include postures that stretch the hip flexors and adductors to reduce tightness and increase hip joint mobility.
• Practice standing posture with the feet closer together. For example, in Vīrabhadrāsana I have the feet closer together in length and wider in width.
• Introduce forward bends gently using a blanket under the pelvis for seated variations

Question 3

List there (3) postures to be avoided for SIJ injuries

Answer 3

• Gomukhāsana.

* Prasaritta Padottanasana

Question 4

What protocol would you follow for a student who has come to Yoga to manage an injury and why?

Answer 4

Appropriate referral to qualified health care practitioner is essential for diagnosis. Should the student then choose to work with Yoga as a part of the healing plan then approval from their GP/Health Care Practitioner must be sough prior to returning to practice.

The Philosophy of Healing – The Six Principles
At Moksha we adopt the naturopathic paradigm of health and follow the six principles of health and healing:-
1.Vis Medicatrix Naturae - The Healing Power of Nature. The belief that the body has an innate abilityto heal itself. The Yoga Teacher works with the 8 limbs of Yoga to support this belief.

2. Docere - Educating the Yoga student is an important part of empowering the student
3. Primum non nocere - The principle to first do no harm is fundamental to Yoga practice.
4. Tolle causam - To treat the causes of the disease and/or injury rather than the symptoms.
5. Holistic approach - Each person’s practice is individualized and takes into consideration all thepresenting symptoms and causative factors.
6. Prevention rather than Cure - The belief that prevention is the best medicine for good health.

Question 5

Name two (2) postures contraindicated for each of the following injuries and why?
• Rotator Cuff injuries
• Sciatica/Lumbar spine injuries • Soft tissue injuries
• Prolapsed disc
• Neck Injuries
• SIJ Injuries

Answer 5

Rotator Cuff
Adho Mukha Savasana and Phalakasana

Sciatica/Lumbar
Seated and standing forward bends (aside from Downward-Facing Dog)

Prolapsed disc
Child's pose.
Sage's pose.
Standing forward bend.
Head to knee pose.
Wide angle forward bend.
Big toe pose.

Neck Injuries
In a Yoga class this may be caused by a student holding Sālamba Sarvāṅgāsana without building up strength in their practice over time or by looking around the room at other students in postures such as Setu Bandha Sarvāṅgāsana.

SIJ
•Ūrdhva dhanurāsana.
•Pelvic asymmetry causes tightness in the hip flexors, avoid postures that create asymmetry of the pelvis such as Gomukhāsana.
• Avoid seated, standing and supine twists as this exacerbates the more mobile half of the pelvis and encourages this side to compensate.

Soft-Tissue Response to Trauma
Musculoskeletal soft tissue responds to trauma in three phases: the acute inflammatory phase (0 to 7 days), the proliferative phase (about 7 to 21 days), and the maturation and remodeling phase (21 days thereafter).
Repair Phase - Weeks 1-3
Students with an acute musculoskeletal soft-tissue injury will need to abstain from Āsana for 1-3 weeks post injury.
Repair Phase - Week 3
After the third week, soft tissue regeneration begins, and gentle stretching of the muscles and tendons begin to stimulate healing.
Repair Phase - Week 4-6
Between 4-6 weeks, the goal is to return to pre-injury level of practice.
Medical advice must be obtained prior to a student returning to practice.

Question 6

Name two (2) postures indicated/beneficial for each of the following injuries and why?
• Rotator Cuff injuries
• Sciatica/Lumbar spine injuries • Soft tissue injuries
• Prolapsed disc
• Neck Injuries
• SIJ Injuries

Answer 6

SIJ
Include postures that increase symmetry such as Caturaṅga Daṇḍāsana and Adho Mukha Śvānāsana, Utkaṭāsana.

Rotator cuffs
Gomukhasana - Cow face arms
Baddha Virabhadrasana
Bharmanasana - Table top
Phalakasana - Plank

Herniated disc
Seated Forward Bend, Locust Pose, Cobra Pose

Neck
Utthita Trikonasana, Bitilasana - Marjaryasana, Balasana - Childs pose

Sciatica
Adho Mukha Svanasana, Balasana Childs pose, Ardha Chandrasana