Yoga & Stretching Injuries: Why people get hurt on their quest for bendiness

Yoga
photo: coordinator_tarun

I’m not sure about the rest of the world, but I live in Vancouver, BC and it seems like everyone is either doing Yoga or feels that they should be for some reason.  Its’ popularity has steadily grown over the past ten years to include a more and more diverse group of people.  Business men, athletes, seniors and kids have all joined in the sun salutations and downward dogs in a quest for flexibility and inner peace.  For the most part I think this movement is great, but as a physiotherapist I see countless injuries, postural issues and persistent pains that have their roots in people’s regular Yoga routines.  There are a lot of great things about Yoga, but it is not meant for everyone and you can have too much of a good thing.  In this post I discuss some of the negative consequences of Yoga, not to scare you away from it, but to help you go into it armed with the awareness of how not to hurt yourself.

Before you decide to start any new type of exercise you should ask yourself ‘what am I trying to get out of this?’  Many people blindly feel that Yoga is the answer to flexibility and although it can be for some, it can be an awkward, uncomfortable path to injury for others.  Flexibility is partly genetic, but largely a product of what you do all day; how you stand, sit, walk, breathe and feel will and does affect your flexibility.  It is a misconception that you are stiff because you don’t spend enough time stretching.  You are stiff because you either don’t move enough or you don’t move very well, or both.  Stretching more is simply not the answer.  In fact, I would say that there are millions of hours wasted every day by people stretching in attempt to get more flexible.  Some people will gain benefit, some won’t change a thing and some will actually end up tighter from trying to stretch; which one will you be?

Yoga can be a very calming, stress reliever for some people and they are the ones that typically gain the most benefit.  Finding a mind-body connection or awareness that relates to movement is essential to create change in your body.  Simply going through the motions and trying to force yourself into specific poses won’t get you very far and can initiate a tug-of-war with your body that you are likely to lose.  In order to do stretching based exercises effectively, it is important to understand where the tightness that you feel in your body is coming from.  Not all tight feelings should be stretched and a feeling of tightness does not necessarily mean that you should try to increase your flexibility of that area.  Let me explain…

The structure of your body is a boney framework that is held together by muscles, tendons, ligaments and connective tissue called fascia.  There is a genetic variability from person to person in how tightly all these tissues hold you together.  Some people are genetically very loose jointed or hypermobile, while others are tightly packed together or hypomobile.  As you would guess the hypermobile people are naturally more flexible than their counterparts, but what you wouldn’t expect is that they typically feel the stiffest.  Hypermobile people have great flexibility but always feel stiff like they should be stretching and tend to take pleasure out of things like Yoga.  Hypomobile people tend to have awful flexibility and feel guilty that they don’t stretch enough; they don’t necessarily feel tight unless they try stretching, but it doesn’t seem to change anything and doesn’t feel very good so they just don’t bother.

We function in this world in the vertical or erect position.  We spend long periods of time either standing, sitting, walking, pushing, pulling, lifting or bending with gravity trying to drag us down the whole time.  Some of us are tightly held together and some of us are loosely held together, but we all have the same basic anatomy and the same challenge of trying to keep our bodies vertical throughout the day.  No one teaches you how to stack everything up when you are a kid, but everyone figures out their own way to move based on their genetics, their sports, their injuries and their personalities.  Starting from a very young age children start to develop muscle imbalances and inefficient movement patterns that can mold how they stand, sit and walk the rest of their lives.  As an adult you just take most of these basic movement patterns for granted, but as I have said before: just because you can stand, sit and walk, does not mean that you do it very well.

Below is a picture taken from my last article ‘Why Hips Hurt- an illustrated explanation,’ it shows some examples of common postures and muscle imbalances that develop in people over time.  Each imbalance creates its own kinks and hinges in the spine both as you move and as you attempt to stay still.  Some vertebrae or joints get overly compressed and others get way over stretched.  Typically when one area doesn’t move enough, somewhere else will move too much, and conversely, if something moves too much, another area will likely brace and become stiff.


When you are vertical your spine and the nerves that extend from it are happiest when you stay in more or less a ‘neutral’ position.  Neutral refers to the natural S-curve in your spine (see below).  This is not to imply that you should never move out of this neutral position, but you should become aware of how easy or hard it is for you to attain it.  Ideally you can move through your entire spine in a controlled manner or stabilize it back into this neutral S-curve.  You should be able to coordinate and control the movement of your lower body and your trunk, but unfortunately due to some of the above common postural imbalances, this can become very challenging.

Poor movement and postural patterns over time will lightly annoy various nerve roots as they extend from your spine.  These nerve roots are like the electrical wiring extending from a fuse box to all the muscles throughout your body.  When nerves get annoyed they get overly sensitive and can start creating bands of tension in your muscles; this tension will affect your flexibility and may give you the sensation that you want to stretch that muscle.  The trouble is that the muscle is not just shortened and needing to be stretched, it is that a portion of it is lightly contracting, even at rest, all the time, because the nerve that innervates it is annoyed.  Trying to stretch that type of muscle can be counterproductive and lead to injury; this happens in Yoga all the time.


Normal state                                      Nerve irritated causing tension

You need to teach your body how to make the muscle stop contracting, not just keep stretching it.  Intramuscular Stimulation (IMS acupuncture) is the quickest and most effective way to reset this negative muscle tone, but various myofascial release techniques like lying on a tennis ball and consciously trying to relax a trigger point can be helpful too.  What you need to learn going into Yoga is what a good stretch versus a bad stretch might feel like.  When you move into a stretch position your muscles, nerves, joints and fascia will all dictate how much you move.  A good stretch should not be forced, it should be gentle and feel like a nice lengthening feeling through the middle of the muscle.  If you end up trying to stretch muscles that are full of taut bands due to nerve irritation, it can feel like a stronger stretch sensation at the ends of muscles, more in the tendons and joints; this is something to be weary of, successful stretching is not a more pain, more gain exercise.  Unfortunately when you put a large group of people with various body types into a Yoga class, the competitive nature of people can come out and injuries can arise.

Movement follows the law of physics: your joints will take the plane of least resistance as you move; for example if you are a back gripper, you likely have a tight back that doesn’t flex very well, but really flexible hamstrings so when you bend forward you tend to move mostly in your hips and not your back.  Conversely if you are a butt gripper, you would tend to have tight hips and hamstrings and forward bending would happen mainly from your back (see below).  These types of differences in people can lead to different results when you ask a room of 30 people to all hold the same poses.

You might be surprised which group makes up the lion’s share of Yoga injuries.  I would say it’s 20% the stiff guys that try to push it too hard and 80% the really hypermobile women that have done Yoga for a long time.  The most common Yoga injury I see is hip and upper hamstring pain in women with overly flexible hips.  When the glutes and hamstrings get too flexible bending forward, they just aren’t strong enough to functionally help the person with activities that require power in more normal range like standing, walking or running.  As a result the person’s back and thigh muscles do most of the work and inevitably get tight.  The problem with this is that your back and thighs are not very efficient at helping you walk and run; it is your butt and hamstrings that are supposed to push you forward.  Over flexibility in the backs of the legs and the resultant muscle imbalances tends to create a lot of tension in the deep stabilizing muscles of the hips like the piriformis.  Too much tension in these muscles will annoy the sciatic nerve and create a feeling of tightness in the hamstring and hip; this is the trap that many ‘Yogis’ fall into.  That tight feeling in the upper hamstring is just begging to be stretched, but too much length in the muscle and relative weakness is how it got there in the first place.  These people need to stop overly stretching their hips and hamstrings and start working on trunk control and proper posture.

uttanasanabridge

If your hamstrings are this flexible…                     and you do a lot of this….


You will have trouble sitting.  You’ll brace until you get tired and then slouchMany Yoga exercises focus on whole back extension and preach chest up, shoulders back and down.  It complements the posture that most dancers tend to develop over time, which is one reason dancers tend to migrate to Yoga.  As a physiotherapist, I have to say that although dancers’ posture can look esthetically nice, it is responsible for a lot of pain and dysfunction over time and that lay people should not strive to look like dancers.  Dancers’ posture and mobility is great if you are going to be a dancer, but awful if you have a desk job, want to be a runner or do a lot of physical work.  Some of the poses and cueing can lead to overuse of the back and lats and generally poor awareness of how to stack your spine up in a strong position.

Related article: Everything your mother taught you about posture is WRONG

The basic cat/cow movement is an example; this is a good general mobility exercise for the spine and is easy for most people to do.  What most people need to learn is that their trunk and pelvis can move independently of each other to make their spine look more like a snake than a cat or a cow.


Cow: torso drooping down                               Neutral spine: torso supported

The bridge is another example.  Most Yoga and Pilates cueing will have people lifting their ribcage and arching their backs up as much as possible; this practice disengages the butt and abs from working properly and exaggerates the back and lats that many Yogis are already too dominant with.  Most people need to learn how to use their gut and butt together in a more neutral position.


This can be helpful                                            This can be harmful

Yoga poses tend to allow your body to move and take the plane of least resistance, which means you will move in the way that you are good at; to an extent this can be a good thing, but too much of it will strengthen your movement and postural problems.  Challenging yourself to move in ways that you are bad at is the only way you will create functional change in your body; it is more mentally and physically challenging, but also more productive.  Not all exercise has to be productive.  Sometimes moving for the sake of moving is all someone needs, but if you are doing Yoga with the goal of improving your posture and flexibility, make sure you go into it with some awareness of your body and know that all cues might not be right for you.  Learn the fundamentals of your posture and movement and consider these principles while you do any form of exercise:

The following video progression will help you develop the building blocks of good posture and movement to help you prevent injury while you exercise.  They are modifications of common exercises taking into account the common muscle imbalances and what to watch out for:

1.  4 point neutral spine
2.  4 point rock backs
3.  Kneeling squats
4.  Bridges
5.  How to Sit
6.  How to Stand
7.  Squats
8.  Thirsty Birds
9.  4 point donkey kicks
10.  One Leg Stand + Hip Flexion
11.  Reaching up 11
12.  Air Bench Press
13.  Counter top push up

See WTH Video section for further progressions

Your muscle and postural imbalances combined with your level of hyper/hypomobility will very much affect your experience when you decide to take up Yoga.  You really need to learn to exercise for your body type and again ask yourself ‘what am I trying to get out of this.’  Is it flexibility, stress release, strength, pain relief, rehabilitation?  When you figure out what you want, do your homework and find the right type of Yoga for you; there are many different kinds.  I would also consider the idea that maybe Yoga isn’t the right choice for you.  Pilates or a good personal trainer might help you build more functional strength and solve more of your problems.  I would consider consulting an experienced physiotherapist to help guide you in the right direction and/or start on my WTH Getting Started page and just start learning about your body here.

If you have any questions or concerns please leave a comment below and I will try my best to answer them.

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2 Comments ↓
  • JS

    Wow. I am new to this site after spending about 8 months dealing with what has become chronic pain and muscle spasm in my back and neck after an injury to my low back last summer. I have to say I have found all of your articles incredibly enlightening and they’ve really resonated with me. It’s funny, because I have been to two physio’s, three chiro’s, four doctor’s two osteopath’s, two massage therapists, an acupuncturist and a naturopath and this website has helped me understand what is happening inside my body much better than any of those appointments. I have definitely gained a little insight from each of these practitioners, but this site just explains everything so clearly and easily to understand….so kudos to you for that!
    Given that, I’m wondering if you can help me out by answering a few questions? I was a yoga instructor, runner,volleyball and soccer player prior to this injury last summer. Still unsure exactly what the "injury" was – but it happened in a soccer game two weeks after running my first marathon – so I’m guessing some kind of overuse thing. It was very acute and localized pain at first, but very quickly became muscle spasms throughout my whole back and neck and nerve tension/numbness and tingling in all my limbs and sometimes even my face. While not as bad as it was last summer, after eight months, I still have more bad days than good days. I think I likely over treated it initially with aggressive chiro manips and didn’t rest enough. I had a brief window back before Christmas when I thought I was "getting better" due to giving up all treatments, and pretty much all physical activity other than my physio/core strength exercises and walking. But since slowly trying to reintroduce activity in the new year I am now again in some sort of pain or nerve irritation pretty much every day – some worse than others. I never considered myself to be "hypermobile" because I have always been very tight through my hips. I was a childhood gymnast and yoga instructor, so my flexibility in some areas was always more than the general population, but I certainly wasn’t the most flexible amongst my peers. I have very flexible hamstrings, but have always had tight hips, and "flat" feet. Combine that with a desk job 9-5 for ten years, and being a weekend warrior – I always thought all my aches and pains and injuries were, as you say, due to bad genetics and my active lifestyle. I really thought that yoga was the only thing keeping me from seizing up – not to mention the mental health benefits. After my injury last summer my physio "diagnosed" me with lumbar instability due to overstretching and that I should "probably give up yoga and take up pilates" if I don’t want it to get worse. I kind of thought it was all just due to the whole tight hips/ flexible hamstrings/ low back compensating over years of trying to "open" my hips. But what you say about hypermobility really rings true to me – particularly because my issues are not just low back based (often the tightness and nerve irritation in my neck/shoulders is worse than my low back at this point) and have suffered A LOT of sports injuries over the years. I guess my question is – Are hyper mobility and flexibility one and the same? Is it possible to be hyper mobile but still tight through one particular joint (in my case hips)?
    Also – I feel that I am stuck in a really bad cycle of nerve/muscle tension and it’s hard to say which is causing the other. My MRI came back normal, a neurologist said I am nerves are "structurally" fine – but I am full of nerve tension, which causes muscle spasms, which intensifies the nerve tension and on and on it goes. I am working with an osteopath who has done a lot of CNS, body image awareness and nerve/ reflex work with me. He is the first person to understand the nerve issue and make me feel like I am not crazy. But I still feel I could really use from releasing a lot of my muscle tightness (and have been told stretching is a no-no). IMS acupuncture does not seem to be available in my area. Is there another type of therapy you would recommend? In the past massage, accupuncture and chiro havn’t really done much for me…it’s ranged from just short term relief that doesn’t last, to all out flare ups with spasms starting mid-treatment that cannot be calmed. Any suggestions/ advice you could give on treatment options would be much appreciated!
    Finally, as mentioned I am slowly trying to reintroduce my normal activities. In addition to my physio/osteo stuff I do the eliptical regularly, am doing some run walking, have gone back to volleyball, gone skating a few times and am hoping to ski this winter. From a mental health perspective, I just really feel like I need to get back to feeling like myself. I generally actually feel better while moving – particularly during volleyball the combination of getting my blood pumping and focusing on the game takes the pain away. However, as soon as I sit down in between sets the pain returns and I do have a lot of anxiety over doing more harm than good. Some days I feel so spasmy and tense that I feel like one false move and I could really do some damage. I am working on learning how to engage my multifidus and transverse abdominals with my osteo, and he’s given me a whole bunch of exercises to do when things are firing inappropriately. They seem to work sometimes…but would like to do be doing more strengthening of the "right" areas – if for nothing but regaining confidence in my body. Am wondering if I’ve jumped the gun on going back to sports and should I be "walking before I can run" so to speak, or is it possible to address weaknesses and faulty movement patterns while still involved in more dynamic activities? I’m really hoping you say YES as I really love being back at it, but am also v. scared of re injury. Appreciate your comments! THANKS

    • Brent

      Hey JS I’m glad you have found the site helpful…

      "I guess my question is – Are hyper mobility and flexibility one and the same? Is it possible to be hyper mobile but still tight through one particular joint (in my case hips)?"

      No they are not one in the same, although hypermobile people are typically more flexible than the average population they can and usually do get certain areas of significant tightness and stiffness. Because their bodies are so loosey goosey, they end up clinging to one strategy to hold everything together….the deep hips, mid back and chest are common ones. These muscles get overworked and typically irritate the associated nerves in the area. I go into it more in theses two posts if you didn’t read them:
      http://whythingshurt.com/blog/post/42/What-does-it-mean-to-be-hypermobile-A-gift–a-curse-wrapped-into-one/
      http://whythingshurt.com/blog/post/72/Why-Hips-Hurt–An-illustrated-explanation/

      If you are quite hypermobile, I find focusing more on postural exercises that preach attaining and maintaining a neutral spine in standing, sitting, squatting, etc to more useful than the multifidus and TA work. Generally yes you can and should retrain movement patterns while staying active so that the new patterns you are learning can work themselves into your sports.

      My post of Golf: the fundamentals of movement has some good video progressions of exercises to work through that may be applicable to you.

      If you are in the States and can’t find an IMS practitioner, check the Kinetacore website to see if physios are allowed to needle in your State http://www.kinetacore.com/physical-therapy/Dry-Needling-Scope-of-Practice/page63.html

      Remember that a negative finding on your MRI is a good thing….you likely just have to figure out how to use your body again to calm down your nervous system.

      Hope this helps….good luck

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