SPRAINED, STRAINED, OR PAINED
By Julie Gudmestad
Published in Yoga Journal
Learn how to identify and heal your students' soft-tissue injuries.
Before class, one of your students tells you that she's strained a muscle. Or maybe torn the rotator cuff, or sprained an ankle. As teachers, we need to have an idea what's going on with these injuries, and what the implications are for yoga. And, we need to understand how to guide our students in class so that they don't exacerbate the injury.
The words "sprain," "strain," and "tear" are all used to describe soft-tissue damage. Some health care providers use these terms very specifically: for example, "strain" refers to muscle or tendon damage, such as a strained hamstring; and "sprain" refers to a ligament, such as a sprained ankle. However, in general usage, the terms are often used interchangeably; and all refer to internal disruption of the structure, whether it be a mild strain or major tear.
What's The Difference?
First, let's clarify that any soft tissue of the musculoskeletal system—which includes just about everything but the bones—can be injured. These soft tissues hold the bones together and also move, position, and stabilize them. They include ligaments, which join bone to bone; tendons, which connect muscle to bone; and muscles, which move the bones. And let us not forget fascia, connective tissue that comes in myriad forms and generally holds the body together. The fascia might be microscopic, like the tiny fibers that bind individual muscle cells into bundles and hold the skin onto underlying structures; or large, tough, inflexible sheets, like the iliotibial band (fascia lata).
Any soft tissue can be injured by bearing too large a load for its strength and structure. These loads can be applied by overstretching, when the forces trying to pull a structure apart are greater than the intrinsic strength of the tendon, ligament, muscle, or fascia. (Muscles are actually weaker during stretching, because the muscle is relaxing while it's lengthening.) Muscles can also be injured during activities requiring strength, when a muscle is contracting to stabilize, lift, push, or pull too large a load.
Soft-tissue injuries happen when you put an abnormally large load on normal tissue, as when trying to lift a piano, or when you put a normal load on abnormal tissue. "Abnormal tissue" in this case means tissue that is deconditioned due to lack of exercise or load-bearing, or degenerated due to disease, previous injury, or poor circulation. Scar tissue also sets the stage for tearing because it's less mobile and flexible than the normal tissue it replaces, and it can tear under a load instead of stretching. Once the tissue is overwhelmed by the load, it begins to pull apart. These tears can vary from microscopic and mild to a serious and complete tear.
The degree of damage determines what level of care is required to support healing. If a muscle, ligament, or tendon is torn completely apart, that body part won't usually function: A person won't be able to raise the arm overhead with a torn rotator cuff muscle, or walk on a knee with a torn ligament. Surgery will be needed to pull the separated ends back together and attach them securely, and a lengthy rehabilitation period usually follows the surgery.
If the damage is mild or moderate, without a major or complete tear, the treatment plan isn't as clear-cut and requires more judgment on the part of professional caregivers, yoga teachers, and the body's owner. Here are a few guidelines for yoga teachers, so students can get all the benefits of coming to class without exacerbating an injury. These suggestions should be followed during the acute phase, when the injury is still painful and inflamed (red, swollen, and hot), which may last a few days with a mild condition or a few weeks or even months with a more serious injury.
• Avoid painful activities and positions. While the body is trying to repair and "stitch up" the torn tissues, pain indicates that the healing process is being disturbed and the new repairs are being torn up. At best, it will take even longer for the injury to heal; at worst, the tissues could be injured more severely.
• Avoid the position and activity that caused the injury. This will minimize disturbance of the healing process. For example, if the lower-back muscles were strained while bending over to pick up the lawn mower, forward bending in yoga could reinjure that area. If an ankle sprain occurred when the foot slipped off the outer edge of a clog, grounding the outer edge of the back foot in a standing pose such as Virabhadrasana II (Warrior Pose II) reproduces the position of injury.
• Know when to encourage immobilization. Mild muscle strains, including stiffness and soreness from overworking in a new activity, shouldn't be immobilized: Don't spend 48 hours lying on the couch with back muscle soreness after the first gardening day in spring. In fact, some gentle movement helps circulate the blood through the injured tissues, facilitating healing. However, with more serious injuries, such as a sprained ankle or knee ligaments that are swollen and painful, immobilizing the area with an Ace bandage or brace allows the body to go about stitching up the tissues without repeated disturbance.
• Gradually rebuild activities. Encourage your students to practice gentle movement and very gentle stretching of the injured area as the pain subsides. Depending on the severity of injury, it takes time to rebuild the strength and flexibility of the injured area. If your student returns to full activities after a week or more of rest-and-repair time, chances are good that the de-conditioned tissues will be re-injured.
What's the bottom line for your yoga students? Encourage them to listen to their bodies and make choices that will lead them toward health and wholeness, not repeated and chronic injuries. Don't urge them to push into or "work through" pain, especially in an injured area. And finally, teachers you need to know that stretching isn't a panacea for every musculoskeletal problem—sometimes stretching can make an injury worse. Sometimes a period of stillness, to allow the body's innate healing process to take over, is just what the doctor ordered.
SPRAINED, STRAINED, OR PAINED