Yoga Therapy Articles

Yoga Therapy and Muscular Skeletal Injuries

I often tell my students in class that the majority of their new clients will come to Yoga Therapy with a muscular skeletal injury complaint: lower back, shoulder, knee and neck pain being the most common ones.

I also like to remind them that we, as yoga therapists, are not physiotherapists, even if our clients come to us to find solutions for these issues.

We should not try to play their role or pretend that we can treat specific physical injuries like a physiotherapist would do. On the contrary, the Yoga Therapy approach is totally different in the sense that we look at what Dame Cicely Saunders once described as “Total Pain”, or what we call today, Bio- Psycho- Social- Spiritual-Pain (BPSS). 

Cicely Saunders was born in England in 1918 and trained as a nurse, a medical worker and a physician, and she was involved in the care of terminal patients. In 1967 she founded the first hospice dedicated to the understanding of pain, compassionate care and clinical research. 

She defined the concept of Total Pain as “The suffering that encompasses all of a person’s physical, psychological, social, spiritual and practical struggles”.

When confronted with pain, whatever the origin might be, a yoga therapist will look at the individual’s physical symptoms, psychological effects, social environment, belief system and day-to-day limitations.

This process involves a detailed Pain Assessment, in which we find out the pain patterns such as: “When does the pain occur?”, “Is it worse in the morning or at the end of the day?”, and “What activities aggravate it and which ones relieve it, and what kind of pain is it?”

This assessment includes pain scales (from bearable to unbearable) to medication side-effects, and any other physical symptoms that might come with it (trembling, nausea, dizziness). 

The yoga therapist will also enquire about the psychological and emotional effects of pain, digging into what we would describe in yoga tradition as the Manomaya Kosha (thoughts and emotions), but also the Vynanamaya Kosha (the wisdom body).

“How does this pain make you feel?” Angry, frustrated, tired, defeated, sad, anxious? “What do you think about this pain?” or “Where do you think it comes from?”

More than physical pain

It is always surprising how your client will answer these questions, especially about the origin of their pain. Given the right time and safe space, your client will respond from a place of self-understanding and wisdom, such as “Maybe it started when I was pushing myself really hard at work”, or “Maybe it was when I was playing tennis with my son”.

Those ‘maybes’ are really important for our work, and as yoga therapists we should always listen to our client’s tapping into their own inner wisdom. 

In the same way, it is also essential to understand how their physical injury affects their own relationship with their outside environment. Human beings, by nature, are meant to connect with others. The feeling of disconnection caused by an injury can perpetuate pain, and delay the recovery process. 

Most of us have experienced, at some point in our lives, pain that has limited us in our work and social activities, perhaps having had to take sick leave or miss our friend’s birthdays party. Added to the physical pain that we suffer, is the feeling of disconnection from others and the feeling of being left out, not to mention the worries about financial issues such as “Will I be able to pay my mortgage or rent?”, and “How long can I survive without going to work?”

 

As the spiderweb of pain grows, it might filter through the layers of your client’s belief system, or as we call it, the “Why me?” effect. This results in questioning one’s own relationship with God, the human condition and the Universe, manifested as skepticism, sarcasm and fatalism.

Statements such as “I give up”, “The medical system is a sham”, “What’s the point anyway”, “No-one cares” should give us a clear idea of our client’s spiritual pain, whether they are religious or not. 

Finally, but not less important, are the day-to-day limitations. Simple things such as being able to do the grocery shopping, cook our own food, dress ourselves and go to the bathroom without assistance. Not being able to do these things ourselves is possibly the most impactful pain of all, as it takes over the most basic human needs that we tend to take for granted until it happens to us. 

The Yoga Therapy Approach

Yoga Therapy’s approach to muscular skeletal pain from an injury follows the same path in our treatment.

We will find out all the different aspects that make the full package of our client’s pain, and start from the basis, building up through the layers of the human condition. This involves pain-free physical practices and movements – no matter how small and simple – breathing techniques, relaxation, guided meditation and sharing of experiences through trauma-sensitive conversations. 

The good thing is, Yoga Therapy treatments can take place parallel to conventional medical care and physiotherapy, and can be really effective for the relief of symptoms, changing destructive patterns and introduction of new beneficial habits.

It offers tools for better quality of sleep – hence facilitating healing – and pain management skills in the form of mindfulness and self-regulating breathing practices.

Yoga Therapy gives us an all-round approach to what might seem like a simple muscular-skeletal injury, by treating it from a wider, more complex perspective of the different human dimensions. Just as I like to remind my students, “attached to a shoulder injury there is whole human being”.

Montserrat G. Mukherjee C-IAYT,

CEO & Founder of The Yoga Therapy Institute