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  • Yoga Teachers Are Not Doctors
    One Possible Approach to Alleviating Joint Pain While Doing Yoga

    Most yoga teachers I know haven't received training as doctors.

    This though occurred to me after a student asked me what to do about her hip pain.

    I thought back to how I've approached problems in my own body.

    First of all, if I've just injured something then the first thing that I may do is rest the injured part by working around it and limiting movements so that I don't move into painful positions.

    From there, any time I feel pain in some part of my body, I'll experiment and see what I can change to make the pain go away.

    Experimenting With Hip Joint Pain

    As an example, for the longest time when doing revolving triangle with the left leg forward my left hip hurt. I still haven't fixed the problem completely but part of the solution is to pull the left hip back. I then squeeze the muscles of the left thigh.

    One of the challenges of twisting triangle can be moving out of it slowly, without bending the knees and without "pushing off" and so I use standing up from reverse triangle as a test to see if what I have done is actually helping make my hip feel better.

    Now that is only two actions: pulling the hip back and activating the thigh.

    Other actions that I have experimented with include:

    • activating the foot,
    • rolling the thigh inwards or outwards,
    • pressing the thigh inwards, outwards, forwards, backwards,
    • protracting the sitting bone,
    • retracting the sitting bone,
    • pushing down or forwards with the foot
    • and/or pushing up/back on the ischio pubo-ramus.

    Stop Doing It All At Once

    I didn't try all of these actions at once, instead I worked through them slowly getting comfortable with the actions themselves and trying them in different poses just to see how they felt.

    Generally I've had best results by only working with a few actions at a time, particularly when I'm unfamiliar with those actions. To get familiar with whatever actions I am using I might use the same actions in

    • triangle pose,
    • side angle pose,
    • standing forward bend,
    • chair pose, even
    • warrior or warrior 2.

    Then I might see how I can try the same actions in a single leg balancing pose.

    Testing Hip Stability while Standing On One Leg

    These are the poses that I like to spend a lot of time on because if anything is going to test hip stability it is standing on one leg.

    Note that standing on one leg with the other leg touching the standing leg is different that standing on one leg with the other leg free. The contacting leg changes the tension in the standing leg and so I'd suggest that when working on hip problems it's good to be aware of this.

    You may find that you can use your free leg in a pose like tree pose to exercise the standing leg by, for example, pressing the inner thigh against the lifted foot.

    Because the second leg isn't on the floor in a single leg balance, the muscles of the hip have to work against each other to create stability.

    Single Leg Stability

    For single leg hip stability:

    • Flexors may work against extensors,
    • adductors against abductors,
    • internal rotators against external rotators.

    These are all quantities that you can play with when working towards fixing, say, a hip that isn't quite working right.

    Working with Knee Joint Pain

    As for knee pain, that is something that I am again currently working on.

    With knee pain it could be beneficial to focus on hip stability and foot stability, using standing poses and one legged balance poses. Focusing on the knee itself, the quadriceps and hamstrings are of equal importance. Learn how to engage both groups of muscles. For the hamstrings I like to focus on feeling the two groups of tendons at the back of the knee.

    Also important are the inside and outside of the knee. When I practice tensing the quadriceps I'll occasionally focus on squeezing the inner head (vastus medialis) but also the outer head which seems to have an affect on the outside of the knee. It may actually tighten the tendons that cross the side of the knee.

    Meanwhile on the inside of the knee the gracilis and sartorius may also be important.

    In general, the qualities that you can control are shin rotation at the foot and knee, and hip rotation.

    When doing squats, I experiment with different foot widths and also with different amounts of foot turnout. I also experiment with slowly shifting from one foot to the other, seeing if there's ways that I can vary leg tension or foot tension so that both knees feel good.

    When squatting (or doing yoga chair pose) I also experiment in the thighs horizontal position as well as the bottom position with legs still active.

    Shoulder Joint Pain

    For shoulder pain, or even shoulder imbalance, my first area of focus is scapular stability and awareness.

    Actually I try to feel my scapulae and control them. Basic movements include retraction, protraction, elevation without rotation, elevation with rotation, forward depression, rearward depression.

    I also practice these movements with different arm positions, different arm rotations and also both un-weighted and weighted.

    Noticing Ribcage, Pelvis and Cranial Alignment

    An important factor in my own exploration of the shoulder was to notice ribcage/pelvis/cranium alignment.

    A long time ago a friend and I were playing with NKT and I discovered that my right psoas was inactive. (The word generally used is "inhibited.")

    So rather than being tight or weak, what was happening was that my brain wasn't flicking the switch that turned it on. Perhaps some muscle was engaged and because of that engagement the psoas wouldn't turn on.

    (During my time in the army fixing guns I saw quite frequently how gun design meant that certain operations wouldn't occur unless certain relationships were already in place. Work on electrical circuitry I learned how to connect relays in such a way that when one set of contacts opened it prevented another set from opening, or kept them open. It seems that the body may have similiar mechanisms in play either for safety, for effective operation or both.)

    I later figured out that because one psoas wasn't turning on that may be effecting the alignment of my ribcage, lumbar spine and pelvis. Or, perhaps the alignment of these body parts was what was preventing my psoas from activating.

    What has the psoas to do with shoulder mechanics. If you read the NKT blog, a lot of times an inhibited psoas will be compensated for by the pec minor (or the pec minor inhibits the psoas.)

    Since an inactive psoas my have been throwing off my ribcage alignment, my own solution was to notice how my ribs and pelvis related.

    I practiced moving them relative to each other, either with sliding movements or rotation movements. Then after this practice I'd try to center my ribcage relative to the pelvis.

    Then I'd carry on with my shoulder exercises.

    Now when even I have a kink in one shoulder I'll try to adjust the position of my ribs relative to pelvis to see if that's alright first, then look at scapular positioning.

    Wrist Joint Pain

    For wrist pain I'll also look at the shoulders.

    The reason is that tension, or a lack of it, in the shoulders, or between the shoulders and the ribcage may have an affect on tension in the upper arm and the forearms.

    So since the shoulders/scapulae can be dependent on the ribcage and pelvis, it could help to look at those first, then the shoulders, then from there the arms.

    With respect to the shoulders I'll look at

    • protracting and retracting the shoulder blades
    • rotating the arms externally or internally
    • bending the thoracic spine forwards or backwards.

    Then I'll experiment with combinations of these actions.

    So Much Work, So Little Time

    Oh that's so much work you might say.

    And you'd be right. I've been exploring this stuff for the last few years.

    But the thing is, if you are interested in learning your body then these problems provide the perfect opportunity to learn your body so that you can use it better (and appreciate it) when there aren't problems.

    Qualities to Aim For in Movement Experimentation

    When experimenting my suggestions are to pick a movement or action.

    Say you are experiment with external rotation of the front leg in reverse triangle.

    • Make the movement slow and smooth.
    • Focus on feeling the movement, see if you can feel where the muscles are that are causing the movement.
    • If you are dealing with knee or hip pain, notice how each feels. To test it try lifting your bottom hand. Does the knee or hip hurt or feel relative stable?

    Once you have the feeling of external rotation, try to vary it.

    Probably what happens when you externally rotate is that your leg moves. Now try to keep the leg stable.

    Duplicate the feeling of external rotation without moving your leg. You'll probably find that your pelvis moves in some way instead. Again notice how your hip and knee feels.

    Are you strong enough to lift the bottom hand easily?

    • Next notice the position of your pelvis. Is it level from left to right? If not make it so. Also make it square to the front. And repeat the experiment.
    • Then you could try pushing your front leg hip back a little. Or push the back leg hip back. Or push the hips to one side or the other.

    In each case the action is clearly defined. That makes it easy for you to try to do it.

    When experimenting, clearly define what you are trying to do. Then do it. And while you are doing it feel what is happening.

    As you build up your repertoire of actions you'll begin to find that you'll automatically know which actions to try. And if you find yourself habitually using the same action over and over again, make a note to experiment again. Ask yourself: What can I vary to change the experience of this pose?

    Exercising Creativity

    Note that a lot of this "experimental" approach has been inspired by the dance of shiva.

    If you find yourself having difficulty thinking of how to define movement, then practicing the dance of shiva may help.

    Creating Stability

    Quite often, joint pain may simply be because of a lack of stabilty. The above experiments are for the most part experiments in how to create stability.

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