Why Do I Have Pain with Yoga, and What Can I Do About It?
POSTED ON 7/26/2017 IN Research BY Christopher Centeno
You may be one of the millions who swear by the physical and mental benefits of yoga, and maybe you've even enjoyed the bonus of pain relief from the practice. Yoga is a vast and ancient India-originated discipline with many styles and techniques, each featuring physical, spiritual, and meditative elements. However, I've noticed through the years that many of my patients tend to get pain with yoga or get injured. Now a new study confirms that some people do have pain with yoga and even experience a worsening of their existing injuries. Why is this, and is there anything you can do about it? Let's explore this by first reviewing the study.
Study Review: Pain with Yoga
The study consisted of 354 subjects from two separate yoga studios. Questionnaires were conducted that asked for feedback on pain with yoga, specifically, whether it exacerbated existing pain, caused new pain, improved pain, or had no impact on pain whatsoever. If there was pain with yoga, the research tool also questioned how and how often it affected the subjects. Indicators such as experience levels and number of yoga hours were also considered. At the one-year mark, the same questionnaire was completed again by the same subjects.
The result? Musculoskeletal pain with yoga occurred in over 10% of the subjects, resulting in missed yoga classes by over one-third of the participants. In some cases pain lasted for greater than three months. Additionally, for participants with pre-existing injuries, in 21% pain and injuries worsened with yoga. The study authors concluded that musculoskeletal pain and exacerbation of existing injuries and pain can be caused by yoga.
So why is this—why does yoga help pain in so many and cause pain in others? And if we're one of the others, what in the world can we do about it?
Yoga Is the Mount Everest of Stability
Yoga is all about stability. The problem for many patients with neck and back problems is that the stabilizers in the spine are damaged, off line, or atrophied. Hence, when they challenge their spines with an activity that requires high levels of muscular- and ligament-based stabilization, their spine can't handle the load. When this happens, things like facet joints, discs, and nerves get tweaked, leading to a pain episode. The same can happen with ankles, knees, hips, shoulders, elbows, and wrists. So what can you do about this? Let me explain through some examples.
A patient comes in who relates that she can't perform downward dog because her wrist hurts every time she tries. An exam shows that the ligaments in her wrist were injured at some point and are now stretched, allowing for too much movement between the many carpal bones in her hand. So every time she places her weight on her wrist, these bones move slightly too much in strange positions. This causes extra wear and tear on these joints, and that leads to swelling. A few quick and precise injections of platelet rich plasma into the appropriate wrist ligaments and she's back to a mean downward dog.
A second patient comes in who says that every time she tries yoga, her low back flares up and her leg gets numb. Her MRI shows that the multifidus stabilizing muscle at L5–S1 is mostly gone. Hence, she has no way to stabilize this area of her back. So every time she tries a move that requires her to hold a plank, while her big muscles turn on, the small muscles near the spine are overwhelmed by the load and allow her vertebrae to get into some strange positions. This can cause the facet joints, discs, and nerves between those back bones to get injured. She enters into a treatment program whereby we inject platelet growth factors around irritated nerves and platelet rich plasma precisely into the atrophied muscle combined with specialized physical therapy. After a few treatments, she slowly transitions back into yoga.
The upshot? While you might exacerbate an injury and have pain with yoga, the cause isn't usually the yoga itself; the injuries may be your sign that your body has a stability problem. Yoga takes a fully functioning stability system to pull off gracefully. Hence, looking for problems due to lax ligaments or atrophied or inefficient stabilizing muscles is a good place to start your quest for why your body and yoga don't get along!
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