How Yoga Enhances Recovery

As a culture, we have become very familiar with the suffering and loss associated with substance use disorders.  We are also quick to notice the psycho-biological symptoms associated with them. What we may not be as familiar with, and completely unprepared for, however, is the discomfort associated with Post Acute Withdrawal Syndrome or PAWS.  PAWS refers to abstinence-based biological changes that occur once an individual has made a decision for change and entered recovery. It is the abstinence-based biological symptoms of PAWS that makes early recovery so uncomfortable and hard to understand, and therefore extremely difficult to maintain.

Join us for a special lecture on Yoga and Sobriety Monday, October 8th at 5 pm.

Hot Yoga is a powerful tool for  recovery from substance use disorders. Some of its greatest potential lies in the practice’s ability to alleviate the symptoms of  Post Acute Withdrawal Syndrome.

PAWS is a cluster of symptoms that set in after a person stops using drugs or drinking and has completed detoxification. At this stage, the severe symptoms of acute withdrawal have passed and a person can begin to focus on their recovery on physical and emotional levels. PAWS can make this second phase extraordinarily difficult because it has a severe impact on a person’s thought processes, decision-making, ability to control emotion and ability to maintain physical coordination.

“Everyone said I would feel better and I feel worse. I feel like I am going             crazy.”      -Anonymous

Below, find common PAWS symptoms and how yoga can help:

Inability to Process & Organize Thoughts: Feeling unable to solve simple problems, maintain focus on a specified task, or reason in the abstract.

  • Yoga increases focus, concentration, and attention through the practice of both concentration meditation and mindfulness meditation during postures.
  • The practice of yoga improves circulation in the entire body, including the brain, potentially leading to improved neurological function.
  • Yoga postures improve the movement of cerebrospinal fluid, bathing the brain with biochemicals and nutrition, and facilitating the removal of wastes.

“The presence of brain dysfunction has been documented in 75-95% of the recovering individuals tested. Recent research indicates that the symptoms of post-acute withdrawal associated with alcohol/drug-related damage to the brain may contribute to many cases of relapse.” ~ Terrence Gorski

Depression.  Inability to experience pleasure or joy (anhedonia), pessimistic and/or negative thinking, irritability, anger.

  • Yoga promotes a positive attitude, improves mood, and helps decrease stress and tension.
  • Massachusetts General Hospital is in the middle of a comprehensive study on the effects of hot yoga on clinical depression. Preliminary results show a statistically-significant negative correlation between number of classes taken and depression symptoms.
  • In our preliminary Sober Yogis study at Bikram Yoga Portsmouth, participants saw a two-thirds reduction in depression symptoms.

Memory problems

  • Yoga increases the movement of cerebrospinal fluid and increases blood flow to the brain.
  • Practitioners engage in breathing exercises that require them to breathe in rhythm in a group. Clinical studies on rhythm therapy show that it causes improvements in short term memory and facial recognition.

Lack of initiative/motivation

  • Yoga increases energy.
  • Yoga causes a sense of wellness and self-acceptance.
  • Participating in a challenging class that the yogi may not yet believe they can “do” and proving that inner voice wrong over and over again increases motivation, grit, drive, and sense of accomplishment.

Increased sensitivity to pain

  • Yoga improves the practitioners self-awareness to what is happening in the present moment. This improves proprioception and helps to develop a realistic sense of pain and injury.
  • Yoga reduces symptoms of arthritis, rheumatoid arthritis, fibromyalgia, and other autoimmune diseases, reducing pain.
  • Studies on fibromyalgia and yoga have shown an over 50% reduction in perceived pain in patients after starting yoga.
  • Yoga improves joint mobility, muscle strength and flexibility, skeletal alignment, and improves overall health, reducing pain.

Emotional overreactions or emotional numbing

  • Yoga is the practice of being present within one’s body. As the practitioner begins to feel their body, part-by-part, they also learn to feel the emotions inside the body as well.
  • Yoga trains the practitioner to breathe calmly, even when uncomfortable. This allows the yogi to experience uncomfortable thoughts and emotions without triggering a fight-or-flight response, diffusing the challenging feeling.
  • Across the board, yoga students report a reduction in emotional overreaction that continues to grow the longer they continue the practice.
  • For yogis who have long suppressed emotions, accessing them through the body is sometimes the only way to “metabolize” these “stuck” emotions.
  • Therapists have found patients stuck in PTSD treatment move forward in leaps and bounds through the therapeutic practice of yoga.
  • People talk about a “yoga glow” which is a deep feeling of wellness after practice. A body that feels good is much easier to “be present” inside.
  • In our preliminary Sober Yogis study in Portsmouth, New Hampshire, the average participant saw a reduction in Emotional Overreaction and/or Numbness from Severe to Mild.

Anxiety

  • Yoga increases feelings of wellness and decreases anxiety.
  • Yoga trains the body, through focused breathwork, to activate the parasympathetic nervous system, circumventing anxiety.
  • In our preliminary Sober Yogis study at Bikram Yoga Portsmouth, participants saw an average 67% reduction in anxiety symptoms.

Sleep disturbances (including using dreams) Sleep disturbances may range from insomnia to narcolepsy to sleep apnea, the most commonly reported problem is the inability to maintain a regular sleeping cycle.

  • Yoga decreases tension and anxiety and improves the capacity for restful sleep.
  • Yoga practices like deep breathing techniques, savasana, and restorative postures strengthen the vagus nerve and decrease activation of the sympathetic nervous system, allowing the practitioner to fall asleep more easily.
  • Yoga helps to stabilize production of cortisol, a primary hormonal driver in sleep disturbance.
  • Yogis practicing 45 minutes of yoga three times a week for twelve weeks saw an average 31% reduction in cortisol (the “stress” hormone).

Physical Coordination Problems: problems with balance, hand-to-eye coordination, fine motor skills, and impaired reflexes.

  • Yoga seeks to bring the practitioner to mental and emotional wellness by moving through the door of the body.
  • Each posture starts with direct awareness and attention to the body as a whole and as parts and allows the practitioner to slowly introduce movement and depth with control, regardless of health and wellness.
  • Yoga improves the physicality and function of all who practice.
  • Yoga is a therapeutic practice that improves coordination, balance, strength, flexibility, range of motion, joint health, strength, circulation, and fine and gross motor skills

Feeling unable to cope with stress:  overreaction to a situation that does not warrant it, or no reaction to a very grave situation. A person also might feel stressed all the time without being able to articulate why.

  • Yoga decreases stress, tension, and anxiety.
  • Yoga increases self-acceptance.
  • Yoga encourages the development of a healthy ego, the ability to see one’s self through the lens of right now, an ever-changing person.
  • Yoga provides community. Individuals with social connections are not only healthier, but also cope with stress more easily.

Cravings/Urges/Thoughts of Using

  • Yoga strengthens the mind and the body.
  • The practice of yoga teaches the yogi mental strength, discipline, self-control, determination, concentration, and will power.
  • Yoga helps to regulate and stabilize blood sugar and blood pressure, two factors known to increase cravings.
  • Yoga decreases depression, anxiety, and other PAWS symptoms, common causes for cravings.
  • A regular yoga practice also decreases cholesterol, associated with sugar cravings and binge eating.
  • Yoga allows the addict to experience euphoria by moving their body therapeutically, allowing the practitioner to develop a healthy relationship with “feeling good”.
  • The therapeutic Bikram Yoga series is particularly effective at creating this feeling of euphoria because it improves circulation and function of the entire body in a heated room. The sweat-factor or heat therapy imparts a feeling of well-being that is unparalleled.

Why does it have to be hot?

Hot Yoga shows particular promise in improving health and enhancing recovery in three primary way. Learn why our classes are heated

Detoxification Detox is a popular buzz word in the wellness community. Many health gurus have over-stated the benefits of sweating and detox, but let’s not throw the baby out with the bathwater.

The liver, kidneys, lungs, and excretory organs are the primary players in the detox game. They do the bulk of the body’s detoxification. The skin is the largest organ in the body and through that organ we excrete sweat primarily for cooling and scent purposes.

Our sweat is comprised of water and several important minerals, but studies have also shown sweat to contain heavy metals, fat-soluable toxins, and urea in the same concentrations found in human urine. While sweat is not a primary mover of wastes in the body, it does have the potential to reduce amount of detox required of the liver.

Each sweaty yoga class you take is like a mini vacation for your liver and kidneys.

Hyperthermia Hyperthermia has been studied since the 1970s for it’s positive effects on depression. Culturally, saunas have been used for centuries in Siberia and the Baltics to reduce the impact of seasonal depression. In study after study, results show a “significant reduction” in depressive symptoms.

If you want to feel better, get hot!

Vasodilation Exercising in a heated environment causes immediate and complete vasodilation throughout the body. This process improves the ease with which the body can transport blood, waste, nutrients, and biochemicals, which increases the speed of recovery and healing.

In addiction recovery, we talk often about the protracted healing time for the brain as it adapts to life without the substance of choice. During this painful process of neuroplasticity, if we support the body by increasing circulation, we simultaneously shorten this process and improve it’s efficacy.

For those new to exercise or recovering from a lifetime of illness or injury, practicing in a heated room allows for more movement with a drastically-reduced risk of injury. This makes the practice safe and effective for people of all levels of health and wellness.

Heat speeds healing.

If feels good to move your body. It feels good to sweat. Completing a full-body workout like we do in Hot Yoga lends a sense of accomplishment and pride. Through a regular practice, we can rebuild our fragile egos as a solid foundation on which to build a new and satisfying life.

We are very excited to announce a new group starting at a Portsmouth location this fall. We look forward to sharing more information with you at our upcoming lecture on Monday, October 8th at 5 pm. Preregister for this free lecture here.

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Hot Reveal

New Name, New Look, New Schedule, Unlimited Possibilities

As individuals, it is our obligation to take responsibility for our own continued growth and development. Sometimes that growth involves changes that impact mostly our personal lives and sometimes those changes have a big impact on the world around us.

Since our 15-year anniversary last September, Jaylon and I have spent a lot of time reflecting on all of the transformation our studio and our community has gone through in the last decade and a half. Through our mutual commitment to self-improvement we have facilitated some amazing changes together both inside and outside the yoga room.

Now we approach a new season of change for BYP. This summer, we started testing out additional healing modalities to supplement and compliment your Original Hot Yoga practice. The results have been nothing short of amazing.

As a community, our excitement about the new classes is super-charged. We have recommitted with new energy and enthusiasm to our practices and our health. Students with chronic pain and injuries are finding answers, solutions, inspiration, and resolving these problems.

We have carefully selected Barkan Vinyasa and Inferno Hot Pilates and our new 26+ classes because they have the same therapeutic focus, translate in to powerful results, and complement our traditional hot yoga practice of the Bikram Yoga method.

To celebrate these new changes in our offerings, we are so excited to bring a new name to our studio community that better represents all we have to offer here at BYP.

What’s the new name?!? You’re going to have to wait until the big Hot Reveal on Saturday, September 8th.

Save the date for our Grand Reopening Open House and Hot Reveal on Saturday, September 8th. We’ll have free classes all day and a pizza party from 1:30-4:30 pm.

Learn the new name. See the new schedule. Check out our new look. Bring your friends!HOT REVEAL

I can’t wait! Sign me up!

Bring your friends and family! Special intro offer pricing: One Day Only! New students can purchase the intro month for $20 at the Open House. For the price of a drop in, they get a whole month of unlimited yoga!

If your BFF out of town on the 8th? They can buy online Saturday and Sunday the 8th & 9th and use coupon code HOTREVEAL.

You’re gonna love what we have up our sleeves!

Let’s sweat,
Sara

Hot Reveal/Special Deal!

Special Open House Pricing on Intro Special

We love what we do and we love sharing Yoga and Pilates with new students! To get you in the mix and pumped on our offerings, we offer special pricing for new students: $30 for your first 30 days of unlimited yoga.

It takes 30 days to build a new habit. When you commit to yourself for your first month you’ll see changes in the way you look, feel, and live. This powerful practice spills over from the yoga room into everything you do in your daily life. We recommend practicing at least 2-3 times a week to see maximum benefit from your Yoga and Pilates practice.

To celebrate our new name, new logo, and new schedule, we are offering a Hot Reveal Grand Reopening Open House Special on Saturday and Sunday, September 8th & 9th of $20 for 30 days of unlimited yoga.

During our Open House weekend, for the price of a drop in you get a whole month of Hot Yoga, Pilates, and Vinyasa classes!

Join us for free classes all day on Saturday, September 8th. Save your spot now! Formerly Bikram Yoga Portsmouth, Plaza 800, 800 Islington Street, Portsmouth, New Hampshire.

Sign up now and use coupon code HOTREVEAL so you can feel the best you’ve ever felt!

Pull up this video now to learn tips on surviving your first class!

What’s Hot Yoga?

What’s Hot Pilates?

HOT REVEAL

Commit to 90

Our powerful Commit to 90 Whole Life Challenge is back and better than ever!

We’re so stoked to team up with Functional Nutritionist Erin Holt to bring you our new and improved Commit to 90 Whole Life Challenge.

Commit to 90 is a 90-day challenge that rewards you for taking care of yourself. Instead of blasting out classes every day for a month like we’ve always done in our September 30-day Challenge, we’ll focus on building a regular, steady practice. CT90 is designed to help you make informed decisions around nutrition, learn to fuel your body, heal your relationship with food, build community connections, and make time for activities that enhance your life.

Watch this video the learn more!

How does it work? From September 15-December 15th, you will be awarded points each week for taking Yoga and Pilates classes, meeting Erin’s nutrition goal of the week, and engaging in enrichment activities like special workshops and events at the studio. Yes, we still have gold stars!

At the end of the challenge, the individual with the most points will win our Commit to 90 basket, valued well over $900 with killer prizes like three months of unlimited yoga and Pilates and a $200 lululemon gift card.

What do I get? For the monthly fee of $250, you have access to:

  • Unlimited Hot Yoga and Pilates
  • Weekly Nutrition Education
  • Weekly Facebook Live videos on nutrition and more
  • Up to three total enrichment activities (choose from any workshops at our studio or our sister studio Steam House Hot Yoga)
  • Online support group

These services have a retail value of over $379/month. This monthly fee is a wicked discount that represents our commitment to helping you kickstart your life.

But we love you, so we want to offer you a special deal.

You all know by now that we’re rebranding the studio this fall. We’re so excited to bring the new studio, new name, new logo, new name out of its chrysalis and into your lives. As a special gift to celebrate our reopening, we’re offering a deeply discounted price through September 8th.

Sign up now and pay just $200/month for the Commit to 90 program.

Sign up before our rebrand on September 8th and save $50 per month! Smash the I’m in button below if you’re ready to commit to a better life.

I’m in!

Wondering about what’s in the grand prize? Watch here.

Eight Pillars of BYP

At BYP there are eight central pillars that serve as the foundation for all that we do.

With the support of these core values, we are able to implement our mission as a yoga studio to support our community members to take charge of their health, to heal their wounds, and amplify their lives so they can maximize their impact on the world.

By practicing our Eight Pillars, we are able to achieve our vision that our studio is able to create a robust and impactful community that brings positivity and change to the world.

  1. Acceptance: The first principle of yoga is acceptance of one’s self. As we love and accept ourselves for who we are, we also accept and appreciate everyone who walks through our doors. Each student is a valued member of our community. We show up each day and face ourselves in the mirror so we can learn to love and accept who we see looking back.
  2. Healing: Our bodies are in constant states of change, growth, age, and development. Here, each yogi commits to take responsibility for their own health and wellness by continuing to take steps toward healing. As teachers, we offer the most effective Yoga and Pilates methods and mindfulness practices available so that our students can heal and recover from any obstacle life throws at them: physically, mentally, and emotionally.
  3. Growth: In yogic philosophy, growth is the constant willingness to observe, reflect, and move continually toward the truest expression of one’s self. We believe in continued growth, transformation, and change. Our teachers are dedicated to continuous professional development so our students can truly thrive.
  4. Community: Bringing people together is what we do best. Our thriving community is the most supportive group of caring individuals you’ll ever meet. We sweat together, struggle together, challenge each other, heal together, and laugh together. In addition, we live the yogic principle of seva or selfless-service through community outreach, scholarship programs, and by supporting like-minded organizations doing good works in our area. Through giving back, we build a stronger Seacoast community and make it a better place for us all to live.
  5. Green: We believe strongly that how you do anything is how you do everything. We are committed to reducing our impact on the environment in all aspects of the business from green cleaning products and energy-efficient appliances to the most sustainably-sourced and local retail partnerships. By improving the way we do business in the world, we have the power to change our future.
  6. Integrity: The strength of our community is built upon trust and that trust comes from the unfailing fairness and integrity of our staff and leadership. We hold ourselves, our teachers, and our community to high moral and ethical standards. BYP will always be a safe place to practice and to heal.
  7. Compassion: Every day we practice compassion for ourselves on the mat so that we have the capacity to do so for others. We treat our students with kindness and compassion so our studio is a safe place to heal from any kind of pain and suffering. “I was shown kindness at a time in my life that I didn’t even realize I deserved it.” -Nick
  8. Courtesy: We practice civility and courtesy in all of our interactions with others to show our respect for every member of our community: changing the world one act of courtesy at a time.

Join our tribe today!

 

Healing Hamstrings Attachment Injuries in Yoga

a.k.a. Yogic Butt Pain

The most prevalent injury in the field of yoga is proximal hamstring tendinopathy (PHT). You may know it better as a deep pain in the butt, right where your leg and pelvis meet. It is also commonly referred to as hamstrings attachment injury.

hamstrings pain

Studies estimate that nearly 80% of yoga practitioners will experience this injury at some point during their practice. It is most common in flexible, female yoga practitioners. Proximal means that the injury is close to the hip joint. Hamstrings refers to the three muscles that make up this group: semimembranosis, semitendinosis, and the biceps femoris. These three all connect with the ischial tuberosities or the “sitting bones” of the pelvis at their origin (for my anatomy nerds, one of the two biceps heads originates on the femur, not the pelvis). The location of the muscle attachment is the reason for the buttock pain during sitting or deep hip flexion.

I use the word tendinopathy here to cover three types of tendon disease: tendinitis (acute injury with inflammation), tendinosis (chronic injury with cellular degeneration but no inflammation), and paratenonitis (inflammation of the outer layer of the tendon). In the field of yoga, we are not here to diagnose or treat injury, and the way we’d approach any of these conditions or a combination of them is the same, so PHT is a good coverall for our purposes.

Depending on the severity of the damage, an injury to our tendons can take from two to 26 weeks to heal. The average yoga practitioner in America heals a PHT in about 18 months. If we want to shorten the healing time, feel better, and get back to our yoga practice we have to unpack some of the reasons that healing isn’t occurring.

Why are so many yogis getting hurt?

It’s helpful to know that this injury happens most commonly in our most flexible and moderately experienced yoga practitioners. It frequently occurs three, five, ten, even 15 years into practice and is generally seen in a practice focusing more on increasing flexibility and range of motion than on strengthening the muscles and tendons at the back of the leg and hip. This is endemic in American Yoga culture.

The challenge for flexible students is that a few months into their yoga practice, the sensations in forward folds decrease significantly as they rapidly approach maximum range of motion for their genetics. The “pursuit of sensation” leads to a tricky situation where students struggle to differentiate between uncomfortable sensations of stretching and uncomfortable sensations of damaging the muscle or its attachment.

In the field of hot yoga, particularly Bikram Yoga’s 26 posture series, the raging debate about “lock the knee” or “micro-bend” have both led to exacerbating the prevalence of PHT because neither side of the debate addressea the supportive role of the deep six hip rotator muscles in preventing hyper-extension and supporting the hamstrings attachments.hyperextended standing bow

As teachers, we need to deepen our understanding of body weight distribution, hyper-mobility, and the roles our muscles play in taking the pressure off of our soft tissues. Too often, I see Instagram posts of yogis in Standing Bow or Dancer’s Pose with a relaxed posterior hip, internally rotated femur, and a hyper-extended knee. The answer to this problem isn’t a “micro-bend” in the knee. It is a stronger set of hip muscles and a well-aligned femur. More on how to do this under “Pranayama” below.

Note how internally rotated the standing leg is in the above photo and how far behind the ankle her knee is located. (photo credit 105f.com)

Our responsibility as yoga teachers is to help our students both build strength and control, and also tune in to their bodies to listen for clues to injury in its early phases. We are obliged to seek continuing education with experienced teachers who can help us “see” in a body when more or deeper is no longer better.

If you have a history of knee problems, Baker’s cyst, patella-tracking problems, it may all boil down to not stopping the thigh from internal rotation. If you want to heal your knee, you have to strengthen your hips. Or use your ass as a doorstop for your knee.

Did I over-stretch it?

One of the greatest damaging forces to tendons is compression, not stretching. All of our forward-folding postures press the hamstrings tendons against the bones of the pelvis and continually increasing the compression over time gradually increases the extent of the damage.

Many yogis hang in the back of the hip for standing postures with the hip joint behind the ankle. This misalignment puts a tremendous amount of compressive force on the hamstrings tendons against the bone. The issue is often not one of stretching the tendon as much as it is aggressively compressing it.

How do we stop the injury?

The first step in helping my students with PHT is getting them to understand that you can’t stretch out an injury like this. Imagine you are reading the Sunday paper and the top crease has a small tear in it. “Shoot!” you think. “My newspaper is torn. I’m going to grab both sides of the paper and pull them apart so I can get it to stick back together.”

That doesn’t make any sense, does it?

Most of us think, like we do about lower back pain, that the answer to healing an injury is to stretch out the pain. The solution to healing an injury like this is to stop tearing and micro-tearing the area and give it time to heal.

You need to glue the paper and leave it alone so that has time for the glue to dry firmly. That’s our number one problem. We can’t seem to leave the paper alone long enough for the glue to dry. We keep going back to it, “It is ready yet? How about now?” In this way, we keep re-injuring the damaged tissue.

Most of my students say. I don’t want to stop forward bending. It’s going to limit my practice! Here’s the truth bomb. You have a choice to limit your end-range hip flexion for four to six months or be in pain for over a year and have to limit your end-range hip flexion for four to six months then. Which one sounds better?

Understanding the Healing Cycle

The healing response in the human body is a predictable process of three over-lapping phases: inflammation, repair, and remodeling. After an injury, your body immediately rushes blood and white blood cells to the area to stop the injury and begin the healing process. The inflammation phase usually occurs during the first seven days following an injury. This part of the process is generally painful and accompanied by redness and swelling.

Next, the body begins the repair phase or proliferation (of new cells) phase. Here the body lays the scaffolding that will bridge the damaged tissues. The process in this phase of healing is called granulation. The body sends tiny tendrils of scar tissue across the breach to show the body where to lay the permanent tissue.

Granulation occurs around 6 to 14 days and the area immediately feels more stable. Pain and inflammation decreases and you start to feel better. There is a strong urge to return to normal activity around two weeks post-injury. This is where we make our biggest mistake.

We resume normal use of the area and the granulation tissue is not strong enough to bear the load.  I picture these granulation tissues like the tiny gossamer filaments of a spiderweb. Under normal use, the tender fibers tear and the body initiates the inflammation phase again.

If you can wait, if you can stop yourself, the next weeks of healing are the remodeling phase. Around three weeks after the injury, the collagen of the scar tissue laid during granulation matures and is constantly remodeled until permanent tissue is achieved. This process takes around 12-16 weeks, but some tissues can take up to 26 weeks to fully mature. Mark your calendar with these dates as points to check in with your own healing process. With this injury, you must limit end-range hip flexion for three to six months.

Enhancing Maturation

While most students can grasp this healing protocol, most of us forget to put in the time  to strengthen the support muscles of the back of the hip and the hamstring muscles and tendons. If we are going to prevent this injury from happening in the future, it’s imperative to also strengthen the tendons. A tendon is strengthened by loading the muscle and, thereby, the tendon.

I’m a big fan of Jules Mitchell’s progressive loading technique for healing PHT. Take your time with each of the phases of this loading technique. Give yourself a week or two with each exercise before moving on to the next. Remember the exercises can be done with your feet on an exercise ball, a chair, your coffee table or couch. You can also do all of the exercises in the Bridge Pose position and slowly move your feet farther away from the buttocks as your strength increases.

In addition to these tendon-toning exercises, you must immediately improve the way you use the muscles of your hip and the alignment of your body in one-legged postures.

Most of us under-utilize the deep six rotator muscles that stabilize in the hip and forget to fire the hamstrings to keep the body’s weight forward rather than hanging from the back of the hamstring tendons. I’ll go into the 26 postures from the Bikram series in detail below, but remember that the bones of the leg do their job best when they are lined vertically hip over the knee and ankle joints. The bones of the leg bear weight longitudinally much more effectively than horizontally or at an angle.

When the body’s weight is in the heel in a hip-flexing posture like Warrior 3/Balancing Stick, most of the body’s weight hangs from the tendon of the hamstrings muscles. When the leg is aligned vertically, the majority of the body’s weight is borne on the bones of the leg and the muscles and tendons of the leg simply stabilize your balancing body.

Can I heal my injury and still go to yoga?

Absolutely! Yoga benefits healing by increasing circulation throughout the body and giving you the opportunity to build muscular strength. If you’ve been overworking the hamstrings, I’m confident there are at least another dozen other muscles you can wake up and get them to do their fair share of the work around your body.

Increasing circulation speeds healing. We get the waste products out and the building blocks in. By increasing circulation you help your own body do what it does best: keep you healthy, active, and pain-free.

Your first rule of thumb in healing a sprain, strain, or tendinopathy: Don’t poke the bear. If you can feel it, you went too far.

I grew up in rural Vermont. We give directions like, “Turn left a half mile before the big, red barn.” That really is how you get to the Cabot Creamery, but sometimes you have to go too far a few times to figure out how to get there. The goal of the mindful yogi is to stop before you feel sensation: pain, pulling, stretching to the injured tendon. In the beginning, you’ll go too far a few times, but hopefully you’re a fast learner.

You have to stop the cycle of injury to the area. In biomechanics, this means no end-range hip flexion. Hip flexion refers to flexing or closing the joint of the pelvis/hip and the femur bones. In yoga class, this means no full forward folds for about a half year.

Healing and the 26/2

Please find below specific instructions to modify and/or moderate each of the Classic 26 postures.

Pranayama/Deep Breathing:

In Pranayama, you have an opportunity to practice strengthening the muscles at the back of the hip to prevent injury in the future. Stand with your feet together in front of a mirror. Side-by-side and touching or with a small gap in between for those with hip injury/pain. Look at your legs in the mirror. For most flexible people you’ll notice that the femur bones internally rotate and the kneecaps have a very slight inward cast as if you were going slightly cross-eyed.

Note: The more internally-rotated the thighs, the wider the gap will be between the knees. There are some students with a true “bow-legged” stance who will have a large gap regardless. This student is the exception, not the rule. Many students think they are naturally bow-legged when they just have weak hip muscles.

Internal rotation of the femurs is a prerequisite for a hyper-extended knee. If you can stop the femurs from turning inward, you will prevent the knee joint from moving beyond 180 degrees,effectively stopping hyper-extension.

The muscles that do this work are some of the deep six rotator muscles: the piriformis, the obturators, the gamellus, and quadratus femoris. They are also part of the base of the pelvic floor. These unsung heroes are some of the most important muscles that connect the legs and trunk. Take a look at them here. They’re very cool! Looking and seeing where the muscles insert and originate will help you understand what they do and how to find them.

Looking at yourself in the mirror, very slightly externally rotate your thighs. For some it helps to imagine you were turning the backs of your knees towards each other. What you want to see in the front mirror is a small movement of the kneecaps outward until they point straight ahead. It is a subtle, but visible movement. If you see gross movement, you’re trying to do it with your glutes.

Place your hands on your buttocks muscles. Relax them. Then place your first two fingers in the “gluteal fold” between your buttocks and the back of your thighs. Now contract there by trying to turn the backs of your knees closer together.

Those are the muscles we seek. Feel the way those muscles deeply contract underneath your fingers. Still having trouble? Ask your yoga teacher or a pelvic floor physical therapy specialist to help you find those muscles. Finding and strengthening and increasing the flexibility of those muscles will not only help with your ass pain, it’s also going to help you stop peeing your pants when you jump on the trampoline.

Pranayama deep breathing is your chance to practice contraction of those muscles so you’re ready later when we try to balance on one leg.

Pro tip: During Pranayama, contraction should be softened on the inhale and deepened on the exhale in rhythm with the natural movement of your pelvic floor.

  • Exhale breathing: pelvic floor, deep hip muscles, and abdominal wall contract.
  • Inhale breathing: pelvic floor relaxes and abdominal wall inflates.

Half-Moon pose:

In Half Moon, we continue to work on engaging the deep rotators. In this pose, you’ll create the contraction and hold it the entire side. Relax. Engage. Start left side. Repeat for the back bend.

Pro tip: Can you feel your hamstrings muscles engage, too? The hamstring and calf muscles are important counteraction of the strong quadriceps muscles at the front of your thigh. The traditional “lock the knee” cue means a Battle Royale between the muscles that extend and flex the knee. If both sides are equally contracted, you have a very stable standing leg.

Hands to Feet:

Pump your brakes, big time. This posture centers around complete end-range hip flexion. We are trying to fold the pelvis down completely to the thighs. Remember your rules? No end-range hip flexion for 3-6 months.

Mind the warm-up in this posture. Simply move the hips side to side. Some teachers have added a cue to their class to “Bend into the right knee. Bend into the left,” or “Walk in place.” Bending the knees applies a tremendous amount of compression to the hamstrings tendons and should be avoided in any case where the yogi has a history or suspicion of PHT. Do you remember the stat from the beginning? That’s 80% of the people in class. In other words, that cue is inappropriate for the general public.

There are two approaches to this posture with a PHT. Some teachers will tell you that you MUST bend the knees. There is no science-based evidence to prove this assertion is true. Depending on the location and severity of the injury, one may work better than the other for you.

  1. Straight legs: Keeping the legs and spine straight, slowly walk your hands down your thighs or to the floor until your body makes a 90-degree angle. Press your hands against your thighs to create traction along the spine. Stop at any point you begin to feel pulling on your granulating injury.
  2. Bent knees: Bend your knees and lower your upper body toward your thighs. If you are asymptomatic here, you may reach around and grab your heels. Proceed to depth with caution. Do not straighten the legs completely until the maturation process is complete and your injury does not bother you at any time.

The one absolute no-no is to come down into a forward fold with straight legs and then bend your knees. Imagine the hamstrings muscle like a rubber band that is attached above the hip joint and below the knee joint. When you flex the hip, it pulls the rubber band tightly over the hip and knee joints. If the tendon is already compressed against the ischial tuberosity and you bend your knees (picture yourself plucking the rubber band), you will increase the load and compression to the tendon and aggravate the injury.

Either bend your legs before you flex the hip or keep the knee straight and only flex the hip to tolerance. This same principle will apply in Standing Separate-leg Stretching, Standing Separate-leg Head-to-knee, and Paschimotthanasana.

Awkward pose:

Awkward presents another opportunity for you to practice the action of contracting the deep muscles at the back of the hip. I like to picture those muscles like a great big hand holding me from the outside of the hip on the thiPosterior Pelvisgh bone (the greater trochanter of the femur) to the bottom of the pelvis where you sit (your ischial tuberosities, pictured right). Imagine that hand, those muscles, pulling the femur and pelvis together, and closing or stabilizing the back of the joint.

When you sit down in Part One, instead of flaring your pelvic floor backward, try to pull the back of your hips together. It almost feels like you could pull your pelvic bones together. Again, it’s a small movement. If your knees fly out, you’re using your butt. If your tail tucks under, you’re using your psoas. Try to create a sensation like are lifting above the hip flexion, rather than sinking back into it. The movement of the deep hip rotators are subtle, but strong. Repeat this action in Part Two.

In Part Three, most yogis naturally engage the deep six on the way down. It’s how you keep your spine straight. If you’ve been pitching forward to come up, it’s because you’re under-utilizing these hip muscles on the way out. Before you come up, imagine you could pull your two ischial tuberosities (sitting bones) together as you lift your pelvic floor. You’ll have so much strength and control on the exit that it feels like you’re riding out on a geyser.

Eagle pose:

Don’t be surprised if you can’t hook your toes or sit very low in this one with a PHT. Depending on the location of the injury, the internal rotation required by the femur to hook the toes beneath the standing-leg’s calf muscle can twist and pull on the back of the leg enough that it can irritate the hamstrings attachment. Cross the legs and make sure you’re asymptomatic during the posture. Don’t poke the bear.

If it feels okay, go for it!

Standing Head-to-Knee pose:

Just like your teachers told you back in your first class, your standing leg is the most important part of this posture. For at least a couple of weeks, practice next to a side mirror and watch your body’s alignment. It requires the same engagement we did with double legs in Pranayama and Half Moon of that hand-like set of muscles of the back of your hip. Before you even shift the weight, engage the posterior hip muscles and stabilize your leg.

Look at yourself in the mirror from the side. When you stand on one leg, does your hip joint hang behind your ankle joint? Close the gap between the greater trochanter of the femur and the back of the pelvis/sacrum to keep your weight forward. See below. The picture on the left shows support from the muscles at the back of the leg and hip. The photo right shows a relaxed posterior hip and weight in the heel.

 

When you round down to grab the foot, and again when you start to kick forward, your weight will attempt to shift back into the heel. Be vigilant with these hip muscles and focus on keeping the weight forward so you don’t strain your healing hamstrings attachment.

When you are holding the leg with the tendinopathy in your hand, it’s OK for you to kick the leg forward as the hip will only be at 90° of flexion. Since this injury happens frequently with flexible students, you may be very easily able to straighten the kicking leg and still be asymptomatic. If it does hurt to straighten the leg, keep it bent for the duration of the healing process.

For flexible students: as you begin to round the spine over the thigh and bring your elbows down, keep the movement in your spine. Don’t proceed to end-range hip flexion by laying your torso on your thigh as this will increase the stretching and compression of the hamstring tendon and aggravate the injury. If you can get your elbows below your calves without feeling pain or pulling, you are more than welcome to drop your head on your knee.

Proceed carefully. It doesn’t matter if you can’t do this posture for a year. It’s better than living in pain and not being able to sleep at night.

Pro tip: When standing on the injured leg, try to feel the hamstrings muscles contract. In this way, you’ll be contributing to strengthening the muscle and its attachment so the injury doesn’t happen again in the future.

Standing Bow pose:

Utilize all of the work with the deep hip rotators that you’ve been working on since beginning breathing. As you begin to come down in Standing Bow, you are increasing hip flexion and compression of the tendon. You may need to execute this pose in a partially upright position. Mind your end-range hip flexion and proceed to tolerance.

Be vigilant in Standing Bow about the quality of your standing leg and prevent the weight from sinking backward and the knee from hyper-extending. As soon as you sink back, you are loading a damaged support structure and will only drag out the healing process.

Can you go down when you’re standing on the side that’s not injured? Sure!

Balancing Stick pose:

Come down only as far as you are asymptomatic. It is likely that your body will only come down to something like a 45° angle from vertical, maybe even less. The work you get to do here is contracting the hamstrings muscles so that even as you begin to introduce stretching back into your hammies, you’re doing it from a place of support and strength rather than hanging into the back of the hip. When you are lifting the injured leg, concentrate on deep contraction of those muscles, building strength as you heal.

Standing Separate-leg Stretching pose:

We approach Separate-leg Stretching just like Hands to Feet.

  1. Keep a flat back and bend your knees until you can touch the floor. Be mindful of your injury and slowly press your knees back to tolerance.
  2. Keep your legs straight and walk your hands down your thighs as far as your body goes without pain.

Pro tip: Many students find it helps to have something to put their hands on like the top of their water bottle or even a yoga block. That way they can practice weight forward, contraction of the back, legs and hips, without being tempted to sink down deeper into end-range hip flexion.

Triangle:

The primary concern for the injured hamstring is when it is the bent leg. Students should not be encouraged to sit down if it feels like pulling or stretching to the hamstrings attachment. It’s okay to stay up high and move the arms. For some students it’s impossible to move the arms and torso without feeling the pain. Start from the first cue the teacher gives and proceed only as far as you can asymptomatically.

Standing Separate-Leg Head-to-Knee:

This posture should be approached like Standing Separate-leg Stretching and Hands-to-Feet. Depending on the spot of the injury and the sensation the yogi feels, choose optoin one or two.

  1. Keep both legs straight and round the spine down like a candy cane as far as you can go without injury or pain and hold it there.
  2. Bend your front knee and place your hands on the floor. From there, keep the leg bent and curl the spine up towards the ceiling.

In my own recovery, I found both sets gave me different sensations in my spine and hips so I would practice one in the first set and the other version in the second set.

Tree pose:

In most cases, people are asymptomatic in Tree pose. If it pulls to lower and rotate the thigh, don’t do it.

Toe Stand:

In some cases, clients are asymptomatic in Toe Stand. Great!

If the forward fold creates a pulling sensation at the point of injury, simply repeat Tree pose.

Wind-removing pose:

Wind-removing pose is comfortable for most students because the knee is bent and torque on the muscle and tendon is reduced.

In a few extreme cases the student may feel pain simply flexing the single leg up. There’s nothing you can do about this but wait. In that case is I’ve had students simply bend the hip to a 90° angle and hold there.

Cobra series:

All the Cobra series postures require contraction of the hamstrings and hip muscles. These contractions stimulate circulation to the muscle area and build strength in tissue structures. Give it all you’ve got!

Fixed firm:

Fixed Firm is generally unaffected by PHT.

Half Tortoise:

Most students are comfortable in this pose.

Rarely, you may have a student with a very serious injury who needed to do a version like what you’ve seen in some Vinyasa classes called Puppy Dog pose. In this position, the shins are on the floor hips directly above the knees at a 90° angle and then you walk the hands out in front and drop the chest towards the floor. This allows the student to maintain some of the spinal traction and shoulder-stretching benefits of the posture, without aggravating their injury.

Camel:

Camel is another opportunity to strengthen the hamstrings, hips, and buttocks muscles with the same principles as the Cobra series.

Rabbit:

Most students are asymptomatic in this posture. Proceed in depth to tolerance.

Head-to-Knee pose:

This is a sticky posture for most students with PHT. Some feel pain when the injury is on the straight leg, for others when it’s bent. In the beginning, most students should simply sit upright and set the legs. Then, lift the arms overhead creating spinal traction and  begin to rotate towards the side. Most students will not be able to grab the foot early on. Arms can reach up over head for spinal traction or be placed on the floor on either side of the straight thigh.

Many students will feel pain if they bend the knee and grab the foot or if they round down. It’s more important that the student is asymptomatic in this posture than that they get the spinal flexion. Help the student to explore different parts of the ranges of motion  in this pose to see what they can do without feeling the pain or aggravating the hamstring attachment. This pose needs to be modified on a case-by-case basis.

Stretching pose:

One of the most challenging aspects of this posture is the set-up cue to “walk the hips back right and left.” For some students this pinches the hamstrings tendon between the pelvis and the floor and can be extremely painful. This cue should be skipped in students who are symptomatic.

Choose the start bent or start straight approach for Paschimotthanasana. The major principle here is no end range hip flexion and no pulling or pain at the point of PHT.

  1. Bend the knees and hold the feet with the spine straight
  2. Keep the legs straight, flex the feet, and sit up straight.

Spine Twist:

Most students are asymptomatic here, but you may get a few who have pain when folding in the bottom leg. Treat these students like you would a knee injury. Keep the bottom leg straight, foot flexed, and across the top leg over the knee.

Khapalbhati:

The client should be asymptomatic.

As you can see, at least half of the postures in the series are unaffected by the hamstring injury and all of them can be modified to accommodate the student’s needs for however long it takes them to heal this injury.

It may also be worth it to look into how your diet can support your healing. One of the strongest indicators of healing is albumin levels in the blood. This is a protein that is critical in healing process. Low-protein diet should not be attempted while healing an injury. There is also some evidence out there that certain nutritional supplements can support muscle and ligament healing. Consult with your doctor, functional nutritionist or naturopath to get suggestions for those products.

In addition, if you are experiencing tendinitis or inflammation and pain, it may be helpful to add foods to your diet that help to decrease inflammation. The powerhouse most folks know about is turmeric with black pepper. It’s in lots of really delicious foods, so why not add it to your fried rice or your coconut curry soup? Google is a great place to find more foods to add to this list like green tea, salmon, and blueberries. Healing an injury is it just the process of getting your postures right, but getting your mind right, reducing stress in your life, and getting plenty of rest. Pain from an injury like this is a cry for help. What other places in your life do you need support?

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Sara Curry is a therapeutic Hatha Yoga teacher from Portsmouth, New Hampshire with over 15 years experience in the field. Right, she assists a student in activating her posterior hip muscles to prevent hyper extension. Look at that nice, straight leg!