Tuesday, November 13, 2012

Injuries, research, physical therapy, and teaching (and a little rambling)

I have a lot to cover on this post and I apologize for my blog absence. I am struggling with a low back injury (and consequential pain all the way up my spine) and how to modify my physical yoga practice and teaching to keep me healthy and continue to do what I love... teach.

I have been under the care of two physical therapists that were treating different problems but with similar therapies. One expressed that I had some SI joint issues, and had me doing some nifty exercises to strengthen the core and stabilize the SI joint (hips). She also advised to forgo vinyasa-style yoga as the SI joint problems are MOBILITY issues... the dysfunction was happening when I moved (from neutral or extension to flexion). Hence, not doing fast forward folds was the way to go.  

One exercise worked the outer hip flexor (abductor) of the dysfunctional side well, and another worked, alternately, the adductors (inner thighs) and then abductors (outer). The interesting part her is that when I first did the inner thigh work, I felt a small but releasing pop in my pubic area, which was the pubic symphasis (the joint at the front of the pelvis where the two halves meet, created your public "bone") realigning.  

A few others were meant to help strengthen the core but required twisting on my back with legs bent. At first this was a good exercise, and made me feel capable. But now, six weeks later, any twisting is out of the question. The problem has increased rather than decreased, perhaps in part to my resistance to 'slow down' and in part my carelessness in doing exercerbating tasks like putting Eli into his car seat, bending forward to reach into the fridge or laundry, or even turning the wrong way in the shower to wash (no joke).  

I went to the HMO-based PT and was working on the strict diagnosis from the radiologist of spondylolysis (a defect or break in the pars or one of the bony processes along the side of a vertabrae) and grade 1 spondylisthesis (shifting of position of the affected vertabrae). These symptoms can exist in someone and they might NEVER know it. Pain is one indicator of a problem, that could mean some nerve (and there are many radiating here) is being irritated. Another indicator would be weakness in the lower limbs, bowel/UT issues, backache, numbness, etc. Ever since I moved to CA I have had discomfort in my low back that I thought was just a chronic issue that was alleviated with regular yoga and chiropractic visits.  

But now I'm coming to think that THAT was the first indication that something was amiss with my L5-S1 joint (the connection between the lowest lumbar vertabrae and upper sacral one). And then more recently, when extending my spine deeply in up-dog (urdvha muka savanasana) or even warrior 1 (virabhadrasana 1) I would get this sudden and disconcerting weakness in my legs.  

In any event, this summer I went to an SI joint workshop, and while trying to get deep into a twist, something popped. Maybe it was the last straw, or maybe it just took me to a place so deep (with incorrect pelvic positioning) that I FINALLY felt the defect in all it's irritating glory.  

Note: If you have SI or low back issues, when twisting, it is recommended to LET THE HIPS MOVE WITH THE SPINE..in other words, DO NOT fix the hips and try to twist the spine away from them. That lumbar/sacral area only allows 5 degrees of axial rotation, so forcing it can punish the SI joint, making it flex rather than stabilize, and/or overtax the thoracic and other lumbar vertabral joints, creating more problems.  

So I have been doing some reading about the spine, and trying so hard to NOT further compromise my life line during my practice and teaching. It's so important for me to be a good example of yoga, which would include demonstrating poses accurately...and yet I cease to follow my own advice when I take chances with my own health and stability by overdoing it. I need to continue to develop my teaching skills to create a learning environment where I can TALK to what needs to be done, use my hands to help students align properly, and create SPACE for the motion of breath which EXCLUDES putting yourself into postures that cause PAIN. I have to think of myself not so much as a teacher than as a facilitator...one who is ALSO a student that needs to be mindful. Today I am going to see a rheumatologist who I hope will offer me advice on what is really wrong, what I can do to help heal, and maybe an MRI too so I can SEE what is going on.  

I hope that I do not disappoint my students by being restricted in my own movements. I want to offer then a good yogic experience even if I can't throw down with a Parsvottanasana that embodies strength and grace and looks like a page from Yoga Journal. So much of that is letting go of ego, I know, but also from wanting to feel capable, healthy and secure in my own body.  

I know this process is helping me to truly practice yoga off the mat..and that is what makes me a better facilitator because I can exemplify the yogic skills gained that have nothing to do with asana - things like removing dukha (bad space) and filling up with sukha (good space)...like regulating the flows of apana (downward/outward energy) and prana (upward/inward energy), and ultimately, calming the mind to free it.

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