WAWADIA Update #4 /// Emerging Psychosocial Themes in Asana-Related Injuries

Ten days ago, Diane Bruni and I hosted a public event called “What Are We Actually Doing in Asana: an exploration of yoga-related injuries.” There were about seventy people in attendance at Diane’s studio here in Toronto. When Diane asked who had been injured through asana practice, virtually everyone raised their hands. Of course, we get injured doing all sorts of things in daily life. But in the majority of its discourse, yoga holds forth a therapeutic promise that its culture might not be fulfilling. What’s more is that most of those in attendance were teachers, who one might assume to be better versed in avoiding injury than most.

We were joined by Dr. Raza Awan, medical director for Synergy Sports Medicine and Rehabilitation. He gave an overview of the epidemiological research he has begun with the yoga injuries that his clinic has been treating over the last several years. Diane shared a personal account of her 20 years of dedicated practice, and how injury has led to innovation. I nervously presented some preliminary themes from my own research, based so far on over sixty interviews. Kathryn Bruni-Young spoke on her transition from vinyasa-only practice to the more eclectic (and, she claims, healthful) mix of strength and movement disciplines she engages with and teaches today.

The main part of the three-and-a-half hour meeting featured an open and wide-ranging discussion. Participants shared concerns, some injury stories, and general feelings about the state of asana education.

We’ll be publishing several clips from the evening over the next few days. Here’s my bit.

Because it’s over 30 minutes long, and we’re all very busy, I’ve summarized my central points here, along with a few clarifications (which I’ll present in parentheses).

— I’ve practiced all kinds of things in my life, and asana has been the most powerful tool for putting me in touch with the intimate presence of my existence. So, contrary to some of the criticism I’ve received in starting this project, I have no intention of discrediting asana as a wellness practice, or discouraging people from practicing. I also have no interest in harming the reputations of any teachers or lineages: thus the anonymity policy of my interviewing process. I’ve also been criticized for “wanting to destroy people’s faith” in yoga. Well — this is absolutely true. In my view, there is far more faith in yoga practice than inquiry into it, and we generally need less marketing and more study. (After listening again to Dr. Awan’s presentation, I’m struck by the fact that avoiding frank discussion of injury is toxic for a practice that might take the Hippocratic Oath as its first principle: First Do No Harm.)

— There are many themes emerging from my interviews so far. Here’s a grab-bag of categories that describe the psychological, pedagogical, and sociological contexts in which yoga injuries occur. Some of this material might be triggering.

(At this point, I make no claims as to how representative these themes are of the experience of asana in the general population. What I can say is that no one I have interviewed or discussed this project with has expressed the opinion that these themes are anomalous. As you might see, each one of these themes opens up a huge can of related issues that I’ll attempt to explore in the eventual book.)

— Prior conditioning that encourages the sublimation of pain. Practitioners can be confused not only about whether they should be in pain while practicing, but about whether they are in pain at all. (This theme exposes the difficulty of the subjectivity of pain, and highlights the insufficiency of instructions such as “Go to the point of discomfort, but no farther”, or, “If you are in pain, you’re not doing yoga.” The hard truth is that we have very little access to each other’s pain states.)

— Group sacrifice. Some practitioners report injuries arising from feeling pressured by in-group expectations, including being told things like “Hold this pose for everybody.”

— Valuing and performing hypermobility. Practitioners with wider-than-normal range of joint motion are socially (and even professionally) rewarded, whether or not their capacities are representative of the population or healthful for themselves to exploit. (This is part of what I’d call the “openness bias” of MPY, which emphasizes mobility over strength and receptivity over resistance. This bias is potentially harmful for everybody. People with wide mobility are not benefited by expressing it, and people with more limited mobility can injured themselves by trying to mimic it. The openness bias also has psychological and perhaps even socio-political implications that I’ll continue to explore.)

(– In a conversation that followed the event, Jess Glenny kindly alerted me to the problems involved with using the term “hypermobility”, which used too loosely as an adjective can obscure diagnosable conditions and marginalize those who suffer from them. She explores some of the nuances of this issue here. Greater care in terminology is needed.)

— Spiritualization of pain, or, the “pranic model of injury”. This involves rationalizing discomfort, pain, and even injury as an inevitable part of spiritual growth. (This may or may not be true according to one’s commitments, but assuming that it is true can dissuade people from learning how to be more safe-smart in practice.) The pranic model of injury suggests that tissue damage might be a sign of a “reorganization” that will allow prana to flow more freely. Paradoxically, injury can then be seen as a sign of healing. The pranic model of injury does not map onto any biomedical understanding of injury.

— Prior conditioning that encourages compliance. Some practitioners report that they were acclimatized to accepting harsh adjustments from teachers because they had been trained toward self-sacrificing compliance in prior disciplines, such as sports.

— Physical abuse/corporal punishment softening students up for harsh adjustments in postures. Reports of teachers slapping students for failing an alignment task or not paying sufficient attention. This can create an atmosphere of inappropriate compliance to teachers who are overly assertive.

— Prior trauma involving violence that disrupts interpersonal clarity. In which a practitioner’s personal history predisposes them to reframe harsh adjustment in an unhealthy way. (Another part of this theme involves practitioners who are injured by words, requests, or displays that the teacher does not realize could be triggering.)

(– I’m not claiming that all of these themes and their occurrences can somehow be eradicated. My goal is to raise awareness so that that yoga pedagogy can improve.)

I rounded out the presentation with four more-detailed reports, involving:

— The dedicated practitioner who severely injured her shoulder doing intensive arm balances. She continued to practice, believing along with her community that practice would improve the condition. When she could afford an MRI, her physician examined it and advised that she stop.

— The former elite athlete who accepted a harsh adjustment because prior training had prepared her for this. The adjustment injured her severely, but her instinct was to blame herself.

— The philosophy and religious studies student who took up asana in a quest for mystical experience. He reported that “I continually had the idea that the flesh was illusory, but that there was this amazing healing ability connected to hatha yoga that whatever pain that would arise would be cured through mystical states.” He practiced through substantial lower back pain, which lingers into the present.

— The practitioner who was told that her pain in asana was “karmic” in nature. The explanation went so far as to claim a causal link between pain in a particular area of her body and the notion that she must have injured someone else in that particular place. This might seem far-fetched, but it is actually only one possible conclusion of any impulse we might have to attribute psychic meaning to tissue damage. (This is not a problem in itself, but becoming aware of how and perhaps why we do it might be helpful.)

I concluded the presentation by referring to how many of the subjects I’d interviewed so far had been able to utilize their injury experience to innovate more functional and therapeutic approaches to practice. The happiest part of this research is in seeing how asana pedagogy is experiencing a surge in creativity in response to the last century of methods that may have fallen short of the promises of yoga.

However, harnessing that creativity into a set of better and more actionable standards than those currently in place will be an enormous challenge.