Complaint from student with hypermobiliity

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claireylane
Posts: 13
Joined: Thu Sep 22, 2016 1:35 pm
Location: Sydney, Australia
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Complaint from student with hypermobiliity

Post by claireylane »

Hi Bernie.

This week I wrote a short newsletter to my small student group about myths in yoga - one of them was the myth about yoga causing injuries.

In it, I said that I have a number of dear friends who I know would benefit from yoga but that they refuse to come to my classes on the basis that they once got injured in yoga, therefore yoga causes injuries. I went on to explain that yoga itself doesn't cause injuries - that indeed the intention of yoga is to relieve stress, not add it in.

I acknowledged that people often do get injured in yoga classes, but suggested that yoga itself doesn't cause the injury - it's usually a case of a teacher not giving appropriate guidance or a student going too deep / not understanding their own limits etc etc.

My intention being to show that yoga in and of itself is not an inherently dangerous activity.

I received a reply from a regular student who I had not seen for a while. She says that she received an injury in my yin class six months ago due to being hypermobile. She said that when she "let her arms and shoulders go, when she was going to bring them back, she didn't engage the muscles properly and messed up both her shoulder joints/ligaments" and that it has taken time and treatments to get them back to normal.

I think she just wanted to make the point that injuries can happen in yoga (which I stated myself in my newsletter). She said that injuries can happen "if you are not under detailed instruction or know your body's strengths and weaknesses" (which I also explained).

She finishes by saying she will come back to class soon, just not yin class.

I am wondering how to reply to her.

This is the first I have heard of the injury.

I am mindful of going back and saying "Gosh, I'm sorry you got injured" in case that opens me up to any kind of liability (I am insured).

I am also mindful of the fact that even though she is disagreeing with me in principle, she also agrees with me on two of the main points.

But I would like to reply thoughtfully and with all the facts. I have read your post about hypermobility on this site and feel I have a good understanding of it.

I also think that surely it's not possible to move your arm without engaging muscle, so surely that cannot be a full explanation of her injury.

Anyway interested in your thoughts before I go back to her.

Thanks!
Bernie
Posts: 1198
Joined: Sat Sep 23, 2006 2:25 am
Location: Vancouver

Post by Bernie »

Hi Claire

Thanks for sharing this story. Like you, I am sorry that your student had such a bad experience, and I can understand why she doesn't want to return to another Yin Yoga class. I can't say that I blame her, but neither would I blame you for her experience.

You are right; injuries can and do happen in yoga classes, and of course in any form of physical exercises. Sometime the injury is a result of the “last straw,... tissues become weak with repeated stresses and not enough recovery time and then one small, final stress is enough to trigger the injury. We humans love to look for the proximal cause of events and confuse those with the actual causes. It is easy to believe that “Because we were just in a yoga pose, it must be the pose that caused the injury., This attitude ignores all the prior, predisposing events that set up the conditions for the injury. I would love to hear from your student about all the other things going on in her life before the injury: what other physical activities had she been doing, had she experienced any little “tweaks, or pains before, how is the level of stress in general in her life. Also, I would have liked to asked her what she was feeling while she was in the pose. Were there any warning signs that maybe she was holding for too long or had gone a little too deep in the pose?

But, regardless of all that, injuries may still happen. It is rare, but not unheard of. It is more common for hypermobile students, but not for all hypermobile students. There are 3 general causes of hypermobility, which I describe in more detail in this article Hypermobility and Yoga, (this is a revised version of the article which you may not have seen yet):

1. Enhanced ranges of motion due to an injury to a joint
2. Enhanced ranges of motion due to a connective disease or disorder
3. Enhanced ranges of motion due to skeleton variations.

Do you know the cause of your student's hypermobility? If it was one of the first 2 categories, Yin Yoga may not be a great practice for her. She would be better advised to work on strength than enhancing length. However, if she is hypermobile simply due to the shape of her bones, that is usually not an indication against Yin Yoga.

For hypermobile students in the first 2 categories, it is possible to gain benefits from a yin practice but they should 1) start with very short holds ~1 or 2 minutes and 2) only go halfway to their ultimate end range of motion. And, then, they should be taught how to attend; how to listen for signals from the body that may signify “enough for now!, And, coming out of the pose should be done carefully, with some prior muscular engagement to stiffen the joints before moving them. This is probably what she was referring to when she said, “she didn't engage the muscles properly and messed up both her shoulder joints/ligaments,. Yes, we do engage muscles to move the body and come out of postures, but there is a fragility that develops when we stress the tissues for a long time. Adding a bit more muscular engagement around a joint can help to stiffen it and protect it better. This is rarely a problem for normal people (even category 3 hypermobile students) but can be a challenge for category 1 and 2 students.

What to say to your student? That's a good question. Perhaps something along the lines of “I am sorry to hear that an injury prevented you from doing your yoga practice for so long, but I am happy to hear that you plan on coming back soon. I would be happy to talk to you about your experience and the possible causes of your injury. It could be a great learning opportunity., I can understand your fear of opening up some sort of liability for her injury, but it would be great to know the answers to the above questions and use it as a learning opportunity 1) for her to understand her body's signals better and 2) for you to learn how to cue students to better attend to their signals and guide them safely out of poses when these signals arise. Having said that, I don't believe that you are personally responsible for the injury, as you are not a therapist or doctor and your yoga class was not offered as therapy. Any physical activity has an inherent risk to it. It is unfortunate that this time, it triggered an injury for your student.

Let us know how it goes.
Good luck
Bernie
claireylane
Posts: 13
Joined: Thu Sep 22, 2016 1:35 pm
Location: Sydney, Australia
Contact:

Thanks Bernie!

Post by claireylane »

Thanks Bernie!

This is all good stuff... you set my mind at rest and helped me understand in more detail.

I replied to her in the way that you suggested and got this response today:

"I have never been diagnosed with anything- have never pursued a diagnosis either- just something I have learned through chiros and yoga teachers along the way.

In terms of yin yoga, if I can't go to the extreme stretches or need to hold it for shorter times - I just will not find it satisfying. I think the classes are not - let's say- challenging enough as it is."

So, this seems to be resolved and she seems happy.

Thanks again for your help. This whole website and forum is an invaluable response.
Bernie
Posts: 1198
Joined: Sat Sep 23, 2006 2:25 am
Location: Vancouver

Post by Bernie »

Alright! It is great that your student both knows her intentions and is aware enough to know what works for her or not. She is “flying her plane, so to speak, which means she is willing to take responsibility for her life. That is very good.

I would wonder, however, if her logic is sound: she says that she hurt herself in Yin Yoga, but that the practice is not challenging enough for her. That seems contradictory. If she was to try Yin Yoga again, I would advise her to try backing off from her end range to see if she could linger longer in the middle area. Time is more important than intensity. She doesn't have to get the most stretch, just enough to trigger the cells (through mechanotransduction). Consider an imperfect analogy to acupuncture: needles are left in for a long time, but they don't have to be placed really deeply into the skin. Just enough to trigger the effect and then they linger. Yin Yoga can be the same; just enough to feel something and then linger.

Many hypermobile students who love Yin Yoga come, not to gain more range of motion-they already have all they need, but to enjoy the stillness, the mindfulness or to stimulate energy. Yoga is not always about range of motion and rarely should it be about maximizing anything. Optimal is better than maximum. Hypermobile students can still benefit from the practice even if they are not at their ultimate edges.

But, for this student, I applaud her decision to do what she feels/knows to be best for her. Bravo!
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