2017. június 28., szerda

The most common yoga related injuries: how to prevent and treat them? Hamstring and Adductor Magnus overstretch in Ashtanga Yoga Primary Series part 1.

An injury, caused by any particular yoga asana is a result of a long time dysfunctional movement pattern combined with poorly (with this dysfunctional pattern) executed asana in a repetitive cycle. The more complex the asana is and the more dysfunctional patterns are included, the more chance to get injured. In this post, we will research Upavistha Konasana, from Ashtanga Yoga Primary Series, which - specially in this particular sequence, provided by Ashtanga Yoga - can cause Hamstring (knee flexor) and Adductor Magnus (thigh adductor) muscle overstretch injury.  

The Causes Of Having A Yoga Related Injury

Since I'm practicing and teaching yoga, every practicioners and teachers I've ever met (included myself), came to the yoga world, seeking for a kind of 'healing' process. Everyone a different kind. They mostly wanted to gain and recover it or (the long time practicioners) retain It. People also came from variety of sports for rehabilitation or – the minority, the clever ones – for prehabilitation. A lot of newcomer has stepped to the yoga mat to maintain or gain back their mental health and release their daily work related stress.

So, most of the practicioners I've met in the last 10 years, have begun their practice to heal, very often came with concreate injuries and movement dysfunctions to treat with a therapeutic yoga mindset. So why is it then, that they are leaving the classes with more injuries and movement dysfunctions than they came with? 

In this post, we will research only the techniqual characteristics of this question. We will search for the reason behind the phenomenon that why a great amount of yoga practicioners injure their Hamstring and Adductor muscles while practicing the Ashtanga Primary Series (which is called Yoga Chikitsa, aka. Yoga Therapy by the way).

In the 'western' part of the world, people begin their practice with their dysfunctional movement patterns and competative mindsets, usually with less patience than required. But on the other hand - unfortunatelly - there is a current mindset ('cult') amongst the practicioners, built around Ashtanga Yoga, which supports this mentality. When Ashtanga practicioners defines their 'yoga style', and separate themselves from other schools, they emphasize the dynamic and athletic elements to make it look more tough and competitive in the fitness industry. But in the meantime, the system is not optimized for the dysfunctional movement patterns of the westenern bodies. These factors combined, can cause serious injuries.

You simply can not facilitate myofascial and musculoskeletal changes in such a fast pace without a prize. You're trying to work your way trough decades of sitting and it is not so easy, because your complete body-awareness and 'movement-awareness' is based on not moving. So, if you are not doing functional movements for years (doing sports are also not functional and also causes repetative strain injuries), sitting most of your life, why do you think, your movement patterns in your yoga practice will be functional at all? 

'Sitting lifestyle' = Shortened Hamstring

In the case of Hamstring overstretch injuries, the main problem is our 'sitting lifestyle' since elementary school. Sitting for years in only 90° knee flexion and 90° hip flexion, with posterior pelvic tilt and lumbar spine flexion causes chronic shortness in the following muscle groups:

- Hamstring Muscles (Biceps Femoris, Semitendinosus and Semimebranosus), because of constant knee flexion.
- Iliopsoas (Psoas Major, Iliacus), because of the constant hip flexion.
- Rectus Abdominis, because of the constant lumbar spine flexion.

In Uphavista Konasana your target of stretching/lenghtening is the Hamstring muscle group by knee extension and hip flexion on the same time. But because of our sitting lifestyle, hip flexion is non-existent after 90° and a full Uphavista Konasana needs 180°. When you first see Ashtanga practitioners struggling with asanas, which require maximum hip flexion and knee extension in the same time, like Uphavista Konasana, you can see, that with straight knees, even 90° hip flexion is a huge challange for them. In the meantime, the Hamstring muscles are the most vulnerable at maximum flexion of the hip and extension of the knee, when they are in their maximal lenght

Persistent internal/medial rotation of the tighs

The other problem is the persistent internal rotation of the Femur (Tigh Bones) for a great amount of pepole (usually combined with illusory hyperlordosis of the lower back and anterior pelvic tilt), while standing, walking but also while sitting. The cause of internal rotation is the shortness in the following muscle groups:

- Tensor Fasciae Latae (TFL)
- Gluteus Medius
- Gluteus Minimus
- Hip Adductor muscle group (Adductor Longus, Adductor Brevis, Adductor Magnus, Pectineus, Gracilis). 

In Uphavista Konasana your target of stretching/lenghtening is not only the Hamstring, but the hip internal rotator muscles, (Tensor Fasciae Latae (TFL), the Gluteus Minimus and Medius) and the Hip Adductor muscle group (Adductor Longus, Adductor Brevis, Adductor Magnus, Pectineus, Gracilis) which working in hip internal rotation too. In Upavistha Konasana, the hip is not only in flexion to stretch the Hamstring muscle group (as mentinoed above), but also in abduction (moving the tighs apart), and external rotation. So the most important problem is that for a huge percent of the western population has their tigh bones locked into internal rotation. This is one of the most common dysfunctional pattern practicioners bring into the yoga studio from their daily life. The constant internal rotation cause tention, and this tention (with the activation of trigger points) keeps the internal rotator muscles shortened and these muscles will not get long enough for the exercise, but the impatient practicioners still want to reach the full Upavistha Konasana. So instead of patiently work on the weak-link and stretch the internal rotators with steady practice, they go deeper with the wrong form (internally rotated Femurs), therefore overstretch the Hamstring muscles.

Internal rotation + too much abduction = Adductor Magnus overstretch

The other muscle, which can be a 'victim' of overly used internal rotation is the Adductor Magnus. You can easily overstretch this already shortend muscle and injure its tendons around the inner knee, if you fail to realize and maintain the normal alignment of the knee joint and go deeper into the Upavistha Konasana with internally rotated knees. Rotating the thighs internally (wrongly) can also help to create a bigger distance between the tighs (more abduction), because you can fix your inner feet on the ground and on your non-slip yoga mat and open more space between the two tighs. It is dangerous, but not only for the Adductor Magnus muscle, but to the aterior cruciate ligament (ACL), because it can rupture very easily in this knee position, where the muscles around the knee are not sufficiently strong or not adequately stable.


So the basic problem is that we create these muscular imbalance and get used to it, so it feels natural. Therefore, we bring it with us into every movement we do, included yoga. If no one tells you, you will not even notice your internally rotated thighs in Upavistha Konasana. So, with internally rotating your tighs, you can go deeper into the asana and increase the hip flexion and abduction more than you supposed to between your safe limits. Your Semitendinosus, Semimebranosus and Biceps Femoris Hamstring muscles and/or the Adductor Muscle group get extremelly lenghtend with the combination of extended knee, overflexed and over abducted hip and get injured by overstretching them. In the best case, you will not tear the tendon and cause Hamstring or Adductor tendon rupture or creating even more serious knee joint injuries, but it is possible.

There is a certain body awareness needed to expreience the difference between going deeper into a yoga asana with normal, natural alignment of a joint or with a certain dysfunctional pattern. In this case it is quite easy to spot the difference. When you feel pain in the inner knee or you feel, that you could go deeper but only with increasing the tension and pain in the inner knee, back off in that instant, before the injury occurs!  

In our next post, we will talk about the proper alingment, joint stability, muscle activations and execution of the Upavistha Konasana and after I will give you a complete treatment protocoll, for this exact injury. 

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