There was some spillover from New Year into today as I could not get to sleep early last night and did not wake up in time for my yoga class. Bummer! So I punished myself by going to the gym and putting in 30 minutes on the stationary bike and 40 minutes on the treadmill, alternating between a brisk walk and jogging. I tried out my new Asics GT-2150 that I had my daughter give me for Christmas. I had been using Brooks Beasts, which are the running shoe with maximum support against pronation, for my running for the past two years, but I wanted to get something that did not get in the way of running. The new shoes are much lighter and fit my feet like gloves so I really enjoy using them. I will have to see how my feet and legs hold up under the renewed challenge of light running. I am not expecting to get back to what I was doing before my knee injury and surgery, but I want the option of jogging and running to supplement my yoga. It will also allow me to back off a bit and take my yoga with more ease and stamina.
On my trip to Miami in late November, a heel spur on my left foot became irritated and inflamed. In fact, I first notice the problem when I was doing savasana (in other words, lying flat on my back), and my legs rolled out and put pressure on my heels. I noticed a shot of pain on the heal and had to avoid putting weight on that spot. It did not bother me after class. But when I went to the airport for my flight to Miami, I wore my Brooks Beasts and those shoes irritated the heel spur even more. By the time I got into the hotel, I was limping from the constant pain. I started taking non-prescription anti-inflammatory drugs and putting ice on the heel and sole when I could. The other lucky break was that for the rest of the week I wore dress shoes that did not allow my heel to move around, and that allowed the inflammation to decline gradually. By the end of the week I no longer had to limp. When I got back to Washington, I decided to see a podiatrist since I could see the little knot on my heel and knew that it could be inflamed again. But the first available appointment was not until December 17 so by the time I got to see him, the worst symptoms had disappeared.
Since I knew that I wanted to get back to running, I asked the podiatrist multiple questions about my feet. First, the heel spur (a calcium deposit at the end of my plantar factia) is not something that will prevent me from running if I keep it from getting inflamed again. Second, I should not fear running because of my knee surgery. Third, my arches had not fallen as badly I thought. Getting fitted with a new pair of running shoes would get ahead of those three points, and he suggested JnR Sports in Rockville. I also learned that I was developing peripheral neuropathy in the sole of my feet. I had noticed some numbness as well as tingling sensations and pin pricks in my feet. This condition can be due to multiple causes -- I can immediately rule out some of the more obvious ones, such as diabetes and side effects from certain drugs. The doctor wanted to see how I respond to increased exercise so I'll be seeing him again this month.
At JnR Sports, I tried on Brook, Saucony and Asics shoes in multiple sizes and support levels, narrowing my choice down to the Asics GT2150. I got them in size 11, double E width, which is the first time that I've purchased a wider shoe. I got them in black because I am a bit tired of how most athletic shoes are decked out in swooshes, stripes and logos, in multiple colors and reflective surfaces. I also learned a couple of useful tricks to ensure that the shoes held my heels snugly, thus preventing any rubbing of my heel spur.
I got in two classes at Thrive Yoga this week: a vinyasa flow with Lisa Johnson and a hatha class with Marylou McNamara. Neither made me work up much of a sweat, but that was not why I was taking them. I was seeking to get back in the groove with my yoga practice after a two-week gap in classes: I did not want to overreach and aggravate one of my injuries or get a new one.
I have a heel spur that flares up when I am savasana. I think that some fatty tissue has moved out of the way in my heel or just worn down with age, and a little bony protrusion sticks out. When I let my legs relax, I put pressure on the bone spur. It does not make for a very restful restoration phase in my practice. It was really bad last week because I wore running shoes on the flight to Miami and it really irritated the heel. It took me two days of soaking it in ice, massaging and stretching it to walk without a limp. I can also feel how the heel injury affects the rest of my body and my way of walking.
I've also had some issues with my core, especially between my rib cage and hips. At my last class before my trip, I had something like back spasms, and afterwards a sore back. I don't know if this is due to not being able to activate the correct muscles or some other issue. It has not been an issue for the past week or so, but I am anxious about it resurfacing.
On a more positive note, I realize that restarting practice after a short layoff is a good time to work on form and alignment because my muscle are looser and willing to take new directions and angles.
In any case, both classes went well. I enjoyed just being in the now of the poses and flows. I trust both instructors and feel challenged by their lead.
Last night, the stars were aligned and I made it out of work before 6:00 pm, the Metro did not stall halfway home, and my wife picked me up on time. So I went to Thrive Yoga for a class of Hatha yoga -- you know, my remedial class. Well, towards the end of the class, I was seat on the floor with my legs spread wide and I noticed a strange feeling in my back, deep within the muscle tissue on my left side. I noticed that I did not have my usual reach. Then, the pain became more focused, and I realized that I was having spasms, seemingly at the height of my kidneys. I waited for it the pass, and then went through the rest of the final sequences ending in savasana. No problem, except for a little discomfort in my back.
This morning, the problem was more pronounced. If I carry my shoulder bag on the right shoulder, it hurts my back; I can sling it across my chest without any pain. If I bend over, however, the pain is most noticeable.
For the life of me, I can think of any pose or movement last night that set off alarms. Marylou, the instructor, takes a lot of care to work through a progression of postures to warm us up gradually. She has her own aches and pains, and wants us to avoid them if at all possible. The one thing is that we were working to loosen up the thoracic spin and rib cage, which I know is pretty tight in my case.
Add to all that a bruised left heel, stiff thigh muscles and soar sit bones, and I am feeling my age.
Los Angeles Times Yoga opened doors she had long ago closed - Writer and teacher Colette LaBouff Atkinson describes how she came to her yoga practice when her body seemed to be breaking down:
But in yoga, as anyone and everyone who's ever benefited from it will say, all kinds of things became possible. I was there only to breathe; nothing to revise or make again. The yoga instructor -- more than one, really -- would walk by me and say, "Soft face." Sometimes the teacher would put her fingers into my furrowed brow as she passed.
My left big toe has recovered enough that it is no longer putting a cramp on my practice. The swelling has gone down substantially and range of movement has also improved. I can now incorporate jump-backs and jump-forwards into my vinyasa flow. It's now been six weeks since I came down full bore on the toe while doing a one-legged jump-back. It will probably taken another six weeks to heal the joint, which is still red and irritated. This week, I noticed that by the end of the day I was not dying to take off my shoes and put my feet in the air. I could fit into my running shows. I did not worry about my wife kicking my toe from her side of the bed in the middle of the night. Funny how a minor injury like this can throw you off.
It's ugly, but it's the biggest obstacle to my practice right now. Twenty-five days after I jammed my left big toe while doing a jump back, my injury has improved only marginally. It's no longer black and blue (I should have gotten a photo of it the day after). It's still swollen, sore and stiff. Touch the toe in the right place, and it's like needle throbs in a major nerve. As can be seen in the photo, the swelling is located from the first joint up. The cartilage around that joint is probably bent out of shape, and I may even have a hairline fracture. Some of the redness (even rawness of the skin) comes from my big toe rubbing against the second toe, even though I wear my loosest fitting shoes during the day and remain barefooted or in socks as much as possible. Range of movement is limited only when I try to curl my toe.
I've decided to treat the injury each day, rather than pretend that it doesn't bother me: I'll apply ice in the evening, take ibuprofen to hold down the swelling, and raise the foot as much as feasible.
Although my knee injury, operation and recovery have been primary concerns for my yoga practice, a more modest injury has been holding back my practice for the past two weeks. I jammed my left toe on a one-legged jump-back (my torn meniscus, by the way, is on my right side). When it happened, I barely noticed it. It made a sound like cracking your knuckles. In the evening, it start to swell up. The next morning it was black, blue and purple, and throbbing like mad. I made it to work, but saw my doctor the next day to make sure that nothing serious had happened. He said that at most there was a hairline fracture and there was not much that could be done: I should take some ibuprofen and raise it off the ground when seated, whenever possible. By the end of the week, the bruising had gone away (so it was no longer a source of conversation at yoga class), but it will take weeks to get back to normal.
Even though the injury is getting better, it is a major speed bump for my practice (not necessarily a bad thing). I now refrain from doing jump-backs and jump-forwards in vinyasas. When the toe jam happened, I was really feeling a rush in my practice, which may have caused me to be over-aggressive. I had gone to class four days in a row, and was starting to feel some momentum. Where the toe injury really hits me is with balance: the big toe plays a big role in keep the foot (and the rest of the body) level. It's probably better to rely more on the sole of the foot (the old "four corners" mantra) as the touch points of balance, but a jammed toe affects the foot all the way back into the ball of the foot and then up the leg.I have made headway in getting back into the swing of my yoga practice. My acupuncturist says that I am ahead of the curve. He's seen several people, 40 years or older, who had have had knee surgery, and in my case, my knee has full range of movement, and I no longer have serious swelling or other side effects. With one month of yoga practice under my belt, I can see I am recovering. I know of two people at my office who've had knee surgery in the last six months, and one has already blown out his knee again because he went back to running too soon.
Knee support and rolled hand towels that are placed behind the knees when in child's pose. At Thrive Yoga this past weekend, I took a vinyasa 2/3 class with Susan Bowen and managed to get through it. The following day, I took a hatha yoga class with Marylou McNamara. It's a nice combination: the advance class tests my limits physically while the hatha class keeps me grounded in the basics of alignment and breathing, and allows me to recover from the hard work with Susan.
I keep some props with me on the mat: a knee support and two rolled-up terry cloth hand towels that I put behind both knees to create some "space" in my joint whenever i am in a stressful pose, like child's pose. The knee support is more to remind me tactilely that I should keep my awareness on my knee, rather than to brace my knee. When I fold my knee, there's always a double-ply of Neoprene between my thigh and calf, offering a minimum of protection. The support also keeps my rolled-up hand towel from slipping out due to lubricating sweat. It keeps my knee warm, too.
I was able to fit in two hot yoga classes with Susan Bowen at Thrive Yoga before Christmas. I've been holding off on taking one of Susan's classes because I wanted to regain strength, flexibility and confidence before taking her classes again. She can lead you to the edge in her more demanding sets, and I did not want to fall off. I now know most of the poses that I have to be careful with, and modify them to protect my knees. All my teachers know that I have knee issues, and they usually alert us when a knee-sensitive pose is coming up and offering alternatives. Since the first class was in the evening and the second the following morning, I was sore afterwords.
I went to class with my wife, Teresa, which was nice that we could share time on the mat together. She's been using my unlimited pass with Thrive Yoga for the equivalent time that I was out of circulation. Next year, we'll have to see how we can keep her practicing at the same pace.
Two evenings in a row I've hit the mat at Thrive Yoga, once with Teresa Beerman and then with Elizabeth Pope, both of whom pushed me pretty close to my rather pronounced limits. I had to keep reminding myself to hold back, move slowly through the vinyasas, and take child's pose when appropriate.
My injured knee has not been a handicap and I have not had to back off of any pose. I don't, however, do any of the poses that put a lot of torque on my knees, usually the hip openers. By the way, even though my right knee was injured, I treat both knees the same. No one has advised me to do that. It just seems the right thing to do to maintain balance in my body.
Inversions have been one group of poses that have caused some problems. My four-month lay-off has led to an accumulation of weight around my waste and weakened my core. The end result is that my breathing is hampered in inversions, and it forces me to come out of the poses early. Just before my injury, I was pleased that I had fuller breathing in inversions because I had eliminate my midriff fat. This is where I really miss my running because it helped keep the weight off without major modifications to my diet.
I took in two classes at Thrive Yoga this weekend, Vinyasa Flow I with Lisa Johnson and Hatha Yoga with Marylou McNamara. Both instructors pay close attention to the details of alignment. Marylou led us through a series of poses that really helped my psoas. I've been looking for poses and routines that will help me open my hips, but won't put pressure on my knees. A lot of poses, like One-Legged King Pigeon Pose (Eka Pada Rajakapotasana), jeopardize the stability of the knees. I want to start using the safe poses in my home practice.
I fit some core strength routines into my Sunday afternoon because level one classes rarely put a strong emphasis on building up physical strength and stamina.
I went to my fourth class on Tuesday evening at Thrive, with Pierre again. I kept trying to throttle back on my practice, to keep from overreaching and getting ahead of my recovery. For the first time, I did some jump-backs and jump-forwards in my vinyasa, but only after warmly up thoroughly. I did notice a touch of stiffness and discomfort in my injured knee. I have to be careful when getting into kneeling positions, like hero's pose (Virasana) and even child's pose (Balasana) because my body weight rests heavily on my knees.
Pierre will not be back at Thrive for a while. His nomadic journey will bring him back to the DC area in February. He's helped me feel more at ease with my injury and inviting me accept the healing process as a renewed exploration of my body: "With the breath, everything you do can be yoga."
I did not take another weekend class just to resist the temptation to overwork my body during this recuperative period. I still need time between class to let my muscles and ligaments heal.
I had a vinyasa flow 1 session at Thrive Yoga early this morning, this time with Lisa Johnson. I almost talked myself out of going because I finished the week exhausted and was sore in my shoulders and upper arms. But my wife wanted to go to yoga and threatened to go alone so I could not let her show more discipline than me so I threw on my clothes, threw together my kit, brewed a quick pot of coffee and jumped in the car.
The class was less physically demanding than my previous two sessions; at least it felt that way and did not have to take any breaks. I know that I have to keep the mindset of a beginner, to approach my practice without any preconceived ideas about what I should be doing. In a way, it's an opportunity to relearn my yoga poses and vinyasas, and perhaps even overcoming some of the tightness in key areas of my body (shoulders, spin, hips).
I found that my right (injured and surgically repaired) knee seemed to track better than my left one. When doing a balancing pose, I felt more stable, with less propensity to shift out of equilibrium. The tendency may be due to overcompensation for the past three months in which I've nursed my right knee while relied on my left knee for support.
I also noticed that my shoulders seemed to have loosened up since my injury. When I'm laying in savasana at the end of class, my palms turn upwards more naturally. In the past, my arms tended to turn palms down when lying on my back. This pattern was probably created by years of pounding a keyboard, with my shoulders rotated forward. I actually worked on loosening up my shoulders during the break by combining a few simple stretches with my pranayama routine.
I went to Thrive again this evening, after giving myself 48 hours to recover from my first yoga session in four months. Tonight's class was with Elizabeth Pope, a new teacher for me, who joined the studio after I hurt my knee. She's been exposed to a range of teachers, from Kasthaub Desikachar to Ana Forrest. It was a good solid class for all levels so I modified most of the poses to concentrate on my knees. Where I really felt it was in my shoulder and upper arms: all the chararungas in the vinyasas were punishing me for wimping out during my convalescence and not maintaining my core strength. Elizabeth confirmed this conclusion by making us do multiple sets of abdominal exercises that left me barely able to lift my head and neck off the ground. I sweated profusely and had to take child's pose on several occasions because my conditioning has lagged far more than it should have, especially in the last few weeks when I was struggling with resistance to going to the gym and the studio.
Labels: balance, class, conditioning, core, injury, teachers
I was finally able to fit in a yoga class at Thrive with Pierre Couvillion this evening. My first class since mid-August and almost two months after my knee operations. I forced myself to go by packing my kit and rolling up my mat this morning before I left for work and giving my wife instructions to take it to the studio when she went to her class in the afternoon. I knew I had to put some kind of imperative in the formula because I was building up all kinds of resistance to the yoga class and even going to the gym, even though I can feel the adverse effects that their absence is having on my body and temperament.
Pierre led a pretty straight forward class that was good for me because it was am all-levels class that emphasized grounding in the basics of good form and breath. I did not do anything crazy — no jump-backs or jump-throughs, no wheels or advanced inversions. I just wanted to feel easy and comfortable in my asanas, and focus on my knees to make sure that they were solid and fully engaged. Pierre led us through some fundamental variations in standing poses that reinforced the tracking of the leg muscles. I think the factor that had deteriorated the most during the break was balance.
In preparation for the class, I had a session of acupuncture in the morning that was supposed to help break up some of the scar tissue in my knee.
I am slowly working my way back to practicing yoga. My orthopedic surgeon has given me a thumbs up on my recovery, and does not need to see me again. I have been putting in a daily average of 30 minutes walking and 30 minutes stationary bike for about a month. I've gone back to climb the eight flights of stairs of my office building. I've been doing some of the rehab exercises. I had a session of acupuncture on my knee today, and I'll get a massage tomorrow, so I've been lavishing care on my body.
If I do a lot of walking, I will have a little discomfort in my knee the following day and it will feel stiff. I've also noticed recently that I have a lot of discomfort in my right sit bone, probably due to the hamstring. I can't take sitting down for a long time.
I am aiming to start up yoga class again next Tuesday at Thrive Yoga. Pierre Couvillion will teach that evening. Although it's a relatively advanced, all-levels, vinyasa flow class, I would prefer to have the watchful eye of a yoga therapist watching as I move through the poses. He told me he could indicate modifications of those poses that might be risky for me.
I really miss the community of the yoga studio, and also the disciplined structure that a regular practice builds into my life. Even though I should have more "free time," I don't seem to get a lot more done. I really miss the big muscle movements from the vinyasa. Aerobic exercise or weight lifting does not provide the same kind of satisfaction.
I got to the gym twice this weekend, and put in two sessions of 60-minutes each on the stationary bike and another 25 minutes on the elliptical trainer. I lifted some weights, enough to make me sore two days later. During the week, I was able to do a few short sessions of rehab.
Earlier in the week, I got my sutures removed and the doc said that everything looked fine and to come back in three weeks. He suggested that I do some physical therapy to get back up to speed.
I also checked in with Pierre Couvillion who recommended that I take at least a month, maybe two, to ease myself back into yoga. Is he being overly cautious? Or am I just an ingrained overachiever who always has to push harder and farther.
More graphics than you may want to see of my torn meniscus,but I couldn't resist. Photo courtesy Dr. Graeter
Today is the first day in which I've been able to string two sentences together. I had my outpatient surgery on Friday afternoon, and was on pain medications until last night. I took off my surgical bandages yesterday, and now keep an Ace bandage to support my knee. I ice the knee as often as I can (15 minutes at a time). Yesterday, I was able to walk around without crutches. Today, I can climb stars. I can go down stairs only one step at a time, placing my injured leg first. The doctor says that I can start exercising on a stationary bicycle by next Saturday. I will get my stitches out early next week. I expect to be back at work tomorrow unless I wake up with a complication (say, overdid walking and stair climbing).
The operation itself went rather uneventfully. I had to wait about 90 minutes at the GW Hospital before they started the surgical prep. I guess they just want to make sure patients are on site and ready for the procedure, but it's boring. I was briefed about the procedure and given post-operation instructions. I was wheeled into the surgery room and I was unconscious before I could take in the full surrounding. I just noticed that it was chilly.
I got a second opinion on my knee injury about a month ago and decided to have orthopedic surgery with Dr. James Graeter because he's on my health insurance network and that will hold down costs. After he looked at my scans, he told me that yoga poses that are really dangerous for the knee are Ardha Baddha Padmottanasana, Gomukhasana A or any pose in which the knee is flexed sharply. The risk is that the meniscus will be pinched between the femur and tibia bones. In this type of pose, the leg is often rotated and that may put additional stress on the menisci or expose them to the bones in harmful ways. hero's pose (or Virasana) (or variations on it) is another risky pose because your upper body is pressing down on your legs.
Once I understood the knee's peculiar risk in yoga, I realized that precautions have to be taken. For instance, putting a rolled-up hand towel or blanket behind the knee so that the bones are stretched apart. Because you can put your knees at risk in both standing and sitting poses, you have to think hard about how best to wedge the towels between your calf and your thigh.
Because there are no nerves (or blood flow) in the menisci, there's no way of telling if damage happens. It's only when you have debris floating around in your knee bursa that problems develop. It can actually lock up your knee so that it can't move.
It's hard for me to fathom how I could have gone a whole month without writing here, after practically four years of steady commentary on my personal practice and the happenings of yoga in America and the world. Since my injury, there was a lot more shaken up than just my knee cartilage. Over four years, I structured my life around my yoga practice, focusing on making it to my classes first once a week, then twice, and, in the past two years, four times a week. And I fit the other parts of my practice around that routine -- pranayama, meditation, writing here and exploring how the whole experience shaped my life. With the injury, I lost an organizing axis around which my activities circulated. I seem to be able to do less in my day even though I have more "free" time on my hands. Go figure.
In more practical terms, I've had some time-consuming and mind-numbing issues with my computer. I had to reinstall my Windows XP operating system twice, and then reinstall my applications and configure the whole shebang according to my working habits. I would not wish that experience on anyone, and it drives home to me the need to be systematic about safeguarding data and taking precautionary measures. And I was supposed to be working on freelance web assignments and other duties during that period. There was at least two weekends, perhaps more, of my free time wiped out. I don't think I've caught up with the backlog of tasks yet.
This coming Friday, I will undergo arthroscopic surgery on my right knee to clean up my medial meniscus tear at George Washington University Hospital. It's outpatient so I will be home in the evening. I will be on my back for three-four days.
I sought out a conversation with Pierre Couvillion, a wandering yoga instructor and bodyworker, about my knee injury. Pierre has been filling some teaching holes at Thrive Yoga due to the August vacation absences. I wanted the opinion of someone who understood yoga and bodywork with a non-medical outlook to balance against what my doctor and acupuncturist told me. He recommended going ahead with the surgery because Western medicine deals more effectively with meniscus tears than other health alternatives.
Although I can trace my injury to the Rumbaugh workshop (part 1, part 2) a month ago because that's when it started to hurt, I can not say that it was the cause of the injury. At no time did I sense a jab of pain or feel that I had gone too far. It was only the next day that I notice a minor ache in my knee. It was two weeks after the event that the injury got in the way of my yoga practice. Pierre told me that injuries often happen at workshops because the "glow of a extraordinary teacher" frequently blind us to the limits of our bodies. I know that I was physically tired towards the end of the weekend, which is a double edge sword: the fatigue breaks down resistance in the body, but it can make me insensitive to the natural limits.
I've made major changes to my life style in the past five years. When I finished my Masters degree in May 2003, I was in sad shape. Working full time and getting a graduate degree, I smoked, ate poorly and was sedentary during work hours and at home. I was at least 30, maybe even 40 at times, pounds overweight. This blog documents my long slog back into a healthy life style. I've only been running since October last year. I've tried to increase my exercise regime's intensity gradually, both with the practice of yoga and running. That's why I adopted Chirunning, because it tried to reduce the heel's impact on the ground. But I could have abused my meniscus over the past year or worn it down over the past five years, or it could have been a problem that was just waiting for the right trigger to set it off, like a piece of paper that had been folded repeatedly in the same place and finally tore apart. Although I've tried to prevent myself from doing harmful things, like fit into lotus pose before my body was ready, I am still laboring with the body with tight hips that has sat in front of a computer for 20 years (if I had sat crosslegged on the ground all my life, I probably would not have this problem). My tight hips are going to stress my knees automatically, and I noticed that as my legs gradually moved closer to resting on the ground in easy pose, it increased the torque on the knees. I am one month short of being 59 years old, after all, and the body starts breaking down at this stage.
There are lots of adjustments that can be done to protect the knees, but when you have a torn meniscus, there's no way around it.
What I am trying to say is that my injury did not happen because I was a bad yogi who was misusing his body. It's not my fault. I think I was especially at risk because my tightly wound muscles were loosening a different speeds.
It's now confirmed: I have a torn medial meniscus that requires surgery. The debris poses a medium-term risk to the integrity of the knee, and Dr. Connell recommends cleaning up the knee by the end of the year, at the latest. He did not leave open a medical option for wait-and-see. The arthroscopic surgery is an outpatient procedure and requires three days of post-operative rest at home. It would then mean 4-6 weeks of recovery and physical therapy before taking up physical exercise. I could expect full recovery within three months.
Curiously, my knee was feeling fine today, with no pain or stiffness, so the news surprised me because I was imagining that I was recovering. If I had felt like this last week, I would never have gone to a doctor. The main problem of the meniscus is that it does not heal. It's a piece of cartilage that has no blood flow, and once it gets torn it becomes a piece of debris that can mess up the rest of the knee. Some people actually have their knees lock up on them because the meniscus moves between the bones and impedes movements.
But Dr Connell is in the business of solving problems by surgery so he has a professional, business and scientific bias to using surgery to fix injuries. He does have a reputation for not automatically prescribing surgery, which was one of my reasons for consulting him.
I already had an appointment with Kelly Welch, my acupuncturist, and so I asked him about the best course of action. He suggested waiting to see how my knee felt. He's had problems with both knees, at least one of them due to overaggressiveness in yoga poses. His biggest reservation about operating is that once part of the meniscus is removed, the knee can never return to its normal state.
He advised against future running because it put so much stress on the knee, even with the best technique. That's a kind of hypothetical questions because I don't have enough confidence to even jog. We closed out the session with acupuncture and electrical stimulus to the knee (so he's got a professional bias, too).
I woke up this morning and felt a big relief in my knee. The relief of tension that I had felt yesterday after treatment had continued after a night's rest. Yesterday, I was really sore, and felt tired from the difficulty of walking and climbing stairs. I could feel the strain building up in my shoulders as I clinched with each step with my right leg. I have started icing down my knee this weekend. I previously thought that my knee did not show any signs of swelling, but today I did detect some puffiness above my knee, which may be a sign of inflammation. Another symptom is that I get pain relief from ibuprofen.
In other words, I am treating it as if it is an injuruy, not just a nick or ding that will go away with a little rest and time.
Another consequence is that I've gone up five pounds over the past four weeks. I have to cut back on my calorie intake due to the drop-off in my physical activity.
Acupuncture chart from Hua Shou (fl. 1340s, Ming Dynasty). This image from Shi si jing fa hui (Expression of the Fourteen Meridians). (Tokyo : Suharaya Heisuke kanko, Kyoho gan 1716). Courtesy of Wikipedia.
My knee bothered me more each day as the week went on. Ibuprofen has become an essential intake several times a day. Last week, I could still feel capable of taking a yoga class. This week, it's out of the question because of the increased pain and the sensation of instability. I was lucky to already have a Friday appointment with my acupuncturist, Kelly Welch, only three blocks from my office. Kelly also practices Ashtanga yoga and had two bad knees so he has first-hand experience about dealing with the problem.
I gave him the background on the injury, which I have already laid out here in excruciating detail. He asked about where the pain was felt, zeroing in on medial side of the knee. He really did not give me a "diagnosis" in a medical sense, leaving that for a Western physician who could use MRIs and other tools to rule out things like arthritis, torn ligaments and other nasties. He gave me some pointers about how to keep up with my yoga while not injuring it further by using a rolled-up towel or blanket between my thigh and calve behind my knee whenever I have to go into hero's pose or similar poses that put pressure on the joint. He gave me the name and phone number of his orthopedist, who handles a lot of sports related cases. He also gave me the name of his massage therapist who has worked with people with knee issues, too.
Kelly did acupuncture on my right knee and left elbow (China medicine is into the yin-yang thing so a Chinese doctor would always treat the opposites to restore balance). He also applied some electrical stimulus, a slight sensation of being shocked. He adjusted it so that it did not reach discomfort or pain. And then he left me to simmer for 20 minutes. The treatment seemed to release a lot of muscular tension that had built up by the pain -- and the anticipation of pain. As always with acupuncture, the treatment seems to wash me clean of tension and compressed energy. I feel lighter, more clearheaded.
Finally, Kelly set me up for three more weekly appointments for follow-ups on the initial treatment.
As soon as I made it back to the office, I shot off an e-mail to the optometrist's office assistant and set up an appointment for next Wednesday afternoon, the soonest that he could see me.
This is not an xray of my knee, but it will serve to illustrate my plight.
My previous entry about my nagging knee injury brought two comforting comments: Mary suggested that I see a sports specialist/orthopedist, and Melissa mentioned that a yoga therapist might help and pointed me in the direction of Doug Keller. Keller is based here in the DC area, but spends a lot of time traveling to yoga workshops and teacher training around the United States and the world so he is not immediately available. His site does contain an archive of about dozen articles that he wrote for Yoga+ magazine, and one did deal with knee issues. I have downloaded several to apply them to my multiple aches and pains.
The helpful responses reminded me that the yogic path should not be isolated, that we can reach out to others for advice, support and commiseration. That's why we have yoga studios where like-minded practitioners can share their experiences. The Internet itself opens up the whole world, both for giving and receiving. Sometimes, injuries and other obstacles get me all wrapped up in the tangles that my mind gets trapped in.
I think my concern was three-fold: first, my yoga-empowered changes have been altering the way that my body parts are moving and changing at different speeds due to variable flexibility, strength and awareness. Second, the injuries themselves can engender changes in the body, compensations for a gimpy knee that may jeopardize my gains of the past four years. Or at least, that's what my neurotic mind was telling me, which just amplified the repercussions of the injury. Third, my ego was telling me that a good yogi would not be hurt himself so I must be failing in my practice in some respect.
Alternatively, I could also take this incident as an opportunity to learn more about how my body works, how it heals, and how it changes in the face of handicaps and stimuli. Greet it as a kind of anti-vinyasa that I have to recognize, accept, deal with, learn from and then assimilate into my yogic path.
I should note that Melissa Garvey and is based here in Washington, DC where she freelances as a writer and editor, and has her own website and YogaPulse blog. Following a link from her blog, I found a fascinating, even-handed article in June 2007 issue of Self, Bad Karma, about the risks of injury in yoga practice. Mary is "anonymous."
Labels: injury, knee, reading, therapy, yoga_resource
For the past week, I have not done any running, jogging or used elliptical trainer, or other gym equipment. The only yoga has been some light, simple stuff at home, except for a Flow I class with my daughter Stephanie at Flow Yoga. This weekend, I did not jump out of bed to get my yoga time in first, as I usually do.
Why? My right knee has continued to bother me, giving me a troubling sensation of instability. Three weeks since the injury first appeared, the day after the Thrive Yoga workshop ended. Probably the most striking complaint is that the knee cap is making a popping sound with a lot of regularity, especially after sitting cross-legged for a while. It has gotten marginally better this week, but not enough to feel that it's healing. I can do yoga without any problem, but I may aggravate the injury in half pigeon or easy pose without even realizing it, even though I never try to push beyond my edge and I flex my foot so that it stabilizes the knee. I have a sneaking suspicion that the injury has more to do with my hips than my legs.
I now believe that I am going to need a professional evaluation, but I am not sure who I should turn to. I have an appointment with my acupuncturist, but I am not convinced that he will be able to address this particular problem. Should I go to my personal doctor, since it's about time for my annual physical? Go to a chiropractor? Go to a professional doing bodywork (Trager, Hellerwork, Rolfing)? Should I find a bodyworker who is familiar with yoga-type injuries? Should I find a sports specialist? I've spent several evenings mulling over the options, Googling and trying to narrow down the options.
For the past week, I have been concentrating on getting priority tasks done at home. They had been piling up since I got back from Spain, and I really needed to focus on them. I had to force myself over and through some mental obstacles. That's why I have not been posting here, even though I have more to say about the Rumbaugh workshop.
It's now undeniable that I have a gimpy knee. It has been bothering me for the past week, with no improvement, so it will be hanging around for months to come. I don't even know when it happened. There was no sharp pain from injury, no sign of tearing a ligament. I just woke up after the Rumbaugh workshop and had a pain in my right knee. Now, it is a steady problem and I walk with a limp, with stiffness and tenderness above the kneecap. I don't see or feel any swelling. The right side is my least flexible. It's frustrating because I had not been trying to force myself in Lotus or anything crazy. I have a sneaking suspicion that my condition is due to a realignment of my leg muscles (quads and hamstrings), which resulted in new cartilage in my knee being rubbed and it's caused inflammation. This is probably connected with my overpronation, poor mechanics and excessive sitting.
This injury means that I will not be running or jogging for some time. I will try to get my aerobic exercise at the gym on an elliptical trainer or stationary bike. I have kept up with my yoga, getting in two sessions of Forest Yoga at Thrive. The injury does not affect me in most vinyasas, and I am careful in any pose that stresses the knee.
