Do you know when to use heat or cold therapy for an injury? If not, a recent review article by two University of Washington sports doctors, Matthew Karl, MD, and Stanley Herring, MD, can be your guide.
Drs. Karl and Herring point out that the application of superficial heat to your body can improve the flexibility of your tendons and ligaments, reduce muscle spasms, alleviate pain, elevate blood flow and boost metabolism. The mechanism by which heat relieves pain is not exactly known, although researchers believe that heat inactivates nerve fibers, which can force muscles into irritating spasms, and that heat may induce the release of endorphins, powerful opiate-like chemicals that block pain transmission.
Increased blood flow occurs in heated parts of the body because heat tends to relax the walls of blood vessels. That’s one reason why sports doctors recommend you steer clear of the practice of heating up already inflamed joints. Heat appears to be best for untightening muscles and increasing overall flexibility; the proper tissue temperature for vigorous heating is probably 104 to 113 degrees Fahrenheit (40 to 45 degrees Celsius) and the correct duration of temperature elevation is about five to 30 minutes. Although heating can reduce muscle spasms after a back injury, heat should not be used on sprained ankles.
A physician, an orthopedic surgeon and a physical therapist all fell into a Rip Van Winkle sleep that lasted 20 years. The physician woke to find everything changed when he began seeing patients again. The medications he wished to prescribe no longer existed or were pulled from the market by the FDA. For the surgeon, the operating room had been transformed; the instruments he had once used were now in a museum.
But for the physical therapist, nothing much had changed. He found he could use the same techniques for mobilization and the same modalities such as ultrasound or electrical stimulation. In addition, the physical therapist found that he had lost his massage patients to massage therapists, stretching techniques to athletic trainers, manipulation techniques to chiropractors and hand therapy to hand therapists.
Indeed, the contemporary practice of physical therapy has had little in the way of modalities added to the techniques of hands-on manipulation. Physical therapists are not always aware of new products that can enhance our ability to help patients.
The positive effects of yoga are widely accepted. Modern science can, in fact, quantify these benefits, such as increased flexibility, improved strength, better posture, positive mood, reduced stress levels, and –the widely desired – weight loss.
Recently, however, there has been an increase in the dialogue about the other side of the coin: injuries that may be incurred while practicing yoga. But before you allow yourself to be scared away and miss out on all the benefits, here are some ways to determine your personal level of risk before stepping onto the mat.
Practicing the asana (posture) aspect of yoga is a physical activity that requires the same level of awareness regarding the body’s capability as when engaging in any other type of athletic endeavor, such as running or soccer. Just as you should not attempt a marathon when first starting to run, pushing the body into the full, or advanced stages of a pose can be detrimental. To be safe, adhere to your body’s natural limits and avoid overstretching, which means moving past the point of first resistance when performing a pose. If you heed your body’s signals, your risk factor for injury is far less than many regular daily activities such as driving a car!
Throughout the years of practicing Body Tuning, I have heard the same story, with only a little variation, from my clients: “I saw an orthopedist… I had an MRI… I was given exercises…I didn’t get better… I tried acupuncture, chiropractic… nothing worked. I finally decided no one could help me. I’ve been walking around with pain for a long time until someone recommended that I come to see you.”
What I know from listening to these personal stories is that musculo/skeletal problems are not getting serious attention from the medical community. Physicians are trained to deal mostly with life threatening conditions. And, indeed, it is a good thing that we have experts who can recognize serious illness, save our health, and often our lives.
But for many who suffer from pain and discomfort in their musculo/skeletal systems, the early stages of their problems are difficult to diagnose. Conventional tests are better for diagnosing a problem when it is advanced and needs surgical intervention. Many physicians are trained to see the worst case scenarios, but not to deal with the small, uncomfortable conditions about which the patient is complaining. If the patient complains of a muscle ache…the doctor may think of a torn muscle, or if the patient has a nerve inflammation the doctor may think of something more serious requiring an MRI or CT Scan to diagnose correctly.
I am the Shmuel Tatz mentioned in William Broad’s excellent article: How Yoga Can Wreck Your Body. Glenn Black studied with me for 5 years in my ‘body tuning’ studio, and is an example to others of how a yoga teacher with knowledge of body mechanics can minimize the damage yoga can do.
Mr. Broad states that I “devised a method of massage and alignment for actors and dancers” which is not correct. What I have done is to create what I call ‘body tuning’ which is designed to tune every part of the body, just as a musician tunes his instrument. I have worked with actors and dancers, musicians and politicians, but my practice is devoted to anyone and everyone who has pain and discomfort in the body and seeks relief.
What I wish for yoga professionals to understand is that they must know the biomechanics of the human body. Also, they need to work with someone, as Glen Black did with me, for at least 5 years to learn about body pathology, mechanics, disease and injuries. Yoga teachers should be aware of all facets of the human body so that they do not themselves nor recommend to their students other than what is health giving and safe. I studied yoga after I learned physical therapy. If yoga teachers have a basic education in physical therapy they will never do hyper-extensions of the spine because they will know the great damage it can cause the discs.
As for yoga students, in my opinion it is best to learn yoga first in private lessons just as a piano student begins with private lessons. In group classes teachers do not have the time to pay attention to each student’s specific problems. After you become adept at learning the basics of yoga practice you can take group lessons. Unfortunately whether you take private lessons or group lessons, most teachers have no training in biomechanics and there is, then, always the danger of injury to themselves and to their students.
Again, I think Mr. Broad’s article was an important one in alerting the many yoga practitioners that along with the good that yoga can do, there is also a downside which can bring pain and limit mobility.
Many yoga teachers come to me to help them with the body discomfort and pain they experience as they advance their practices. As one of them said to me: “Yoga is supposed to be good for the body but I’m finding that yoga injuries are far more frequent than I think they should be…both for myself and my students.”
To this I say: Yes, yoga can be very good for the body, and to derive satisfaction from our yoga practice we need to do some things for the body to make it ready. First of all, we need to watch how our bodies react to what we are doing. But this is not always easy for us to do by ourselves. That is why we need to have a private lesson with a good yoga practitioner who will see if we are moving correctly. And then, even more importantly, we need to have a body tuner who can check our bodies at a deeper level, that is, someone who can go deeper in the body to see what kinds of changes are taking place. And if the body tuner finds something wrong, it may be necessary to slow down the yoga practice.
All of us want to like our doctors. Certainly we want them to be intelligent and current with medical and surgical procedures and medications. But no one of us wants to face a doctor who is brusque, dismissive and ‘all business.’ We want them to look at us as a whole person, not a set of organs or complaints. In the best of all possible worlds, our doctors would be patient, caring, inquiring of our histories and families, beyond the genetic diseases they may have passed on to us.
Sometimes we get lucky. Sometimes, we don’t. A client of mine once complained to her internist that the specialist he recommended for an area outside his expertise was impatient, bordering on nasty. She said: “I looked up his medical credentials and I’m sure he’s very smart but he was officious and rude. So, do I stay with him?” The doctor replied: “You should have both a kind doctor and one with credentials. I’ll see if I can find you one.”
So, what happens if we find that caring and well credentialed doctor, and as our doctor/patient relationship moves on, we develop a mutual friendship? Perhaps we meet outside the office at parties. Perhaps we invite our doctor to our home and our invitation is reciprocated. With the change in relationship, how can we, both doctor and patient, maintain the proper perspective and distancing required to be objective? The answer is: It is very difficult.
Most people who hear the word ‘cane’ picture an elderly person using it as a ‘walking stick’ for balance or as an adjunct to injury or surgical repair of hip or knee. If we are lucky, that is if we get to live a long life, most of us will need to use a cane for one reason or another. Sometimes when our joints are damaged we take pain medication to try to avoid surgery but the damage to our joints continues. Using a cane can take the stress from the inflamed joint, thereby avoiding the side effects of medication and perhaps delaying the need for surgery.
In the fifth century BCE, Socrates walked around Athens barefoot, followed by a crowd of shoeless disciples. Brilliant in his exploration and foundation of the early principles of philosophy, was he also onto a fundamental principle of physical health? Based on alarming increases in injuries related to shoes, perhaps he was right—walking barefoot is beneficial.
Picture Socrates in a pair of Nikes. With every step, the unnatural support of the shoes, while seemingly comfortable, prevents certain muscles in his lower legs from working as they should. Unable to roll through the foot as he walks, his calf, ankle and toe muscles become weak, resulting in foot conditions like flat-footedness and hammertoe. Instead of naturally landing on the ball of his foot as he walks, he lands on his heel. This unnatural gait leads to knee, hip and back problems. In addition, the thick-soles of his Nikes distort this great philosopher’s perspective of the distance of his foot relative to the ground, leading to a greatly increased chance of sprains and other injuries caused by missteps. In addition, the shoes keep his feet in a constant, unchanging temperature and the high concentration of nerve endings on the bottom of his foot are stimulated less, making him more prone to viruses. In the end we see an unhappy, physically compromised, pained philosopher, perhaps eager to drink the hemlock.
In the 2011 world of medicine we have many options open to us as patients. Sometimes, those options are limited by our insurance providers. But within that framework we can still take charge of our needs and find those physicians and ancillary medical personnel who can best help us to maintain our health.
It is of great importance to do our homework when we are trying to find the best person to care for our needs. It takes time and effort. Sometimes we listen to others’ suggestions more than we take the time to investigate for ourselves. If we are considering a surgical procedure, then it is in our best interest to seek other possibilities of solving our problem before we decide that surgery is our best option. Our bodies are fine instruments and need proper care to stay strong and vital. But there are many routes we can take, before the most serious of all: surgery. We can do the best thing for ourselves by going slowly and discovering what paths are open to us.