The Positive Side of Pain

 Not long ago I was taking prenatal yoga class and it occurred to me that I just might actually enjoy pain. It was one of those days when my mind was spinning a mile a minute. I was trying to study for my statistics class earlier in the day and I had so much trouble concentrating and staying focused. When I got to yoga my mind was wandering, noticing all the external goings on around me. Then we got to the ‘practice being in pain’ part of the class. In this case that meant holding arms up and out to the sides until they burn and feel like they weigh 100 pounds each. I found myself dropping so deeply into my focus on breathing that I practically fell asleep! That 2 or 3 minutes was the most grounded I felt all day. My monkey mind returned as soon as we moved on to less challenging poses. Even the restorative Queen’s pose wasn’t as relaxing to me as the ‘hold your arms up until they feel like they’re going to fall off’ pose.

I also really like doing the Thai Goddess pose, another way to practice breathing through pain. I don’t know that this makes me a masochist but it does make me realize that there are benefits to embracing pain. There is probably a similar psychological mechanism at play when participating in athletic events that hurt. I don’t particularly like running but I do like running races. I like that feeling when things get uncomfortable and I have to just hunker down and find a rhythm in order to keep going. I do like mountain biking and xc skiing and I love the challenge of climbing hills. The lungs and thighs may burn but the mind is focused and breath is all there is. The after effects of these kind of athletic challenges is pretty great too. There is a high that I’m sure is some kind of endorphin-based warm and fuzzy feeling.

I will soon become acquainted with what is said to be one of the most painful experiences possible. I can’t say with confidence that I will enjoy the pain of childbirth but I’m beginning to think that it just might be an experience that comes with benefits (aside from a brand new baby!). Two minutes in a painful pose is a lot different from 12 hours of sustained challenge but I expect the resulting high will also be a lot more amazing than just cresting a hill or crossing a finish line. Hopefully I will find out this week...

Asana Analysis: Thai Goddess

This pose is mostly taught in prenatal yoga classes as a means to teach breathing and relaxation in the midst of discomfort. But it also has value for many non-pregnant men and women and I often teach it in my regular yoga classes and to certain physical therapy patients. There are two main benefits of this pose. The first is mental, when used as method for teaching relaxation. The second is physical as it is a great pose for improving flexibility and range of motion (ROM) of the feet.

Muscles Stretched: Flexor digitorum longus, flexor hallicus longus, intrinsic muscles including flexor digitorum brevis, flexor hallicus brevis, plantar interossei. It can also stretch the plantar fascia, Achilles tendon and other tendons and ligaments of the foot. 

Points of Body Awareness:
*Be sure that the soles of the feet are vertical so that the weight is distributed evenly across the balls of the feet.
*Are you sitting upright or leaning forward in an effort to get away from the discomfort?
*Is the spine in neutral alignment: shoulders directly over hips, ears over shoulders?
*Are the buttock muscles gripping? Are the shoulders elevated? Is there tension in your brow? Be sure to let go of all unnecessary muscle tension.
*Drop the chin slightly to calm the nervous system  and decrease the flight-or-fight instinct.
*Take long, slow breaths. Breath down through your toes. Exhale through the nose in a smooth and calm manner.
*Try to hold the pose for at least 30 seconds. Repeat 2-3 times. For women preparing for labor, try to hold for up to two minutes which is the maximum length of a contraction.


To Modify:
*If unable to sit upright on the heels, try placing a bolster or folded blanket between the hips and heels.
*For a less intense stretch of the feet, start in quadraped (hands and knees) with the toes curled under. Then, keeping the hands on the floor, sit back onto the heels. Gradually shift more weight from the hands into the feet.



PT Notes:
Thai Goddess pose is contraindicated for those with acute injuries of foot, ankle or knee. But modified versions may be helpful for those with chronic or post-acute problems associated with decreased ROM or tightness of the plantar fascia. I have found that Thai Goddess is often a great pose for runners with limited extension ROM of 1st MTP. Runners need at least 70 degrees for good gait mechanics and when they lack that amount, they often end up with Achilles tendonitis, knee pain or even lower back pain.

Yoga for Runners

My last post was about how to prevent running injuries. Yoga is definitely a useful tool for incorporating prevention strategies. Yoga obviously can be a form of stretching but it can also be an effective way to strengthen the body. By practicing breathing and meditation, runners may find that they are more connected to their bodies and may recognize tweaks early on and adjust their training programs before outright injury can set in. Vinyasa (or flow) yoga can be a good cross training activity and restorative yoga is the perfect activity for rest days. Scheduling rest days into a training schedule is an essential part of injury prevention.  A restorative yoga practice is extremely beneficial for runners, especially after long, hard runs to facilitate the body’s need for rebuilding and rejuvenation.

Here are some common running-related injuries and yoga poses that may be helpful in preventing those injuries:

Iliotibial Band (ITB) Syndrome - This is a very common injury for marathon runners. It can be associated with tightness of the ITB, over-pronation of the foot and weakness of hip abductor muscles.

• Standing Forward Fold/Utanasana variation with crossed legs - This pose will stretch the ITB along with hamstrings.

• Tree Pose/Vrkasana - When done well, this pose is excellent for increasing strength and awareness of the hip abductors as well as the foot and ankle muscles.

Piriformis Syndrome - This often occurs in runners with significant tightness of the hip and low back muscles, over-pronation of the foot or weakness of the gluteals.

• All of the following are good stretches for the hip muscles including the piriformis, gluteals and small external rotators:
• Sage Twist/Marichasana

• Pigeon/Eka Pada Rajakapotasana

• Cow’s Face/Gomukhasana

• Bridge/Setu Bhandasana variation with single leg. This is a good pose for strengthening the gluteals and oblique muscles of the trunk.

Patellofemoral Pain Syndrome (PFPS) - This is a very common injury among runners and may be related to quadricep weakness (especially the vastus medialis), weakness of the hip abductors and external rotators or tightness of the ITB, quadriceps and/or hamstrings.

• Chair/Utkatasana variation with strap for isometric abduction and external rotation - This pose is excellent for strengthening the quadriceps and gluteals as well as improving awareness of biomechanics and alignment of the knees, hips and ankles.

• Triangle/Trikonasana - strengthens the quadriceps and intrinsic foot muscles, stretches the hamstrings.

• Half moon/Ardha Chandrasana - This pose offers all the benefits of triangle plus even more strengthening of the hip abductors and external rotators.

Medial Tibial Stress Syndrome/Shin Splints and Plantar Fascitis - These conditions are often associated with tightness of the gastrocnemius muscle and Achilles tendon, over-pronation or high/rigid arches.

• Down Dog/Adho Mukha Svanasana - This classic pose is great for stretching the gastrocnemius and Achilles tendons. A dynamic version where you pedal the feet by dropping one heel at a time is particularly nice for working the ankles and calves.

• Standing Hand-BigToe Pose/Utthita Hasta Padangusthasana - This is a challenging balance pose that requires good flexibility of the calves and hamstrings as well as much action in the muscles of the foot and ankle. Be sure to do this pose with a neutral foot position (outer heel in line with pinky toe, weight equally distributed, arch slightly lifted). Use a strap if the hamstrings are tight.

• Thai Goddess Pose- This pose involves sitting on the heels with the toes curled under. It is an intense stretch of the plantar fascia and also of the big toe. It may not be appropriate for those with acute plantar fascitis but it is an excellent stretch for those with chronic foot or leg pain who lack range of motion in the first metatarsalphalangeal joint. Runners need at least 70 degrees of extension in order to have good gait mechanics. I have seen many runners with various injuries who improved dramatically as they gain motion in their big toes. Thai Goddess is usually taught in prenatal yoga classes as a practice in relaxing during intense sensations (i.e. labor contrations) but runners can also benefit from this mental practice of relaxing in the midst of discomfort. 

See Runner'sWorld.com for a nice sequence of restorative stretches for runners.
Image from Zen Girl in the City