Saturday, June 1, 2013

The Key to Preventing Yoga Injuries? Better Professional Standards.


Do you ask permission before you give a "hands-on" assist?
by Kellie Adkins, MSc, E-RYT-500

Preventing yoga injury is of crucial importance and as yoga instructors, it is our responsibility to create a safe environment in which the practice of yoga takes place. However, the profession of yoga instruction is largely a group of independent specialists with few overarching professional practices or procedures for efficacious instruction. While this charming blend of stylistic innovation, lineage-based teaching, and psycho-spiritual-physical practices together give yoga such a broad therapeutic range, it is also the yoga industry’s Achilles heel.

Our job as yoga instructors is further complicated by the variation in how independent studios, gyms, health clubs, and healing centers are operated and whether or not we teach jam-packed group classes, small group, mixed level, or private classes. Where and how the class is marketed {i.e., a power yoga class v. a gentle class}, students’ ignorance about what postures they are healthy enough for and capable to perform, teachers’ ignorance about contraindications, and the lack of regularity between teaching venues {studios, gyms, health clubs} about how to collect health information on students and how to disseminate that information to instructors all create a perfect storm for yoga-based injuries.


Many well-educated and passionate professionals have addressed some of the above issues –including wider knowledge of contraindications of yoga asana, raising the standards of basic anatomy among yoga teachers, and the legality {and ethics} of collecting and keeping students’ health information. Yet there is an obvious gap in our collective knowledge concerning best practices in the profession of yoga instruction to reduce negligence-based yoga injury.

Though many professions establish clear standards for training, continuing education, pedagogy, professional ethics, occupational hazards and safety, the yoga industry is lagging in several of these areas. Though the industry has recognized credentials for education, these are not widely agreed upon. Likewise, though a brief overview of pedagogy is included in many training programs, the art of teaching others how to teach yoga is greatly underrepresented. Furthermore, though the path of the yogi includes a code of ethics {called the yamas and niyamas}, much is lost in translation from personal practice to professional dictum.

The greatest lack in the yoga industry, however, is in codifying policies and procedures for the yoga education industry in order to preserve the health and safety of yoga practitioners. Although there will likely always be stylistic differences and varying opinions about the relative value of this style of yoga versus that style of yoga, the need to reduce yoga injuries is of urgent import: stylistic differences aside, on that point we can agree.

Below is a list of simple preventive measures that together preserve a higher level of safety in your classes. I am certain that some of these suggestions will challenge the method in which you have been taught yoga, taught to teach yoga, and currently teach yoga. That is precisely the intent: in order to substantially reduce injury among yoga practitioners, we must take preventive measures as yoga professionals.

1) Keep Your Hands to Yourself 


Until yoga professionals are further credentialed or licensed to touch, we need to recognize the danger of offering hands-on assists to our students. This is a hot topic and there are many yoga professionals who vehemently disagree with my position on this point. That said, let me flesh out a few of the reasons for keeping your hands to yourself.

Unless you are a massage therapist, a physician, a chiropractor, a physical therapist, a priest, or another of the few professions given license to touch, ethically you are not allowed to touch your students unless given explicit permission.  

But, wait, you say – I love receiving yoga adjustments myself and I was taught how to do so in my yoga teacher training. Why is this even an issue?
  1. A number of yoga injuries can either be exacerbated, intensified, or –dare I say –caused because of well-meaning hands-on assists. Even if you are one of the above professionals, ethically, you are operating outside the boundaries of said profession when you step in front of a yoga class and don the ‘yoga teacher’ hat.  
  2. Even a mild amount of pressure intensifies a posture and many yoga adjustments are the opposite of mild. 
  3. We live in a litigious society. Even if you carry liability insurance, your risk of being sued because of a yoga-based injury increases when incurred from an adjustment. 

It is not my intention to suggest that every teacher stop providing yoga adjustments. I am merely suggesting that we approach the process of yoga instruction with more caution, care, and discernment. To that end, we may have to sacrifice some of the injurious components of our teaching in order to create a safer environment for the practice of yoga.

So while you may choose to avoid adjusting your students with touch {for some of the reasons mentioned above}, you can work to create clear cues that help your students have a broader experience of the energy within the asana.

If you do adjust with your hands, be choosy with how you approach and interact with your students. Asking permission to touch, for example, will keep both you and your students safe from an unwanted or unsolicited approach. If, for example, a student’s upper arm looks very uncomfortable in Triangle, instead of walking over and moving their arm for them, instead ask ‘may I help your arm be more comfortable in this pose?’ By shifting to a question, you’re giving them the power to say ‘no’, you’re asking permission to touch them, and you’re keeping their practice – literally – in their hands. 

2.  Study the Human Body


This both includes and exceeds a basic knowledge of human anatomy. I will assume that you as a yoga teacher are adept at differentiating your adductors from your abductors and can name the origin, insertion, and action of each {if that is NOT the case for you, invest in a Yoga Anatomy workshop or training}. Studying the human form, though, is more than simple anatomy: it invites you to be an observer of bodies in motion. All types of movement tell you something about the embodied energy matrix that is the human form. And when you become a body observation junkie, your students benefit.

Your body observation homework begins before you ever instruct your first vinyasa. As a teacher, develop the habit of observing your student body: observe their walk through the door, watch how they stand {or sit} on their mats waiting for class to begin, note how they hold their bodies in the asanas, witness their final exit from class. The information you will receive from this simple practice is invaluable and the importance of cultivating this skill cannot be overstated.

If this is a new idea for you, provide yourself the opportunity to practice by going to a public place {a mall, a park, or a concert} and observing how people move. Can you tell if they are right or left handed merely by observing the shoulders? Perhaps you can notice which hip is tighter by watching their gait. Can you tell an anterior pelvic tilt, weak adductors, tight lumbars, and weak erectors simply by observing posture? Can you tell which people suffer from back pain, who has knee trouble, and which person gets migraines? Yes, all this and more. Once you learn this skill, your teaching will improve exponentially. And more importantly, you will be better prepared to teach your students about their own bodies and their own postural habits. And isn’t giving people the gift of greater self-awareness all part of the beauty of yoga? Once you refine this skill as a teacher, you will be better qualified and more confident to truly teach to the student.

Sequence isn’t just a pretty word. There is an intelligence behind well-sequenced yoga posture practices. Not only does the practice unravel psychological tension –as evidenced by the feeling you get post-savasana –a well-sequenced class releases long-held tension patterns by spiraling deeper into the physical body. There are many reasons most classes begin with a joint-freeing series like Surya Namaskar or gentle Cat and Cow variations: increasing proprioception, warming the outer layer of connective tissue, regulating breath and movement, strengthening mindfulness of the moment. Yet the intelligence of the practice should carry through beyond the ubiquitous Sun Salutation. Learning to dissect postures into their component joint and muscle actions, then blending them together in an ordered dance of mindful movement is one of the best ways we can prevent yoga injury.

Though stylistic differences in sequencing abound, it is never wrong to go back to the body in devising your class plans. Ask yourself, what muscles need to lengthen and which need to strengthen? Which joints need to be open and which need to be supportive? How can I balance the physical effects of this pose with another? With a little creativity and some critical thought, you will learn to love the art of sequencing for safety.

3. Get Off Your Mat

Again, this is not a popular dictum among yoga instructors. Yet, what is our job as yoga instructors of not to GUIDE your students in an INTERNAL experience of union {yoga}? More than other physical practices, like aerobics, spin, or Zumba, asana is only yoga when it is combined with calm-abiding inner awareness, strengthened by meditative concentration. And as a teacher, you are facilitating that process by offering gentle encouragement, clear instruction, and concise cues. And if your body –and your practice—is providing a visual model of what yoga ‘is’ from the front of the room, no amount of drishti will overcome that.

But, wait, you say, I was taught to teach from the mat! My teacher training never offered me any other alternative! I understand and I empathize. Yet, bear with me for a few more moments: if you are moving through each and every pose with your students, how can you observe your students’ bodies? How can you be there for support if someone is uncomfortable in a pose? How can you provide an alternative if there is a pregnant woman in the class?

While there is nothing inherently wrong with teaching from the mat, recognize that it is impossible to observe your students’ bodies in motion if you are on the mat. And if you are not observing your students’ bodies, you are unable to instruct them appropriately and keep them moving safely.

Communicating clearly is an art you will refine as you continue to teach…and yes, it is possible to teach an entire class with verbal cues. If you were taught to teach ‘from the mat’ and have not developed the capacity to teach any other way, it will take practice. 
 

4. Knowing is Half the Battle


Many teachers ask {at the beginning of class, in front of every other student} who has injuries in the room. From both a professional and personal standpoint, this is a set up for failure.

Many people are generally disinclined to speak out in public: particularly, to single themselves out as having an injury or a condition, in front of 15-20 other relative strangers. So they do not say anything. Then halfway through the class, when everyone else is in Locust Pose, the first-trimester pregnant woman {who is not telling anyone yet, certainly not a room full of people} starts to feel ill. Or you have just cued Shoulderstand and a man in the back comes down because he is getting dizzy, and oh, did he forget to mention he has a herniation in C3?

Instead, get in the habit of asking your students – one on one – as they come in the room: ‘How are you feeling today? Is there anything happening in your body I need to know about?’ You may add some prompts relative to their particular posture, age, or stage of life, too. You may ask the 70-year old woman with a significant kyphosis if she has had a recent bone density test. Or ask the 30-something woman if she is pregnant or trying to conceive {delicately, of course!}.

Above all, try to create a sacred space for a one-on-one conversation to happen. Make eye contact, use a soft speaking voice if others are nearby, and sit on or near their mat if they are already in the practice space. Asking in this way invites a deeper conversation about injuries, feelings, tiredness, pregnancy, and present discomforts while expressing to your student that you care about them as an individual.

Lastly, even when you have covered all the bases above, I still recommend injecting a cautionary word when introducing a pose which may have many contraindications. You can say something like this: ‘If you have high blood pressure, you may want to skip this next pose’ when cueing Wide Angle Standing Forward Fold, or ‘Bend your knees if you have low back issues’ when cueing any Downward Dog.

While there is no possible way to keep every student safe all of the time, we can take preventive measures as profession to preserve an environment of safety in our yoga classrooms. Ultimately, it is our ethical responsibility as yoga educators and our moral obligation as yoga practitioners to do so.


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Kellie Adkins is a holistic coach and passionate yoga educator who founded and directs the Wisdom Method School of Yoga, an integrative yoga therapy institute. In her trainings, workshops, and e-courses, she seeks to inspire others to do the work of deeply knowing themselves, becoming who they are meant to be, and sharing the teachings of yoga from a place of authenticity. Kellie is a nationally recognized yoga expert, a proud mommy, and a creative maven with an infectious passion for all things handmade.

Kellie holds a B.A. in Religions & Gender Studies, a M.S. in Nutrition & Health Promotion, & is an E-RYT500, a registered Prenatal Yoga teacher, a registered Children’s Yoga teacher, a member of the International Association of Yoga Therapists, & founder/director of Wisdom Method School of Yoga.


2 comments:

  1. Such important ideas for our profession to be in discussion about Kellie! Thank you for bringing this up.

    One thought about hands-on assists--
    I teach the yoga teachers that work with me to use these principles when giving an adjustment:
    Is this adjustment helpful? Is it necessary?

    And then after that:
    How could I help them be more grounded in their base of support?
    How can I help them find more space for breath?
    What could I do here to help them feel nurtured?
    And I never recommend moving a student deeper into a pose then they could go on their own.

    With these grounding principles, do you feel it is safe for yoga teachers to touch their students?

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    Replies
    1. Hi Francesca,

      I completely agree with your points. The adjustment 'checks' you provide your student teachers provides an opportunity for a conscious pause, a moment of reflection, and the application of discernment before ever laying hands on a student. All of these checks and balances encourage more self-awareness (from the teacher's perspective) to the role they play in another's practice. Insightful reflection on and sensitivity to that dialectic is the missing piece in many hands on adjustments. Once we reestablish that, however, our hands on assists can evolve the integration the student feels in their own body.

      Furthermore, it's been my experience that --after going through a similar process of inner questioning pre-assist--many assists are superfluous and merely a tool insecure teachers employ to feel that they're "doing" something.

      To address your question of hands on assists in the context you established, I wholeheartedly agree that it is appropriate and timely in certain cases (providing permission has been granted, the checks and balances assessed, and the teacher's motivation checked). And when a thoughtful assist is applied from this place of wisdom, it is as gentle as it is powerful.

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