Thursday, February 4, 2010

Guest blogger, Caitlin White: Different perspectives on injury

Different perspectives on injury
Caitlin White
Since deciding to enter the medical profession, I have found myself analyzing the personal interactions I have with health care providers. I keep a running list in my head of ways in which I would like to emulate them, or ways in which they leave me with a sour taste in my mouth. I tend to dwell on the latter, asking myself: "What is it about that interaction that left me feeling so empty? So unheard?"
I recently injured myself while coughing - of all things - and after several frustrating weeks of practicing through the pain, I re-injured my muscle worse than it had originally been. After about a week of giving up practice to allow it to heal, I found myself back at the studio and impatient for its resolution. It didn’t seem to be getting better so I made an appointment with a sports medicine MD and an acupuncturist/massage therapist, while also soliciting guidance from my Ashtanga teacher (the health care provider I see most regularly!!). Each one left me with a completely different impression.
1. The MD: My visit was less than 15 minutes, and she examined me for less than two of those. Her diagnosis? 
"It is probably a just pulled muscle. I am not going to have you go through range of motion or strength testing because these chest wall injuries are difficult to tease apart anyway."
She told me to take off completely (not even stretching) for 6-8 weeks and take nine ibuprofen a day (3 tabs three times daily).
2. The Acupuncturist: My visit lasted an hour. Of that, he spent about 20 minutes examining my side, rib alignment, and range of motion. His conclusion?
"I think you will respond better to acupuncture than massage. I suspect you pulled an intercostal muscle because your pain tracks along the rib, however I am also concerned that you injured your rib because there is a painful ridge in it near your spine, and it is tender from its origin to insertion. I would like to you see me at least three times over the next three weeks, and I believe that it will improve greatly in that time."
3. My Ashtanga teacher: Our discussion lasted about 10-15 minutes after I finished my practice. His advice?
1) Continue coming to practice daily.
2) "Listen to your body- it is your instrument for exploration; observe and respect it. Do not force it to do something that is painful, otherwise it will not heal."
3) "You likely pulled a muscle. Try not to get too frustrated, and remember that this is not permanent."
4) "Sometimes an injury like this is the body's way of slowing us down. Perhaps you were asking too much of it in the first place, moving too fast. Now is the time to take it slow and reconnect with your body."
Our interactions with people can be so different while trying to accomplish the same goal. I am disappointed that my appointment with the MD was time wasted, I am optimistic that the acupuncturist will help my side heal faster, and I am inspired by my teacher to focus less on the physical poses (asanas), and more on being present in my daily practice.


  1. wonderful observations, thank you. how sweet of you to see your teacher as the health care provider you see most often. it may make me rethink going back on Sundays to my teacher. i've been not doing so because it involves many hours of travel and carrying books for a class plus mat and a change of clothes - all on my back! but if i saw him as a health care provider, i might rethink my stance.
    cheers, Arturo

  2. I just wanted to let you know, I really love your blog! Your topics are ones I'm most interested in.

    I'm glad you performed this experiment with respect to your injury. My experience has been the same, whenever I've had issues. It's just too bad the Western establishment is so limited in terms of time and resources. MDs seem mired in habits and models of thinking that are impossible to refine given the restrictions inherent to the establishment. It is a bureaucracy -- at least that's how it appears to me, an average citizen.

  3. David’s awesome. I agree, keep practicing regularly and mindfully as he described. Your practice will improve as a result of this experience. Our injuries are often our best teachers.

    In my experience, injuries/setbacks in Ashtanga follow a pattern:

    1) You hurt yourself, usually through straining (“straining” here defined as performing a movement without breath or with insufficient breath). In your case, Caitlin, the initial injury had nothing to do with yoga, but the re-injury occurred during your practice.

    2) It heals, either quickly or slowly depending on its nature and severity.

    3) You may still feel the injury during your practice because you begin to focus stress, anger and other negative emotions into that area. You can usually distinguish the two by calmly breathing and focusing on engaging the bandhas through whatever hurts and if the pain lessens as a result, there’s a good chance the injury has evolved – in whole or in part – into something more psychosomatic (although I don’t particularly like that term, given its vaguely pejorative connotation). Sometimes 3) happens while you’re still healing, which means multiple etiologies are at play. This is in no way meant to discount the discomfort that injured practitioners feel, which is very real, but rather to suggest that the source of your discomfort may be the product of an emotional response to what’s going on in your life and perhaps to the injury itself, and if so, this recognition will help alleviate your discomfort.

  4. Thanks, Karin! just checked out your blog too - looks great and can't wait to read more!

    Arturo, so nice to hear from you again. Even if you can't make it to your yoga teacher (seems like quite a trek!), I think the practice helps teach us to be our own health care providers as well!

    Josh, thanks for reminding me of how physical injuries can develop into emotional ones... from fear, anger, frustration, etc. So true.

    Caitlin, I'm so glad you've been coming to practice... I know it's really hard to do when you are in pain and can't do the physical practice like you're used to (and when everyone around you is doing things you can't anymore). But what an important lesson that it's not all about what the physical body can do... but it is about listening to your body, respecting it, breathing, quieting your mind...

  5. from Adam a poem for the injured and suffering

    Morning Song - Alan Dugan

    Look, it's morning, and a little water gurgles in the tap.
    I wake up waiting, because it's Sunday, and turn twice more
    than usual in bed, before I rise to cereal and comic strips.
    I have risen to the morning danger and feel proud,
    and after shaving off the night's disguises, after searching
    close to the bone for blood, and finding only a little,
    I shall walk out bravely into the daily accident.