Practising With an Old Injury

General principles for working around something that healed but changed you. Not medical advice — if something is currently injured, painful, or undiagnosed, that is a question for a physiotherapist or a doctor, and this piece will not answer it.

The distinction that matters

Acute: it happened recently, it hurts now, and it is still changing. Do not work around this. Get it assessed and follow the advice.

Chronic or recurring: it flares up under certain conditions and settles again. Needs proper assessment too, and there is usually a specific programme rather than a general one.

Old and settled: it healed, it does not hurt in ordinary life, but the area is different — less range, less strength, less confidence, and it complains under specific loads.

This piece is about the third case, which is where most long-term practitioners live.

Principle one: find the actual limit, not the remembered one

An old injury leaves two things behind: a tissue change and a memory. The memory is usually the bigger constraint, and it is often years out of date.

Test carefully, deliberately, in a controlled setting. Take the area slowly towards the range you have been avoiding, with no load, and find out where the actual limit is now.

Frequently the answer is that the limit has moved and you have been protecting a thing that no longer needs protecting. Sometimes it has not, and that is worth knowing too.

Do this on a good day, warm, unhurried, and not in a class.

Principle two: load the area, do not just avoid it

The instinct is to protect. Long-term protection is usually the wrong strategy: tissue that is never loaded gets weaker, and weaker tissue is more prone to being hurt again.

The general direction of travel — and this is well supported in rehabilitation — is graded loading. Start well below the level that provokes anything, and increase slowly over months.

What "slowly" means: ten percent more than last week, and only if last week produced no reaction.

What to watch: a reaction within 24 hours means you went too far. Back off to the last level that was fine and stay there for two weeks before increasing again.

Principle three: change the shape, not the effort

When a pose is not available in its standard form, the useful move is almost always to change the geometry rather than to do the same shape with less commitment.

• Knee that dislikes rotation: change the angle of the shin, do not just go less deep.
• Shoulder that dislikes overhead load: change to a different arm position entirely, do not just raise the arms halfway with the same alignment.
• Lower back that dislikes flexion under load: do the fold supine with the floor supporting the spine, rather than a smaller standing fold.

A half-hearted version of a problematic shape is usually still the problematic shape.

Principle four: strength on the other side of the joint

Almost every persistent problem involves a strength imbalance somewhere, and it is usually the antagonist that is missing.

• Recurrent hamstring trouble: check glute strength.
• Shoulder trouble in a practice with lots of Chaturanga: check pulling strength, which is almost certainly absent.
• Knee trouble: check the outer hip.
• Lower back trouble: check the glutes and the abdominal wall.

This is where a physiotherapist earns their fee, because the pattern is not always obvious.

Principle five: warm up more, specifically

An old injury site benefits disproportionately from a longer, more specific warm-up.

Five extra minutes of small, unloaded movement through the range you are about to use, before you use it. Not a general warm-up — the specific joint, the specific direction.

By area

Lower back. Loaded flexion is the usual provocation — forward folding with weight or leverage. Supine versions where the floor holds the spine are safer. Strengthen the glutes and the abdominal wall. Twists: keep the pelvis level and rotate from the mid-back, never crank with an arm.

Knees. Rotation under load is the provocation. Adjust the angle of the shin in every seated and kneeling shape. Avoid lotus and forced pigeon entirely. Strengthen the quadriceps and the outer hip. Deep squats: heels raised, feet wide.

Shoulders. Overhead load and Chaturanga are the provocations. Take the knees down. Add pulling work. Build overhead range passively before loading it.

Wrists. Reduce the angle — blocks, fists, forearms. Distribute load across the whole hand. Strengthen separately.

Neck. No shoulderstand without a proper blanket stack, no headstand, no turning the head in a twist, and keep the head neutral in almost everything.

Hamstring, at the sitting bone. A common and slow-healing yoga injury. Stop stretching it into pain; that perpetuates it. Load it instead, in mid-range, and build. This one specifically needs guidance — get it seen.

What to tell a teacher

Before class, in thirty seconds, specifically:

"My right shoulder dislocated four years ago. It is fine now except overhead with load — Chaturanga and handstand. I take the knees down and skip inversions."

That gives them the area, the history, the current limit, and what you are already doing. It is enormously more useful than "I have a shoulder thing."

When to stop and get it looked at

• Pain that is getting worse over weeks rather than better.
• Pain at rest, or that wakes you at night.
• Numbness, pins and needles, or weakness.
• A joint that gives way, locks, or feels unstable.
• Anything sudden, with a pop or a tear sensation.
• Anything that has not improved after six weeks of sensible management.

Practising through any of these is how a manageable problem becomes a permanent one. There is always a full practice available that does not involve the injured area, and taking six weeks to sort something out properly is cheaper than six years of working around it.