Hi Mukunda,
As I mentioned I recently received your wonderful book, Structural Yoga Therapy. I want to document my history and process here on the forum so that it may of help to others.
GENERAL INFO
Gender: Male
Age: 37
Height: 6’3"
Weight: 164 lbs.
Birth Info: 04/09/1969, 8:13 AM, Arlington, MA
Location: Maui, Hawaii
Prakruti: Pitta-Vata (45%/35%)
Vikruti: aggravated pitta and vata (6/06 diagnoses by Dr. Suhas Kshirsagar BAMS, M.D.:http://www.hawaiiholisticmedicine.com/dr_suhas_kshirsagar.php). I think I have kapha in the lungs as well, as evidenced by constant mucous and smoking in a “former life” (see HISTORY)
Diet: Lacto-vegetarian. Very occasional egg and fish. Following seasonal Ayurvedic guidelines for Pitta-Vata
Energy level and sleep are generally good/sound
PRESENTING/SYMPTOMS (Since March 2004)
- Constant, dull, hot (dry?) pain deep in left buttock
- A feeling of chronic muscle spasm/contraction, toxins (scaring?) deep in left buttock
- Acute, chronic sciatic pain in left upper hamstring/glute area. Aggravated by forward bending, stretching, and standing/walking/running. For the most part the pain stays in the upper hamstring area although I do recall it creeping down the leg and sometimes numbness in the sole of the foot when forcing (himsa) forward bends (a thing of the past)
- “tugging” pain in L4-L5-S1 area, becomes aggravated and more “nueralgic” when probing around intervertebral spaces
- Stiffness, pain, and cracking in knees (I’ve always had cracking, vata joints), aggravated by prolonged sitting.
- Occasional refereed throbbing pain to the inside of the left calf
- Numbness in tip of left big toe (much older symptom, see HISTORY)
Pain is worse in the morning. Spasm/nueralgia seems to be aggravated by standing and stretching.
Emotional/Mental: Indecisive, ambivalent, “feeling stuck,” sad, depressed (because of pain), somewhat angry/resentful
HISTORY
My history of back pain goes back 13 years, perhaps further. In college (UCSD) I was very active/athletic. I rowed crew for university (2 years) and then got into triathlon and distance running. On average, I ran 25-40 miles/week, biked 150-200 miles, swam 6-10 miles, and lifted weight 3-4x/week. I did this for three years. I also dabbled in various martial arts. In high school (Boston) I swam and played basketball.
I always had decent flexibility (as measured by the ease of touching one’s toes), average strength and above average endurance. My first remembrance of back pain was at age 20 (1989/90) – in the weight room while performing oblique twist with a 45 lb. barbell. I felt a sudden pinching pain in my lower back and immediately stopped. Nothing further became of it to my knowledge.
My real problems with lower back pain started in graduate school (London) after a car crash (1993/4). While in a cab, we crashed directly into a car that ran a red light. I saw it coming, and braced my body by extending my left leg straight in front of me, bracing it against the floor/back of cab drivers “wall.” We made impact at about 25mph. I took the shock up into the left hip.
Symptoms started in the months after the accident. Mainly involving pain in the spine and neck. My middle back and neck would “go out” frequently, requiring and osteopath’s adjustment. I had pain and stiffness in my lower back, aggravated by heavy lifting.
I started doing “The Five Tibetans” around this time, but found that upward dog and camel really compressed my lumbar spine. It is also worth noting that I became a vegetarian around this time.
Also during this time, I lost control of my studies, became more sedentary and was not doing much good for my body in general (smoking, etc.). The numbness in the tip of my left big toe started around this time. I think it was directly related to stimulant drug use coupled with a prolonged (5-6 hour) sexual encounter. I had discovered and been practicing (probably incorrctly) Toaist “sexual kung fu,” and perhaps ran too big a charge through my unprepared circuits.
I returned to the states (1996) seeking a resolution to my pain. Uninsured, unemployed, and disinterested in the allopathic establishment, I sought out alternative care. I happened across ashtanga yoga and felt better than I could recollect after one, one-hour class. I jumped into it full bore, like a typical vata, pushing my body too hard and doing himsa in the name of the ego (very typical in ashtanga circles).
It was during this time, studying with my teachers (regina and sri patthabi joyce’s newphew: vishwanath) and attending workshops (birch, freeman, swenson, habbermann, campbell), and doing my best to practice primary series 6 days/week, that I realized the sciatic pain. I thought it was muscle pain, but my teacher told me it was a nerve. David Swenson’s assistant gave me a modified Gomukhasa in a workshop, which cured it almost instantly.
Now it was just the matter of the lower back pain. I attended a 6 day workshop with Karen Habbermann who put my through vigorous back-bending, immediately followed by a week in Boulder at Richard Freeman’s studio where I continued to “abuse” myself. Being at altitude and practicing multiple times each day was the end of it – both my back pain and my stamina. So my after roughly eight months of practice my pain was gone and I was totally burnt out. I took 3-4 months off, without pain and then tried to reestablish my practice without much success. My teacher had moved to NYC and the practice group had diffused. Sometime over the next months I managed to get back to it, but never really back to doing the full primary series. The pain started to creep back. 7 session of acupuncture worked wonders.
In 2001, I moved to Hawaii, planning to study Ashtanga intensively. I never really got there. I’ve practiced regularly, but for the most part just sun salutations, standing and closing sequences. For the most part without a teacher’s guidance as I (naively) thought I had a good foundation and understanding of yoga.
My acute symptoms started in March 2004, after a 3-week (15+ hour/day) stint at the computer developing a website for a client. At that time I was sitting on a swiss ball, vacillating between extreme lumbar/pelvic flexion (holding stress) and extreme lumbar/pelvic thrust and sinking chest. I also had a tendency to bring my left foot up onto the ball and then let the knee fall out and down. I think these patterns contributed to much of the imbalance and problems I’m still dealing with. I now sit on meditation cushion on the floor cross-legged at my computer. I’m considering purchasing a proper ergonomic office chair because of the knee problems…
I injured my right MCL when squatting down too fast and putting too much weight on the right leg. Since I’ve been over compensating for pain in the left leg, by shifting more weight to the right. This was about 18 months ago and has healed, but I know have cracking in my right inner knee when binding. When the right knee was injured I had to put more weight on the left leg and then I injured the left MCL when squatting (I can’t bend over forward). The left knee is much better now, I can sit in Hero again, but I can’t squat (fully) or bind without discomfort.
All along, I’ve been trying to stick with my ashtanga practice, but it hasn’t helped. My teacher started me on second series, but by the time got through warmups and standing, my piriformis and sciatic nerve were so aggravated that I couldn’t relax them even in gentle backbends. Furthermore, I had to discontinue second series when the knee problems began. I have to bend my legs SO MUCH in sun salutations and downward dog as well as thrust my pelvis forward that the asanas are not even recognizable. I always had a tendency to over extend myself in asanas – that is – extreme lumbar flexion and pushing the ribs up and out as well as over flexing the middle/lower back. I’ve corrected this now, partly because flexion is not even approachable.
I been to several chiropractors, ayurvedic massage, lomi lomi, and acupuncture. The lomi was helpful with the trigger points, but I didn’t commit to the acupuncture ($) long enough to have an impact.
An xray about 8 months ago, Showed normal intervertebral space and was “suspicious” for “mild disc disease” – a good thing. I forgot to look at how level the pelvis/SI joint was. A chiropractor said it probably wasn’t a disc problem as well as the MD who read the xray and another MD I consulted.
I’ve tried all sorts of anti-inflammatory herbs, topicals, etc. Dr. Suhas managed to bring down my Pitta with pitta tea, gotu-kolu “herbal wine,” and a pitta diet, and helped me put on some weight with ashwaganda jam and Bala/Ashwaganda oil. But as far as fixing the structural problem, there was really no recommendation except “build up the body.”
On my own and with lomi, I’ve managed to work through a number of trigger points (one the size of a walnut) in the gluteal region (medius, minimus, maximus). Now that they have subsided I have more direct access to the points on the piriformis.
I’ve now resigned to taking it on myself to correct the problems and end this pain. I’m no longer attached to any particular form of yoga. I just want to be able to move through life normally and use my body without constant pain.
BODY READ
Underweight
Tendency to shift weight to right leg
Left leg is extremely externally rotated
Left hip/pelvis is twisted anteriorly
Left hip/pelvis is tilted lower than right
Left leg is slightly atrophied
Lordosis AND Khyphosis
Head titled forward
When bending over/forward and in downward dog (view from back), left hip dips dramatically, left leg bends, and knee floats inward to prevent rotator (piriformis) muscle from pinching nerve
Shortened gate (left leg)
Left hip pops when extending leg while lying on back and when squatting (pops into place – greater trochanter not sitting properly in socket?)
Pavanmuktasana Observations
I don’t have a goniometer, but my range of motion seems to be normal except for (can’t sit in dandasana, so I lean back to open hip/leg angle or bend the knees):
- Can’t achieve full let leg knee extension (est. ~30 degrees)
- Internal hip rotation on left leg is less than average
- Hip adduction going to my left is less than average, but feels kind of good if I’m gentle
- Shoulder internal rotation is somewhat less than average and even when I drop the elbows a bit
- Shoulder extension is maybe a tiny bit less than ideal
- Scapula abduction can cause a bit of a pinch in the sciatic unless VERY slow/careful/present. To clarify, it’s not the scapula abduction but the rolling back (thrust) the lumbar/pelvis with crossed legs.
- Cross legged and seated spinal rotation feel good if I don’t move the pelvis as well. It usually causes a pop or two in mid-lower back which seems to release some pain
GOALS
Stop the muscle spasms, allow the muscle to release toxins regain normal blood flow. Work through trigger points. Correct the structural imbalances by building strength in the appropriate muscles groups. Regaining normal range of movement. To be able to move about freely without pain in order to live a normal life.
Longer term goals are to reestablish a regular asana practice and build strength, flexibility, and balance in my body, and to be able to sit comfortable for pranayama and meditation. Realization of Self.
SELF DIAGNOSIS
Dramatically shortened and weakened left piriformis muscle pinching the sciatic nerve and causing referred pain to sacrum, hamstring, and calf. Resulting in twisted/unlevel pelvis an compromised “foundation.” Possible SI joint instability/hypermobility. Weakened surrounding musculature (hamstrings, glutes and other external rotators, quads, and abs) do to inability to be active. Weak scapula adductors. Asana practice to date has served to aggravate the problem.
Asanas and movements I think are needed:
SI Stabilizers
Cat-Camel
Sunbird
Cakravakasana
Pelvic Tilt/Thrust
Rolling Bridge
Squats
Mountain
Warrior I (II?)
Tree
Bridge
Shoulderstand
Energy Freeing
Child’s Pose
Boat (Navasana)
Cobra and variations
Locust and variations
Hero
Camel
Corpse
Bound Angle
PRESCRIPTION/WHAT I’M DOING
As you mention in your book, stretching doesn’t seem to help with chronic pain. So, I need to focus on strengthening the right (inferior/opposing) muscle groups and focus on relaxation, breath-work and meditation.
-
SI stabilizer movements 2x/day. Joint freeing series in the AM
-
Manually massaging the gluteal area several times a day with a homemade warming oil: bala/ashwgahnda in sesame base with EOs of pine, rosemary, marjoram, black pepper, oregano, chamomile, juniper, grapefriut, and bergamot. Also added some New Chapter Zyflammend to it and St. John’s Wort extract.
-
Using a trigger point ball (http://www.tpmassageball.com/productinfo.php?id=4) to release the piriformis 2x/day and for deeper massage
-
Only sitting at the computer for 20 minute intervals and then getting up to move around for 5 minutes
-
AM/PM 20 minute meditation
-
PM Asanas and Movements as noted above
QUESTIONS
-
INRE SI Stabilizer movements. The PDF you sent states “Inhale and lift your HIPS tensing the outer gluteus medius muscle. Exhale as you lower the HIP coming back facing forward.” Are you supposed to lift both hips or just the hip of the leg folded back?
-
Should I be doing the entire joint freeing series?
-
Are the asanas/movements I noted appropriate?
-
How should I sequence the asanas/movements?
-
How long should I stay in the asanas/movements? Should I move into and out of them repeatedly, or hold for a # of breaths, or both? Should I do “sets” of asanas? I’m comfortable in most of them for at least 5-8 breaths.
-
Is there any more info I could provide that would be helpful?
Namaskar,
-t