“Hey I did it! Look everyone, I’m doing it!” was what I remember thinking when I was Double Dutch skipping at our recent family Christmas function. I was feeling confident, smiling and showing off my superb skills at age 41. Even though I hadn’t skipped in 25 years, I could still keep up with the kids because I take such good care of myself—I’m fit, agile, do yoga for healthy aging, meditate, eat healthy, create joy, educate and inspire others to do the same. Life is good. I’m so perfectly healthy. Then I remember a sudden intense “hit” to the back of my lower calf at my Achilles tendon that accompanied a loud pop. I went down in excruciating pain—and shock. I was looking around to see what steel object had hit me at such supersonic speed. But I couldn’t find anything. My cousin said, “Nothing hit you, you just went down.” It was then that I knew from experience as a physical therapist that I had completely ruptured my Achilles tendon. This is an example of an acute unexpected orthopedic traumatic injury. I have treated several of these types of injuries over my career, but when you are the patient, it’s a completely different ball game.
Shari’s post on Acute Orthopedic Injuries defines what an acute orthopedic injury is and how it is managed. Today I’d like to discuss the process that you may go through after sustaining an unexpected traumatic injury and how yoga can help you through the process. This is based on my experience in treating these injuries over the past 15 years in an outpatient orthopedic setting, as well as my recent personal experience.
Immediately after my injury, I was in shock for about an hour after. I was also in denial, and not thinking clearly. I didn’t even go to ER that night. Intellectually I “knew” the treatment protocol and prognosis, but for some reason, I wasn’t relating it to my own situation. This makes me realize how important it is to have support and allow people to help you when you are going through trauma. I wasn’t in a balanced mental or emotional state, and I certainly wasn’t equipped to be making important decisions. However, it’s in this state, that we are asked to make a decision: Do you want to treat this surgically or take the conservative, non-operative approach?
The benefits of my regular yoga and meditation practice were becoming evident as I embraced the truth of the situation, surrendered and became completely present in the moment. The combination of increased mental clarity and wonderful support from family and friends led me to finally go to the ER the next morning.
I was informed that the recent literature shows that there is not much difference in the long-term outcome between surgical vs. non-operative approaches and that they don’t commonly do surgical repairs to the Achilles anymore. I would be placed in a plaster cast for two weeks, then transfer to a boot cast for six to eight more weeks after that. The surgeon said, “Okay?” I replied “Okay.” Then he left the room and started working on making my cast. I don’t remember asking many questions. Typically, I would ask many! But I was not my usual self. I was still overwhelmed with emotion: fear, anger, guilt and sense of loss. Everything was just happening so fast. I remember hearing similar stories from patients. I would guess many people go through this type of experience.
Over the next week, the question lingered: Should I get surgery or not? There are so many factors to consider when you are deciding whether or not to undergo surgery. For the first several days, I was using vijnanamaya kosha (intellect, wisdom) to aid my decision: researching evidence-based results online, reviewing my own anecdotal evidence from clinical experience, analyzing other PT’s opinions, having discussions with family members and spending time in self reflection. These methods certainly played a huge role in my decision. We must use our mind as a tool to process all the information, so that we make an “informed” decision. But as many of you know, when you have a difficult decision to make, and you’ve analyzed it over and over again from all angles, sometimes your mind is no longer of service to you. You just need to make the decision, and, as Shari said, “make the right choice for me.”
I want to share the role that meditation can play in making decisions. Simply observing all thoughts and emotions without trying to “fix” or “decide” for a few minutes each day helped me in my decision. I found that connecting to that space where my true self lies—without expecting or looking for an answer to my dilemma—was very beneficial to creating a clear mind. Often times the answer comes effortlessly after this (although it’s not wise going into the meditation expecting the answer because then you have defeated the intention of the meditation practice in the first place).
A yoga therapist/PT friend recommended that I try accessing pranamayakosha (energetic body) to help with the decision, an approach you might want to try for yourself. He recommended that I visualize each scenario in detail, and simply watch how my breath responds. I also brought awareness to how each scenario physically felt in my body. It was astounding to see the difference between the two scenarios. In the end, I opted to stay with the conservative approach to treatment and I can say that I finally feel at peace with my decision.
But it’s not over. I was told that rehab would not START for another eight weeks. As a physical therapist and yoga therapist, I intuitively know that there are SO many other areas and issues that can be addressed immediately post injury, even if we cannot touch or move the injured body part.
Allow me to briefly outline how I’ve been able to immediately use yoga for rehabilitation of this acute traumatic orthopedic injury. Keep in mind that yoga is not simply asana practice. “Yoga” means to “yoke” or unite body, mind, breath and spirit. In yoga, we can address all five kosha layers to optimize healing:
Annamayakosha (physical body):
- Asana practice involving non-injured body parts will help me maintain overall physical conditioning, to prevent overuse injuries of areas being overworked due to abnormal mobility patterns and to improve overall feelings of well-being. My practice includes Cat/Cow pose, Thread the Needle hip opener, One-Legged Downward-Facing Dog pose, One-Legged Plank pose, Happy Baby pose, and modified standing poses with a chair and bolster (Warrior II, Extended Side Angle pose Resolved Extended Side Angle pose, Reverse Warrior pose, Eagle pose arms, Cobra pose, Supported Side Twist with bolster, and Legs Up the Wall pose. Here’s the first in a series of videos that show my practice (you can find the rest here on my youtube channel):
Vijnanamayakosha (intellectual/wisdom):
- Injury Education. I researched recent literature about my injury.
- Meditation methods for pain and anxiety control. I’m using a variety of focused mantra meditations and mental/visual imagery via a body scan.
- Breathing methods to address pain and/or anxiety. I’m using belly breath, nadi shodana, and bee’s breath.
- Focused meditation on breath. Simply watching/observing without trying to change pattern has been one of my most powerful tools for finding peace during times of intense crying and frustration.
- Resources and support for grief/loss (injuries resulting in any form of loss are traumatic regardless of ‘severity’). What is working for me includes conversations with trusted family and friends and readings from “Untethered Soul,” including this interpretation of Yoga Sutra 2.16: “Painful effects that are likely to occur should be anticipated and avoided.” (See here for more info.)
- Meditation. I’m practicing observing and watching emotions without trying to change them, but knowing they are “not me.”
- For me, spirituality is connection to that space within that is true self, therefore connecting us to nature and all living beings. Injuries commonly cause a reduction of participation in normal social activities, resulting in feelings of isolation, loss and even depression. Connecting to ourselves, to others and to nature (even a daily brief outdoor meditation) can help us continue to feel this deep connection to spirit, which I believe is essential in any healing process.
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