The physiotherapist and devoted long-term yoga practitioner Lisa Salem (42) shares her therapeutic view on yoga with us and reveals why a lesion doesn’t mean that we have to quit practicing. She explains how she – due to her own pain and suffering – got into yoga therapy and its benefits, letting it inspire her work as a physical therapist. Lisa also discusses with us her opinion that students and teachers do equally have responsibilities in class (and what these are), and talks about some of nowadays most common pathologies – neck pain, among others –, giving practical examples on adaptations in the asana practice.
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Jennifer: Imagine a child asks you: “Lisa, what is yoga?” – what do you answer?
Lisa Salem: Hmm. To a child... I think I would say yoga is connecting your body with movement and creating balance – a connection between your body and mind, your thoughts, imagination and feelings. [She’s pondering a bit] I think I wouldn't make it any more complicated. [laughs]
[More serious] I think it is the connection between the physical mind, the emotional mind and the body. There is a representation of the human body in our brain – so we could say the body is actually all in itself in the mind.
“There is a body map in our brain”
Can you explain what that is, the 'physical mind' and the 'emotional mind'?
In the physical mind, the human brain, there is a "body map" which represents different parts of the body that, in fact, control our movement. It’s not the fact that I point my toe and it sends directly the message; my brain sent, long before, that message to point that toe. The emotional mind is about our past experiences, our fears, inspirations, our connection with other people. It influences all these things that are related to what we feel. It influences us in movement as well as in what we do. I like to refer to it as psychosomatic (psyche - mind, soma - body), linking our body and mind and understanding that we are both mental and physical beings.
All right. So, both are linked with each other, and interdependent, as it seems....
They are very closely interconnected, and I think we should be more conscious that our mind, beliefs or thoughts have the ability to cause physical changes. There are many health problems related to stress and tension and our body reacts to this through physical and emotional responses. To give you an example: a lot of people clench or grind their teeth whilst sleeping at night, medically known as bruxism. One of the main causes is stress-related, psychosomatic, and not just in the temporo-mandibular joint. Unfortunately, as a consequence, it can eventually cause damage to the joint or muscle tissue. It happens for instance because we are emotionally strained, frustrated or thinking too much, or not with a relaxed attitude when going to bed. Consequently, this involuntary grinding of the teeth can lead to constant muscle tension in the neck and, hence, spark neck pain. I think that there is a big part of the population whose neck pain is caused by stress, anxiety and ongoing tightness and tension without learning how to release it.
“I used to be in the air a lot, doing flic flacs”
Why and when did you get on your own yoga journey?
When I was living in Australia, as a child, and later in my early adult life, I used to train gymnastics. Later in life, I got into circus training and then I also practiced capoeira. I used to be in the air a lot, doing flic flacs. Yoga, on the other hand, which I practice since I was 18 years old, is something that provides me with a grounded base to balance with these other types of flighty based sports like gymnastics or circus. It’s funny, because it seems contradictory: a lot of people say yoga brings them to a higher consciousness, which is definitely a true reality. But, for me, it has a grounding effect and helps me interiorize and reconnect me with my true being. Yoga is part of my life. So, later, when I left Australia to travel around the world, looking for a yoga studio was always one of my priorities. When I decided to stay in Spain (17 years ago), looking for a good yoga school just came naturally.
“I am a body person”
Can you describe your yoga practice – where and how often do you practise? Which kind of asanas (yogic body postures) do you like?
I go to class twice a week at an Iyengar center here in Valencia. I’ve been with my teacher, who is really great by the way, for eleven years now. For a good six of those years I attended therapy classes with him for my lumber intervertebral disc related lesion. He has an osteopathic background, so there’s a lot of information in his classes. I am a body person, I studied physiotherapy and physical movement. So, I thrive on the information my teacher provides us with during his classes. In a certain posture, he stops us and teaches anatomical aspects of each asana, the moments when you need to turn and twist, as well as muscle origins and insertions, anatomical function and movement. It’s a lot of information and movement-based work. That’s what I love!
On the other days, I do my self-practice in my studio, usually in the afternoon. In those days, I concentrate more on personalized therapy-based spine practice, because of my herniated discs.
“A lot of people used to say ‘Ah! Yoga is not good for you’”
When and why did you discover yoga therapy and began integrating it into your life and treatments?
My interest in yoga therapy began basically when I began feeling pain and discomfort in my lower back. In the beginning, I didn’t know what it was or why I was feeling this pain, but I did know that some postures were just not good for me. The teachers I had back then didn’t quite know how to adapt the postures, so I knew I had to find another teacher that could help me do yoga without feeling any pain. I found an Iyengar yoga teacher (my current teacher) who happened to also be osteopath. He believes/thinks that it is a lot easier and successful to treat people with yoga and not just through touch. I was diagnosed with three herniated discs after a major back crisis and found myself not being able to walk, I knew that acrobatic and capoeira work had a negative impact on my body.
By that time, I had already started my degree in physiotherapy, and all my past body and yoga experiences just clicked into place. A lot of people, for instance doctors or teachers at university, used to say “Ah! Yoga is not good for you.” But, from then on, I began to figure out that I needed to focus on my yoga practice and make it good for me. It was both the need and the will to continue that made me not giving up on yoga, and had me continue with wisdom and knowledge.
“The yoga teachers didn’t know how to adapt the postures based on my lesion.”
How did you learn more about yoga therapy?
As a physiotherapist, and trying to understand my personal lesion, I learnt a lot from the yoga therapy sessions. Years of observing all types of people with different acute and chronic pathologies or injuries and through anatomical adjustments, posture alignment and adopting tools personally for each body condition. It’s important to understand the body mechanics of each posture and pathological processes in order to be able to use yoga as a therapeutic intervention. There are so many tools at hand, such as blocks, benches, ropes, belts, chairs, bolsters, and the list goes on... You can adapt all postures! The inspiration comes from Iyengar yoga and lot of the yoga therapists are Iyengar-based trainers. Personally, I believe it is a very logical, simple, mechanical and natural way of working the body; using tools or props to help reteach your body. The tools can be used to traction, align, support, simplify, and correct or simply bring attention to a body part or area.
“What people need is based on their experiences and environment”
What would you tell the teachers that defend the idea that the asana practice should not imply the use of tools, that this would not be real, pure yoga?
I would tell them: that´s okay. That is your training and your truth. My truth is that I tried different types of yoga like hatha yoga and it did not work for me. My body needed something else. My truth, in the end, is another than yours. What we need is based on our own experiences and environment. I think Iyengar works well. But I think hatha can also work well too. It also depends on the teacher, and not only on the style.
“One thing is to demonstrate a posture, one other is to give the information so that students can get into it and understand what is going on with their body in that posture.”
What characterizes, in your opinion, a good yoga teacher?
A good yoga teacher is someone who has experience with dealing with people and who knows how to transmit their knowledge and experience to others. Someone who has a deep understanding of yoga and its asanas. One thing is to demonstrate a posture, but one other is to give the right information so that students can get into it and also understand what is going on with their body in that posture. And, personally, I think that one yoga teacher that has some basic knowledge on skeletal muscle pathologies, such as common spine problems and joint problems (like knee or hip, for instance), stands out a little bit from the others.
“Students need to take responsibility for themselves.”
Given the reality that in many gyms and yoga classes there are around 30, 40 or more people and it is not possible for the teacher to know every attendee and their bodies – what can students do before they start their yoga practice?
Firstly, this is my advice to the yoga teacher in a gym environment with crowded groups with little or no knowledge of the attendees are: keep it simple, don’t complicate anything. Basic, simple moves. Don’t ask the student for too much and don’t push. It doesn’t go hand in hand, the yoga philosophy and the gym philosophy. Yoga –it’s all about professor and student. There’s a continuity, time for interaction, understanding and information, and it takes two, it’s interconnected. In the gym environment it’s difficult to teach yoga.
Students need to take responsibility for themselves, to know their body and respect their limitations and even more if they have a lesion.
What are your criteria to decide that you will combine physiotherapy with some yoga therapy in your treatments?
It depends on the clients and their lesion. A session is based on manual therapy, stretching, breathing and homework! I try to dedicate 15 minutes on teaching them therapeutic exercises to take into their homes. Here, I tend to bring in a lot of yoga therapy-based postures which are intertwined with the therapeutic exercises. And I always tell my clients they should get a few blocks, they are going to be amazed about what they can do with them!
“Postural imbalances, like the head forward posture, is a common case in today’s generation, since we look down to use our mobile, tablet or other devices for almost everything”.
What is the most common health problem?
I have clients with a lot of spinal problems, in particular, neck pain. Postural imbalances like the head forward posture are a very common case in today’s generation, since we look down to use our mobile, tablet or other devices for almost everything. The rounding of shoulders, anterior tension in the neck, as well as weak and tense mid back and neck muscles due to inactivity can eventually cause pain.
How do you approach and treat this common problem of neck pain – what are the steps towards healing?
I start with general exploration techniques: I look for postural imbalances, lack of mobility and muscle inactivity, pain and movement... In the acute phase of pain with movement this is my procedure: hands-on manual therapy work, gentle mobilization, soft tissue massage, myofascial liberation. Passive stretching to help open the chest. For postural exercises that students can do at home I would, for example, put a bolster or a blanket or some blocks under the shoulder blades and put them into a type of savasana (corpse pose, final relaxation pose) and let them open up the chest passively. In the second phase: muscle activation. A type of bhujangasana (cobra pose) working with very little and small movements in order to activate the dorsal muscles in the lower trap area. It is important here to tell students not to pull up too far, in order to keep thoracic muscles engaged, and not the lower back. Another pose is the adhomukasvanasana (dogpose): I recommend using a foam block and a yoga belt to bring consciousness to what areas you need to activate, especially the middle back.
During matsyasana (the fish pose), I put a block under their bottom, then I put one other block under the shoulder blades and another one under their head. It is fantastic to open up, and give mobility in the chest area. And, additionally to the extension work, I also do some thoracic mobility exercise in rotation.
“You can adapt almost every posture”
Do you also have yogis as clients with this problem?
Absolutely. Nowadays, everyone wants to do sirsasana (headstand) [laughs ]. My yoga practicing clients ask me: “Am I ever able to do sirsasana again?” I tell them: “Yes, but in another form. The spine is not to be compressed. We need to open and lengthen. You can adapt almost every posture you like.” For example: I train them to do sirsasana with blocks and without putting the head on the ground. It’s like a forearm handstand with the upper back in contact with the block. You can use it as a variation or as a preparatory pose.
It seems that the traditional sirsasana doesn’t fit any longer into our modern times, since we tend to have so many problems with our neck and our back...
I think it can be done if you don’t have any weird sensations or pain in this pose. But it should be done as a process of learning. It’s quite an advanced posture and one of the most difficult ones. Not just the technique should be taught, but you also need a lot of muscle activation when you are upside-down. The big problem with sirsasana is that you need to ensure you have enough strength and mobility in the thoracic spine and shoulders to support the head and neck in a weight bearing position. I think that, as a teacher, you need to understand these postures very well and break them down into individual movements, so that you are able to teach which parts of the body you need to activate in the final posture.
“There is a fear-based pain.”
What kind of body sensations should a yoga student pay attention to – how can yogis distinguish a good pain from a bad one?
It’s difficult to teach this because there are many different types of pain. For instance, fear-based pain. We are often afraid of getting hurt and this “fear” or “warning” can actually trigger off pain. I recommend the book “Explain Pain” by David Butler and Lorimer Mosely. A very simple way of understanding pain and how it works in the brain. Generally, and back to the question, you feel a stretch, but you shouldn’t feel pain in a posture. One thing is stretching the muscle and another thing is tearing the muscle. How do we feel the difference? I think we are smart enough and can feel the difference between these two components, if we pay attention.
What yoga style is less prone to cause injuries?
[laughs]. From my perspective as a physiotherapist, I think that Iyengar yoga is an excellent choice for therapeutic purposes. That’s what I’ve been taught and what I’m based on. But there are many different types and it depends on where you are at and what your goal is. You need to like it and enjoy it, and also feel a connection doing it. But as a therapeutic approach, I believe Iyengar can offer a lot.
“Understanding that my back cannot do the backflip anymore was a challenge”
What were the obstacles that you faced throughout your yoga journey and how did you transform them into positive features?
On a physical level, the major obstacle was my lesion, my back problems, and on a mental level it was lack of patience and acceptance. I’m a very nervous person and it was hard for me to deal with this kind of hyperactivity, especially as I was coming from gymnastics with a lot of air-based high emotions and extreme sensations. So, for me, being patient and understanding that my back cannot do a backflip anymore, was actually a challenge. That was responsible for that major shift, which made me want to become a therapy-based practitioner. Though, I must say, it is always a learning process, and it continues to be.
“Just listen to your body and let go of the all-or-nothing mentality.”
What would you tell someone who is momentarily feeling a bit demotivated and lazy to continue the practice?
Get out, get some fresh air, and move a bit. Just do basic or perhaps even restorative yoga postures without any strain. And just relax and breathe. Breathing exercises are really good for anxiety, stress or depression. Bring some oxygen into your system! I think the problem with us humans is that we have a tendency to go for extremes. Either we want everything or nothing. And we need to understand that when it comes to therapy-based work and yoga, the body has its own process, physically and mentally. There’s a time for everything, we just need to learn to listen and respect this. Whatever it may be: restorative, muscle activation, dynamic core, stretching and breathing or simply calming the mind in meditation. All phases and periods are equally important. Just listen to your body and let go of the all-or-nothing mentality.
Is it a risk for a yoga or asana practitioner to see a common orthopaedist who does not know too much about yoga?
Well, often there’s ignorance and a bit of an old school way of thinking. The continuous debate about choosing the Eastern or the Western way. But I think they can work hand in hand. A lot of the Western medicine is nowadays trying to acknowledge that yoga has a positive influence as there’s more and more scientific evidence. I don’t believe, though, that yoga can be the cure for everything. In some situations, we need the Western wisdom. Yoga, through conscient therapeutic movement can help on reducing pain, gain mobility, functionality and strength. Furthermore, using meditation and a calm attitude can also help our emotional mind to bring stress and anxiety levels down. If, by doing this, we can reduce the intake of medication, wow, we can say we’ve come a long way!
“I don’t believe that yoga can be the cure for everything”
How is the field of yoga therapy going to develop within the coming years?
About ten years ago, there was this yoga boom. So, nowadays it’s becoming more accepted in society as a mainstream therapeutic approach and will continue growing. Here in Spain, more and more physiotherapists work now with yoga and/or pilates, when before they only used to work with pilates.
What role does the diet play? And what is your diet like?
I think that a balanced diet is just good. And what works for one doesn’t work for the other. As each body and each digestive system is different, it’s important to listen to your body and learn what is good for you. And yoga can help here. I personally try to eat food in its most natural form. I tend to eat carbohydrates like rice and pasta, during the day, because that’s when I eat energy the most. I don’t eat a lot of meat, maybe only once a week, because my body just doesn’t ask for it too much. I eat a lot of fruit, veggies and salads and I drink a lot of water. Staying hydrated is really important.
Thank you for this interview.
About
Lisa Salem
Lisa Salem (42) is an Australian born physiotherapist who resettled in Spain in 2002. She used to practice gymnastics and capoeira for many years and along with these sports she has always practiced yoga to ground herself – for more than two decades. When her back problems became unbearable, she had to change her path in movement. That’s when she reconnected with Iyengar yoga and had her first yoga therapy experiences, something which was not only of great benefit for her own health, but is also influencing and inspiring the physiotherapy treatments with her clients. After her travel to India last year, where I had the pleasure to meet her at a yoga school, Lisa is now working as a physical therapist in her own studio in Valencia.
For more information: http://instagram.com/lisasalemfisioterapia
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