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8 Thoughts on the Yoga & Injury Controversy

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There will be many more stories on the “riskiness” of Yoga
Given that Broad’s article drew a huge number of page views, I wouldn’t be surprised if other publications exploit interest in the “yoga injuries” meme. Broad’s NY times article and the NYMag profile of David Regelin allude to (famous) teachers downplaying (even hiding) hip replacements and other surgeries. Would it surprise you if someone does an exposé? In this competitive media landscape, anything is possible.

Modern postural Yoga is a collection of physical exercises
I’ve touched on this before, but there have been a series of books that indicate that yoga asanas in modern postural yoga are not thousands of years old (see the recent books by Buhnemann, Sjoman, and Singleton). Once you demystify yoga asanas and place them in the realm of other forms of physical exercises, then to the general public it becomes hardly surprising that the risk of (serious) injury is present. By now I think most yoga insiders have at least heard that many of the poses and sequences they’ve come to love are fairly recent in origin (less than 100 years old). Unlike many forms of physical activity, modern postural yoga does emphasize the breath — but it is hardly unique in this regard.

It’s ultimately pointless to highlight Broad’s lack of (scientific) rigor
It has been hilarious to read and hear the reactions along these lines: “The FEW examples he cites are old.” Have you read the Yoga Journal? It is hardly rigorous or empirically-driven! Ironically one of Broad’s examples (problems with head stands) comes from the medical editor of the Yoga Journal, and appeared on its pages. As I noted above, once the public realizes that modern schools of postural Yoga aren’t descended from centuries-old traditions, then the thrust of Broad’s article is so obvious it becomes hard to nitpick: challenging poses & physical exercises can lead to serious injury.

[BTW, by most accounts Broad's yet unpublished book covers the risk of injuries in a single chapter. Most of the book is devoted to research extolling the positive benefits of yoga. It will be interesting to see Broad's detractors turn supportive after the book is released.]

For some poses, it is hardly surprising that alignment is critical
Show a non-yoga enthusiast poses like head stand, shoulder stand, forearm stand, and plow pose, and chances are his/her initial reaction would be “That’s nice, but it looks like you can get hurt doing that!” Let’s face it, shoulder stand is awkward (and dangerous) for most beginners, yet many vinyasa teachers routinely include it.

Repetitive use syndrome
Do something poorly, and repeat it with enough frequency, and guess what happens? Glenn Black has pointed out that the repeated execution of Chaturangas can be detrimental. That’s bad news to many flow/vinyasa/power yoga teachers. Many students love these more vigorous styles, and to take away the heavy use of a critical pose (used in sun salutations) is going to be met with resistance. In a recent discussion on SF’s KQED Forum Glenn Black repeats this point, gets agreement from Baxter Bell, only to have an annoyed Jason Crandell pushback strongly. Crandell didn’t really provide a good counter argument to the concerns raised by Black and Bell.

[Jump to minute 36:00 in the audio clip below.]

Modern postural Yoga is very hard to teach SAFELY, at scale
One of the reactions from yoga insiders has been that yoga students themselves should take more responsibility, by listening to their bodies. I agree with that. But walk into a vigorous yoga class (say with 15 students), chances are during large portions of the class, sequences are being called out in quick succession. It becomes hard for a student not to try to keep up, and attempt to execute modifications to the poses being called out in real-time. (“Do pose X, for those of you who can’t do that, do pose Y instead.”) In most cases, fast-paced verbal instructions have to be delivered over loud music.

Now imagine being in a larger class (or even learning from a DVD or an online class), who’s going to check on you then? As I mentioned in my previous post Krishnamcharya preferred to teach one-on-one or very small classes.

One of the fallouts will be smaller classes that emphasize safety
I think a market will emerge for classes that emphasize proper technique, coinciding with students opting for more intimate settings. Some teachers will initiate this shift, a recent example is the NYMag profile of David Regelin. But because the yoga “industry” wants a mass market for its products and offerings, I think that students themselves have to drive this change. Business people can sense an opportunity: Broad’s article has led to potential books deals for Glenn Black. Look for safety to become the next big marketing tool.

The New, New Thing: Casual practitioners will move on to something else
Among tech hipsters in SF and other enclaves, rock climbing is taking off like crazy.

Related Posts:

  • 7 Reasons why safety is an issue within Yoga
  • Headstand isn’t for everybody
  • Paschimottanasana shouldn’t be taught to beginners
  • Finding the right Yoga Teacher
  • Written by virtualsatsang

    January 22, 2012 at 12:40 pm

    Posted in Yoga

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    7 Reasons why safety is an issue within Yoga

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    Inspired by William Broad’s recent NY Times article, here are some reasons why safety is a growing problem in the yoga community.

    Many yoga teachers are undertrained: To put it bluntly, 200-hours of training isn’t enough. If you map that to a 40-hour week, that’s 5 weeks worth of training. Five weeks may be enough to teach English in a foreign country, but many modern yoga classes involve poses that can cause serious injury. I suggest to friends that they seek experienced teachers with 500-hours of training. Ideally 200-hour teacher training should be followed by a year of apprenticeship, assisting a senior teacher.

    Yoga classes have gotten too big: Towards the end of his life, the esteemed teacher Krishnamacharya mainly taught individual and small classes. In a large class a teacher just can’t scan the room fast enough to catch every unsafe alignment. I currently have primarily a home practice that I supplement with regular, one-on-one sessions with my (very experienced) teacher. Because individual sessions can be expensive, the other option is to find a small class in your local studio. Unfortunately small classes tend be held during inconvenient time slots (which is the main reason they are small to begin with).

    Mass media hypes Celebrity teachers: Not all famous yoga personalities are great teachers. Many become famous for reasons other than their teaching skills or knowledge of safety. In addition their classes tend to be extremely large and fast-paced.

    Large, fast-paced classes bring out competitive juices: With music blasting and the teacher yelling instructions, it’s not uncommon to scan the room and compare yourself with other students. “Hey that person can bend far, I can do that too!”

    Many standard poses are actually not as safe as you think: In previous posts I highlighted the headstand (sirsasana) and the seated forward fold (Paschimottanasana). In Broad’s recent NY Times article, he has stories of yoga teachers who’ve gotten injured while executing seemingly standard poses.

    Strict vegan diet and intense yoga practice: I admit this is pure speculation on my part, but somewhat based on anecdata. Many of the busiest yoga teachers are also strict vegans (or vegetarians). If you’re practice puts you at the level of serious athletes, then you have to make sure you have the diet to sustain your level of physical activity. As a group, Vegans probably need to be more conscious that they’re getting enough nutrients.

    Not enough yoga practitioners study history and anatomy: In some circles, there might be too much emphasis on the idealized/spiritual roots of modern asana practice, and not enough on recent academic research into the origins of modern yoga. The result is a physical practice that downplays science and empirical data. Fortunately there is also a growing number of experienced teachers who have assembled materials on yoga anatomy and gentle assists. Consult my reading list for possible resources.

    Related posts:

  • Headstand isn’t for everybody
  • Paschimottanasana shouldn’t be taught to beginners
  • Finding the right Yoga Teacher
  • Jade rides the current obsession with Celebrity Yoga Teachers
  • Yoga Reading List
  • Update (1/13/2012): Yoga teacher Glen Black, who was quoted extensively in Broad’s NY Times article, elaborates further in this excellent Huffpost interview.

    Written by virtualsatsang

    January 10, 2012 at 5:19 pm

    Posted in History, Yoga

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    Headstand isn’t for Everybody

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    A NY Times article about safety and Yoga asanas briefly quotes, Timothy McCall (medical editor of the Yoga Journal), on the dangers posed by Sirsasana. It reminded me of an article he wrote on Sirsasana way back in 2003 (yep, 2003 was 8 years ago).

    Headstand is one of those poses that many teachers introduce and include, without thinking twice. Most teachers are aware that it’s a pose not to be taken lightly, and safety precautions tend to be emphasized. Nevertheless, as McCall’s article below warns, even students who are comfortable executing the pose need to be aware that there are medical risks that come with Sirsasana. Unfortunately many teachers aren’t aware of those medical dangers!

    From the Sep/Oct 2003 issue of the Yoga Journal, page 34:

    Upside Downside?
    by Timothy McCall

    Last year, after developing a nerve blockage in the chest called thoracic outlet syndrome, I stopped doing Sirsasana (headstand). In the months prior, I’d worked up to holding the pose for 10 minutes, and I’m now convinced that the resulting compression of my chest led to the nerve problem. Shortly after stopping Headstand, the intermittent tingling in my arm went away.

    Looking at the faces of people doing Headstand, I often see little of the ease, sukha, that Patanjali stresses should be part of every asana. Some people appear to be straining or breathing erratically; and many students look like they can’t wait for the teacher to tell them to come down and rest.

    Even though the pose was never comfortable for me either, I had stayed with it because ofthe purported benefits. T. Krishnamacharya, the guru of K. Pattabhi Jois, B.K.S. Iyengar, and T.K.V. Desikachar, called Headstand the king of the asanas, and practicing regularly is stressed in Iyengar Yoga, the main style I’ve studied. Headstand is believed to calm the nervous system and promote a yogic mind (that is, foster equanimity), and has numerous physiological effects, including reducing the breathing and heart rates, slowing brainwaves, and enhancing the drainage of lymph from areas below the heart. It also induces reductions in norepinephrine, aldosterone, and antidiuretic hormone levels, and so tends to lower blood pressure.

    Interestingly, the pose is rarely taught by Desikachar and his followers, due to safety concerns, including neck problems such as herniated disks and arthritis in the cervical vertebrae (bones ofthe neck). Of greater significance is the potentially heightened risk of stroke in people with inadequately controlled high blood pressure and of retinal bleeding or detachment in those with some types of eye disease. For people with glaucoma, Headstand may further increase pressure in the eyes, contributing to loss of vision.

    Should you dare to go up? I tend to view the question in light of my own medical training. Doctors are used to the risks and benefits of any intervention before deciding what to do, and I suggest you do the same when contemplating potentially risky poses. For a certain group of yoga students, I have little doubt that headstand can be safe and of great value. These students have enough openness and strength to be able to lift out of the shoulders and thoracic spine and skillfully use their legs to bring further elevation. They are also able to maintain good alignment of the arms, head, and neck and to keep their feet directly over their heads. When the feet drift, it can generate an unhealthy torque on the cervical vertebrae.

    Given how tiny and fragile these vertebrae are, I wonder if it is advisable to teach this pose in open classes, in which students of varying levels may be participating. In a class setting, some people may end up doing what isn’t safe for them or what does not feel good. The desire to persevere with a pose that your body is indicating is not right (or not yet right) for you ought to elicit some serious self-study or svadhyaya. You might ask yourself why you are doing yoga and what you hope to gain from it. In this light, putting off or forgoing a pose you’d like to do can be an opportunity for growth and greater self-knowledge.

    If you have no strong contraindications but alignment is a problem, using a mirror, wall, or comer to give proper support can help. If they are available, wall ropes and props, such as two chairs, can provide excellent alternatives for those with neck or thoracic spine problems (see ‘Everybody Upside Down’ in our September/ October 2000 issue). If maintaining alignment is an issue, come down as soon as you lose sukha, then slowly build up gradually. More time on preparatory poses is also advisable. For those with poorly controlled high blood pressure, glaucoma, or retinal problems, however, Headstand may simply be too risky in any form.

    Luckily, there are many altenatives that can give you a wonderful yogic experience even if the pose isn’t right for you. Ask your teacher for recommendations.

    Related posts:

  • How many variations of headstand are there?
  • Yoga Reading List: My always updated list of favorite Yoga related books.
  • Written by virtualsatsang

    January 6, 2012 at 10:47 pm

    Posted in Yoga

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    Paschimottanasana shouldn’t be taught to beginners

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    In an earlier post, I listed some resources that might help you safely do seated forward bends. Walk into any yoga class, and chances are Paschimottanasana will be part of the session. But unless you’ve receive personalized instruction, I recommend you skip it entirely. Seated forward bends look easy and safe, but I’ve met practitioners who’ve hurt themselves in this popular pose. I just wish that more teachers recognize that Paschimottanasana isn’t something to be taken lightly. Sadly most teachers just include it in their classes, and many don’t even provide instructions as to possible safer variations (e.g., bend your knees).

    Back in the 1970′s, some yoga teachers recognized that Paschimottanasana shouldn’t be taught casually. But nowadays classes can be both large and packed with so many poses. Fewer teachers are taking the time to think through the dangers inherent in some routine poses. (From a profile of Diana Clifton in the Sep/Oct 1979 issue of the Yoga journal):

    Diana’s beginning classes are likely to include primarily standing poses and Sarvangasana (shoulder stand). The standing poses are important, she says, for “strengthening the legs. We have to start with the legs, because you’re constantly standing on your legs. Most peoples’ legs are weak, so they get very tired. When the legs begin to be strong, you can get a tremendous upsurge of health.” For the beginner she recommends Utthita Trikonasana, Virabhadrasana II, Parsvakonasana, and Parsvottanasana. which she feels are “…enough really for the beginner to take.” As for poses which the beginner should avoid, she feels that these are “…the forward bends [such as Paschimottanasana, mainly]. If ever I give people forward bends at an early stage I always point out to them that it’s for a particular reason, nor is this given to beginners in the normal way. If you teach more than you should to beginners they may pass it on, and one of the first mistakes is giving forward bends too soon in the wrong way. If someone has a weak back, the disc can be squeezed out.

    Written by virtualsatsang

    April 25, 2011 at 7:40 am

    Posted in Yoga

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    Finding the right Yoga teacher

    with 4 comments

    Following up a recent post on the same topic, more advice from Max Strom (A Life Worth Breathing, page 134):

    Try practicing with virtually every teacher in your area. You will find someone you resonate with — someone who will be just the right person to help you on your journey. A yoga teacher should be knowledgeable, kind, considerate, a great communicator, and show interest in your practice. Avoid yoga teachers who are vain and self-centered. If the teacher isn’t kind, move on. If they are not moral, move on. If they miss these two precepts, they are misunderstanding the purpose of yoga.

    Also, you should avoid teachers who tend to literally push students deeper into poses with aggressive hands-on adjustments. Hands-on adjustments are very useful, but only when done gently and mindfully. More injuries are caused by the ego of the student, pushing themselves too far, and the ego of the teacher, pushing the students beyond their limits.

    Written by virtualsatsang

    January 19, 2011 at 8:02 am

    Posted in Sadhana, Yoga

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    Safely doing Paschimottana

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    Seated Forward Bend is an asana that is part of most yoga classes. It is accessible and there are many variations using props like straps, blankets, and chairs. Unfortunately, when done improperly it is very easy to hurt yourself. It doesn’t help that students in a class tend to compare themselves with their peers, and in the process go deeper than they should. This is one pose that I wish yoga teachers would not rush into – proper technique matters a lot with Paschimottana.

    I looked around for useful resources on how to do Paschimottana, I didn’t find many specifically addressing safety (I’ve listed what I found below). Let me know if you know of any others that emphasize safety – I’ll add them to the list.

    • Step-by-step written instructions from the Yoga Journal: Draw the inner groins deep into the pelvis. Inhale, and keeping the front torso long, lean forward from the hip joints, not the waist.
    • How to Avoid Yoga Injuries : Yoga Seated Forward Fold

    • Paschimottanasana Benefits and Dangers

      The Sitting Forward Bend (Paschimottanasana) is one of the most demanding poses of yoga. In this pose the body is folded almost in half, providing an intense stretch to the entire back of the body, from the scalp down to the heels.
      Beginners often struggle in this yoga pose. If you pull yourself forward using your shoulders and arms you will create the tension through your body and you will end up tightening your muscles and this will not allow you to get into the posture any quicker. While doing this yoga pose, give some time for the muscles to stretch and to release the tension.

    • Yoga Shouldn’t Hurt: While this recent Yoga Journal article doesn’t address Paschimottana, it does give useful tips on how to avoid injuring your inner knees, hamstring tendons, and sacroiliac joints.

    Written by virtualsatsang

    October 20, 2010 at 7:29 am

    Posted in Yoga

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