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Proceed with Caution

A medical review points to the potential dangers of sudden neck movements in certain poses.

By Catherine Guthrie

Most yogis accept the risk of occasional aches, pains, or minor injuries as being part of a committed practice. But stroke? A recent review in The New England Journal of Medicine (March 22, 2001) lists yoga as an activity that may trigger an unusual type of stroke called arterial dissection.

The review's author, Wouter I. Schievink, M.D., a neurosurgeon at Cedars-Sinai Maxine Dunitz Neurological Institute in Los Angeles, says poses such as inversions (Shoulderstand and Headstand), Parsvakonasana (Side Angle Pose), Trikonasana (Triangle Pose), and Halasana (Plow Pose) were specifically highlighted because they can result in sudden neck movements or put extreme pressure on the neck. Other situations mentioned include chiropractic adjustments, hard sneezes or coughs, and even relaxing into a beauty salon's sink.

Here's how arterial dissection occurs: A rapid rotation or hyperextension of the neck tears a small hole in the lining of one of its two main arteries. Blood seeps into the pocket, causing a clot to form. The clot expands, like a balloon, until blood flow to the brain is stifled and a stroke ensues.

Sufferers may mistake arterial dissection for a migraine or muscle tension. Symptoms often include a piercing pain in the back of the neck; a pounding, one-sided headache; loss of taste; partial facial paralysis; or ringing in the ears. Warning signs can intensify for hours or even days before a stroke hits.

But don't cancel your next yoga session just yet. Arterial dissection is rare and strikes roughly 1.5 out of every 100,000 Americans annually, according to Schievink, with yoga being the culprit in a minuscule number of cases.

However, while arterial dissection accounts for just 2 percent of total strokes, it is one of the main causes of stroke in young and middle-aged people. In those 50 and younger, it accounts for up to 25 percent of strokes. Also, arterial dissection is not linked to atherosclerosis—the hardening of the arteries due to fatty deposits and cholesterol—which means it can strike people who maintain a healthy diet. In most incidences, it affects those who have a genetic predisposition to weakened blood vessels, says David Simon, M.D., medical director of the Chopra Center for Well Being in La Jolla, California. Yet, more times than not, there's no way to discover this defect until it's too late.

Although the condition is hard to diagnose because of its rarity, treatment is simple and recovery rates are high. After an extended course of blood thinners, roughly 75 percent of people make a "good functional recovery," according to the report. Death results in less than 5 percent of cases.

So, what can yogis do to protect themselves? "Listen to your body," says Simon. "Move into and out of asanas smoothly and slowly. Avoid thrusting, jerking movements. Go up to the point of resistance, but never push past it." Simon also says to avoid putting excessive weight on your neck in poses like Matsyasana (Fish Pose), Halasana, or Headstand, especially if you're a novice. "The benefits of yoga outweigh the risk of arterial dissection," he says. "Taking a commonsense approach lowers those odds even more."

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Reader Comments

Madhavi

I was ALMOST one of these people, so take his seriously yogis. As a yoga and meditation teacher, I always thought I was strong enough to practice headstand, shoulderstand, plow and lots of other challenging asanas. I started having problems with my memory.... I would forget what I was saying in the middle of a sentence and I generally felt very spacey. My doctor sent me to get an MRI and they found nothing. I luckily found a yogi neurologist chiropractor who did a test to check the blood flow to my brain. I was a hair away from having a stroke! After several weeks of treatment, it cleared up, Thank GOD it was nothing worse. By all means, anyone would have said I was strong enough and my positioning was perfect. I never teach headstand anymore and only teach supported shoulderstand and plow. I feel like my practice is better than ever... And most of all nourishing and celebrating ahimsa. You will be fine without headstand and can get the same benefits through other supported inversions. Namaste... Om Tat Sat.

Margaret W. England.

After teaching yoga for 35 years and know of the risks, I would not encourage any of my students to work on positions that could a stroke. Remember the first limb of Ashtanga, the Yamas, the first rule Non Injury. The benefits can be gained through working on other poses that do not add risks. Safety first.... Keep well, keep safe. Margaret W.

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