Yoga Injuries: The Bigger Picture

The controversial NYTs book excerpt about yoga and injury made some valid observations, says Baxter Bell, MD. But what the author neglected to mention is yoga's many rewards.
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The controversial NYTs book excerpt about yoga and injury made some valid observations, says Baxter Bell, MD. But what the author neglected to mention is yoga's many rewards.

On Sunday, an excerpt of the upcoming book, “The Science of Yoga: The Risks and Rewards,” was published on the New York Times Magazine. One of my students emailed the link to the article with subject line “Bad Press?” and the simple question, “What do you think?”

As it turns out, I’ve given this a lot of thought over the years. As a physician and yoga teacher, I’m interested in sharing the benefits of yoga with my patients and students, while realistically cautioning them on yoga’s risks for certain injuries, such as the risk of wrist strain with arm balancing poses if one is not properly prepared. I have noted that certain styles of yoga, especially those that seem to have a more aggressive quality to their practice like the Mysore Ashtanga series, if one is a beginner, tend to produce consistent kinds of injuries in students, such as shoulder injury from repeated Chaturanga Dandasanas. But I also know that there are many factors that go in to the development of an injury, and consider yoga poses to be one of many potential issues to address—your age, general level of fitness, history of injury from other activities, as examples. And I have no difficulty acknowledging the reality of asana risks, and in fact teach workshops on how to avoid the potential pitfalls highlighted here.

Perhaps the problem I see here is that this article creates an ongoing case for the negative potential of yoga asana, without balancing this with “rewards” Broad promises in the title of his book.

There are some valid observations. Broad features the experiences of yoga teacher Glenn Black, who cites a shift in the demographics of yoga practitioners, from people in India who are used to squatting and sitting on the ground to Western urbanites, arriving from the office or the car, sometimes ill-prepared for the physical demands of asana practice. He also mentions the lack of experienced teachers and instructors that push their students hard, with strong adjustments and ego-driven practices. Black also reminds us that one of yoga’s purposes is to diminish ego, not indulge it.

But then, the author goes on to mention the yoga community’s apparent silence on the topic of yoga-related injury:

“They celebrate its abilities to calm, cure, energize and strengthen. And much of this appears to be true: yoga can lower your blood pressure, make chemicals that act as antidepressants, even improve your sex life. But the yoga community long remained silent about its potential to inflict blinding pain.”

Although this may have been true in the past, since I got involved in yoga in the mid-1990s, I would say there has been a much more open conversation going on about the benefits and risks of yoga practice.

Broad continues to build his negative case, citing several instances of yoga-related injury, and mentioning statistics showing an increase in yoga-related injuries reported by U.S. emergency rooms, from 13 in 2000 to 20 in 2001, and up to 46 in 2002. What is not considered, however, is the simultaneous increase in the number of yoga practitioners during that time. In just 10 years, it’s estimated that the number of people doing yoga rose from 4 million to as many as 20 million. This could imply an overall decrease in the incidence of injuries, not the reverse. Statistics can be a tricky thing sometimes.

And as more formal study of the risk of injury has been done in recent years, the author makes an interesting statement regarding recent findings:

“The numbers weren’t alarming but the acknowledgment of risk … pointed to a decided shift in the perception of the dangers yoga posed.”

Ah, refreshing, even though the tenor of the article implies the opposite, that we should be alarmed!

Because I work in the area of yoga therapeutics and work with students who have injuries, some unrelated to yoga, some aggravated by their practice, and, on rare occasion, caused as a result of their practice, I might have a more balanced view of what to expect from a modern Western practice of yoga. I have often suggested to the teachers I train that there should be a disclaimer at the first class a student takes. Something like this:

“It is entirely possible that at some time during your practice of physical yoga, hatha yoga asana, you will experience an injury. Don’t be shocked or surprised by this. It is true of any physical endeavor. This may be due to your inexperience, attending a class that is beyond your present level of skill, underlying propensity for your body to become injured, inexperience of your teacher or many other factors. Part of your responsibility as a yoga practitioner, is to take the best care of yourself you can, ask questions when concerns arise, investigate the qualifications of your instructors, and so on.”

Then I suggest they also mention all the rewards one can anticipate, in including improved range of motion of the joints and improved physical strength and stamina. Plus there are mental-emotional benefits of being more grounded, peaceful and centered, just to name a few.

I couldn’t agree more with Glenn Black’s final quote: “My message was that ‘Asana is not a panacea or a cure-all. In fact, if you do it with ego or obsession, you’ll end up causing problems.’”

And I would add, if you develop a broader yoga practice, one that is not solely a physical substitute for other forms of exercise, but one that includes the full spectrum of what yoga is about—regular pranayama practice, meditation, exploration of the philosophy of yoga, involvement in Karma yoga in your communities—you are much more likely to reap the potential positive benefits of yoga and diminish the risk of injury highlighted in this excerpt.

Listen in as Baxter Bell, MD, Yoga Journal Editor in Chief Kaitlin Quistgaard, and yoga teacher Jason Crandell discuss this topic on Forum on KQED, the San Fransico NPR affiliate station.