A Balanced Look at the New York Times' "How Yoga Can Wreck Your Body" - What We Can Learn From William J. Broad's Research and a Response from a Long-Time Yoga Teacher

 

Photo: Danielle Levin, NYT

 

"How Yoga Can Wreck Your Body,"  by William J. Broad, New York Times, January 5, 2012

 

 

"Among devotees, from gurus to acolytes forever carrying their rolled-up mats, yoga is described as a nearly miraculous agent of renewal and healing.

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."

“[Long-time yoga instructor, Glenn Black's] 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.’ A lot of people don’t like to hear that.”

-William J. Broad, "How Yoga Can Wreck Your Body,"  New York Times Sunday Magazine 1/8/2012

 

 

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Last Sunday the New York Times trashed diets, when Tara Parker Pope told us, "Forget about losing weight.  It's not going to happen."

This Sunday, they are telling us to watch out for yoga!  The one physical activity we all thought was "safe" for bodies of all ages.  Not!

But, not so fast!   Believe it or not, the article is worth reading.  If you've attended a yoga class since the article hit the net--I'm sure you've heard the buzz--and your teachers all had something to say about it. 

Mostly, though, it's pretty much common sense.  I'm appreciative of Broad's research.  It confirms what I've thought all along.  Give me safe, slow, and restorative!

But, before I get into what the article says about the risks of yoga--plus a thoughtful, balanced, & knowledgeable response, written by a long-time Iyengar yoga teacher in Massachusetts (who reads HHLL), here's the inside scoop about the author, William J. Broad--the part that the New York Times neglected to tell its readers:

 It puts things into perspective.

 

William J. Broad, didn't only write the "watch-out for yoga" expose we all read in the Sunday Times. 

Here's what the NYT neglected to tell us:

That article was only an excerpt from one chapter of his new book--The Science of Yoga: The Risks and the Rewards.  Yes, you heard that right!  Rewards.

Broad is a Pulitizer Prize winning science journalist for the New York Times, who has practiced yoga since 1970--and he's spent the last five years investigating all the health claims & safety risks made in the name of yoga.

His research confirms that yoga improves stress, health, mood, creatvity--and lowers blood pressure & improves cardiac health.  It won't, however, help you to lose weight or oxygenate your blood with yogic breathing.  Good to know.

Robert Love, who recently reviewed the book in the February 2012 issue of the Yoga Journal, says the book is balanced, with Broad presenting research on yoga's darker side.  It's not without its risks--just like any other sport or physical practice. (Thank you Iyengar teacher from Massachusetts for sharing this review with me.)

 

"Broad's book will no doubt get attention for the 34-page chapter devoted to yoga's dark side--which he defines as the risk of injury, illness, and death.  He writes about the danger of stroke and vertebrae damage in the longtime practice of inversions such as Plow, Headstand, and Shoulder Stand--correctly labeling medically documented tragedies as rare but significant events.

Broad sees his work as a kind of "informed consent" for yogis.  He reveals the dangers, and he leaves it up to the individual to find an intelligent, healthy practice."  (Amen, I say! H.L.)

 

 

The Darker Side of Yoga

 

OK, a little back story.

I took my first yoga class in 1972--and back then, it was the slower, gentler variety.  I've practiced on and off over the years, but I've been a regular for the past 10 years or so.

I've been to every possible kind of class. 

• The Power Yoga classes taught by former-aerobic instructors and dancers.  I'm not a fan.
• The Restorative Yoga classes with props--and careful moves.  I'm a fan--but I don't attend these often enough, because I still like to be challenged. 
• The generic yoga classes taught by teachers who have studied for years, and the newbie teachers who know less than I do--and were "certified" with a 30 hour course.
• Iyengar, Ashtanga, Hatha, Anusara, Jivamukti, Kripalu, Integrative, & Vinyasa Yoga.  I've attended classes with teachers trained in all these disciplines.  Dr. Loren Fishman, the physical medicine specialist who uses yoga in his own practice, recommends Iyengar & Anusara, because of the training required, and their more gentle, safe, and careful yogic approach.  And going to a teacher with at least 5 years of training.
• Since reading Broad's article, I've attended two classes that prove his point.  There were older seriously out-of-shape beginners who were doing moves that could hurt them--and the class was too big for the teacher to either notice, or be able to properly correct them.  Students can easily get caught up in trying to "do everything" and not listen to their own bodies.

Bottom line for me.

• It's all about who is teaching the class.  I want a teacher who is experienced, careful, and can describe in minute detail how I can self-adjust my body to get into the proper position.
• I want a class that restores my body, doesn't punish it.  I do yoga to gain flexibility, balance, strength, calm me, and change my outlook.
• I'm not looking for a cardio work-out, or to get into crazy scary poses.  I've never done the crow pose, let alone side crow.  I no longer do shoulder stands, or the Plow.  I've only done a very carefully executed headstand, without any pressure on my head--assisted by a teacher I trust--and supported by a wall.
• Yoga postures balance out my tight spinning-class muscles.  I absolutely have experienced the benefits of yoga postures that relieved the discomfort I sometimes get from piriformis muscle strain (aka sciatica) caused by sitting & crouching-over on a bike.  Dr. Loren Fishman does a good job of explaining just how yoga helps sciatica.  But, that's for another post.  Promise!

 

 

Yoga's Risks - William J. Broad's Warnings

 

Broad's a long-time yoga student, who began practicng in his 30's, after he ruptured a disk in his lower back, and found that he "could prevent bouts of pain with a selection of yoga postures and abdominal exercises."

But, then....while in an extended side-angle pose in 2007--"hailed as a cure for many diseases"--his back gave way.  That's when he had his epiphany--that yoga can work both ways.  As a source of healing, and of harm.  

Side Note:  The side-angle pose gave me some instant back problems, too, a year ago--but, in my case--it was the "straw that broke this camel's back".   It was really started by a combo of bike riding in that awkward crouched position, coupled with inadequate stretching afterwards, a couple days of too much sitting, and twisting my torso to work on my computer.  Yeah--too much info. 

Just saying...Broad's back problems might have had a non-yogic origin.

 

Problems in the Yoga World

• Some teachers who try to make it "as hard as possible"  & leave it up to the student to make it easier on themselves.
• Many celebrated teachers sustain their own injuries, because of underlying physical weaknesses, that make injury inevitable.  There are teachers with bad backs & degenerated hip sockets--but their egos prevent them from realizing that yoga has caused the damage.  They would be wiser to work on strengthening the weak parts of their bodies and improve the range of motion, instead of doing a set series of poses.   (H.L.  In my favorite class, that's exactly what we do--work on strengthening weak muscles, and improving range of motion)
• Well-known yoga teacher, Glenn Black believes he developed painful spinal stenosis from over 20 years of extreme back bends & twists.  Black has now recovered from the spinal fusion surgery that relieved his pain--but his range of motion will never be the same. Without surgery, his surgeon said he eventually would have been unable to walk.

The  Downside of Yoga's Increase in Popularity

• Popularity has soared.  More people--more injuries.  Yoga's exploded from 4 million students in 2001 to 20 million students in 2011
• Older & less flexible students.  Many student's are older--and most of us sit in chairs all day long and we're inflexible.  Going to a studio 1 or 2 times a week & then twisting into "ever-more-difficult" poses is bound to cause strain.
• The Gentler Alternative Isn't Always Gentle.  Many student's come to yoga as a "gentle alternative to vigorous sports or rehabilitation for injuries"--but, too many studios have teachers who "lack the deeper training necessary to recognize when students are headed toward injury".  Some teachers unwisely, push students beyond their abilities.

Poses to Watch Out For

Broad goes on to list a number of serious injuries that are blamed on specific yoga poses--and he's interviewed some of the physicians who have written articles on yogic injuries.

Here's what I want to stress.  Much of what Broad puts forth as evidence of risk is coming from "case reports"--which is a medical article written about an unusual, previously unreported case.   Get that?  Unusual.  Previously, unreported.

 

"A Growing Body of Evidence?"    When I did a literature search of the PubMed database of medical articles back to 1946, I came up with only 17 articles on injuries reported from yoga.  Most of these were case reports--which most physicians wouldn't get too excited about.  Granted, I didn't spend a long time coming up with the most detailed of search strategies--but, far & away, most of the articles written about yoga were on its benefits--not its risks.

I've created at page with the medical journal citations I found on Medline/PubMed.   Click here to see them, if you're interested.  If time permits--I'll search further.

 

Now back to Broad's list of yogic injuries & risky moves

• Yoga foot drop.  This will surely scare you.  A male college student sat upright on his heels in a kneeling position (vajrasana) for hours a day.  He experienced difficulty walking, running, and climbing stairs because of nerve damage to a peripheral branch of the sciatic nerve.  He improved rapidly when he gave up the pose.  There are about 5 reports of yoga foot drop.  (Watch out for this one, dear readers!)
• Excessive neck flexion & head trauma.  Vertebral artery injuries.  Nerve compression. The serious stuff.  "While rare, some yoga postures threaten to cause strokes, even in relatively young, healthy people," according to Oxford neurophysiologist, Dr. W. Ritchie Russell (see: British Medical Journal, 1972)  

Watch out for direct trauma to the head in head stands, quick movements or excessive extensions or hyperflexion of the neck, as in cobra pose, the wheel, or incorrectly executed shoulder stands "with the neck maximally flexed to the floor" (click here for that report)--which Russell warns can injure vertebral arteries, producing clots, swelling and constriction, and eventually wreak havoc in the brain.  These poses can also cause nerve compression.

The basilar artery is of particular concern, according to Russell--because reduction of blood flow can produce strokes.  The majority of patients suffering such a stroke do recover most functions.

"Normally, the neck can stretch backward 75 degrees, forward 40 degrees and sideways 45 degrees (good to know), and it can rotate on its axis about 50 degrees.  Yoga practioners typically move the vertebrae much farther--like 90 degrees."  I'll be watching for that one.

• Emergency room visits have increased with 13 in 2000, to 20 in 2001, and to 46 in 2002.  Broad seems to forget that he already told us that the number of students is increasing rapidly.  Of course we'd expect to see more injuries.  That said--remember that only a fraction of those injured ever visit an emergency room.  Most people just see their family doctor or a chiropractor. 
• Hot yoga.  "[H]ealth professionals [have] found that the penetrating heat of Bikram Yoga could raise the risk of overstretcing, muscle damage and torn cartilage. One specialist noted that ligaments--the tough bands of fiber that connect bones or cartilage at a joint--failed to regain their shape once stretched out, raising the risk of strains, sprains, and dislocations."
• Lower back injuries are the most common yogic injuries, followed by shoulder injuries, knee & neck injuries--as reported in a 2009 Columbia University College of Physicians & Surgeon's worldwide survey of yoga injuries.  There were 4 cases of some degree of brain damage caused by extreme bending & contortions also reported in this survey.  Sorry, I was unable to find a citation to the survey results.  

 

The Flip Side--Yoga Can Relieve Lower Back Pain

 

Yoga trumps traditional medical care for chronic & recurring lower back pain.  This article appeared in the Nov 1, 2011 issue Annals of Internal Medicine 2011;155:569-578 and I definitely took notice. 

But this wasn't just any yoga.  This large, well-designed 12 month British study employed an Iyengar-style yoga that was practiced at multiple study sites, where students attended 12 weeks of yoga classes. 

The movements are careful and slow.   Instructor's make sure that the students' positions are correct, and they teach safe postures & body alignment, along with relaxation.  But, gee whiz!  Why were the researchers surprised to find out that in order to keep back pain at bay--the students had to keep attending classes & practicing? 

All the students received a book of detailed postures & routines for home study, as well as a relaxation CD.  Interested?  Here's the good news:   the book & the CD used in this study will be available for purchase around December, 2011.   Go to this website for all the details.   Go to this link for 2 short videos that explain the results of the study, and the specific yoga techniques that were used.

 

The Other Side of the Yoga Story - A Teacher's Response to "How Yoga Can Wreck Your Body"

 

Last Friday night I emailed a regular blog reader, who I know is the kind of yoga teacher we all want to have.  She's dedicated, well-trained, and brings a quality to her classes that not only improves her students bodies, but nourishes their souls.

I asked her if she would write a response to Broad's New York Times article--and she generously accepted.

Here it is.   Thank you so much, my favorite Iyengar yoga teacher from Massachusetts!

IMHO--She does a much better job than William Broad, in explaining how to safely navigate the yoga world--and find a class that will work for you!

 

 

What a Yoga Teacher Wants You to Know

 

Her Back Story

"I have been studying yoga since 1993 and teaching  since 1999 after graduating from a intensive teacher training program. I have been fortunate to study and teach in the Iyengar style for all of that time. I see about 80 students a week and many have been with me since I began teaching.

I love what I do and I have witnessed the deep and profound benefits of yoga for myself and my students.

I consider yoga a kind of extreme mindfulness training that begins with the physicality of asana practice and eventually, hopefully, spreads into all aspects of one's life.

 

The Yoga Disconnect - Unrealistic Expectations

 In response to the William Broad article, I believe yoga suffers from two popular disconnects: a very high expectation level (I can look like the models in Yoga Journal and attain a high level of strength and flexibility if I attend class on a weekly basis) and a very low threshold of admittance (yoga is for everyone no matter what one' s physical condition).

 

These two beliefs create a pool of students with enormously unrealistic expectations who are the majority of students seen by yoga teachers.

Over time both of these expectations generally even out through experience and sadly enough sometimes through injury. One can imagine the result if these two kinds of thinking were applied to attaining minimal proficiency in almost any other physical discipline, e.g ballet, martial arts, archery, swimming.

 

Students are not the only ones with unrealistic expectations.

Yoga teachers with backgrounds in dance and gymnastics may also meet their students with unrealistic expectations.

It's like having a math teacher who finds the currency of numbers an easy universe in which to move. One really wants the math teacher who knows and understands the struggle of making that universe feel like home. In addition, what teachers expect and in some cases demand of themselves can also be unrealistic and ultimately injury producing.

 

In the early days, yoga was transmitted individually from teacher to student.

Only later when yoga became popular were large classes considered acceptable. This has enabled many people to enjoy yoga who would not have in the previous arrangement, but presents serious issues for students as well as teachers.

 

The Iyengar method in contrast to some other yoga schools has a very solid pedagogy.

There is a syllabus of poses in ascending difficulty and technically one does not progress to the next level unless proficiency is demonstrated in the lower levels. In a general class that is not always possible.

The Iyengars have changed the way shoulderstand is done since the early unsupported method and now it would be very unusual to find an Iyengar teacher who did not required the use of stacked blankets under the shoulders to prevent the flattening of the cervical curve.

However, one problem is that teachers tend to expect students to self-eliminate themselves from poses that concern them. That is very tough for students to do who driven by the desire to please the teacher and do what they sense is expected. 

My teacher used to say to some very driven students in class, "Work with 20% less effort." Perhaps that percentage is too low now and should be revised upward.

 

Some basic bottom-line suggestions

1.   Insist on an a certified teacher. Check with Yoga Alliance: www.yogaalliance.org for a certified teacher.

2.  Hunt out a small class. Ten is ideal. Over 20 is getting too big.

3.  Attend class regularly.

4.  Avoid classes in gyms. Sorry, but I've taught them. They are too general. Too many newbies and not enough consistency. Once in awhile, you'll get an exceptional teacher but it is an exception.

5.  Graciously decline doing poses that worry you or make you tense. Ask for  similar but not so difficult poses.

6.  Accept that you will need to practice at home to enrich your class experience and commit to it. 

7.  Be kind to your yourself and savor what should be an absorbing and interesting time on the mat.

Namaste!

 

 I cannot thank our "anonymous" yoga teacher from Massachusetts, enough.  Her response to the article, and her suggestions are helpful, balanced, & honest.

I know one thing--I'm going to start looking for a smaller class.  She's absolutely right.

 

OK, all you yogis & yoginis out there.  What did you think of the New York Times article?

What kind of yoga class is your favorite?

 

Coming up:  What's good about yoga?  What does Dr. Loren Fishman say about how yoga can benefit our bones & joints?

 

 

 

 

 

Comments

[Barbara]

Dear HL,

I'm so glad you posted this. I, too, took my first yoga class in 1972. I was a college student and took yoga for phys ed credit. I've practiced off and on since then, but really regularly since about 1999. I started with Iyengar--and I really recommend that everyone start with Iyengar to build a strong practice foundation. An experienced Iyengar teacher can help you work with your physical limitations (we all have them), and once you know yourself as a yoga practitioner, it's safer to try other types of classes.

I've done every type of yoga imaginable with every kind of teacher. I seek out yoga classes when I travel, and I've had some wonderful (and terrible) experiences. I do yoga for exercise (a good vinyasa or ashtanga class is very aerobic. Emphasis on good.), for grounding, for peace, for serenity, for relaxation, for energizing. It's my first choice of activity in almost any circumstance. It's my love.

I've always had some restrictions in my right hip (probably from a bad fall I took as a child), and about 5 years ago, I found that I was losing considerable range of motion. There are those who would say that that's when I really began to practice yoga--when you come up against not being able to do the things you used to do, it's very confronting.

But I got to a point where I had to stop--I hurt worse when I practiced than when I didn't. The diagnosis was arthritis, and the treatment is a hip replacement. Which, since I'm only 57, I'm trying to put off for as long as possible.

So now I'm back in yoga. I started with gentle beginner classes, and I make sure I do the stretches I was taught in physical therapy every day. I now take an Anusara class with a teacher who works with me, and a vinyasa class with a wonderful woman who pays attention and advises me on how to modify my poses.

But I also had a teacher tell me (privately, thankfully), that since we store so much emotion in our hips, and there's generally a sexual connection, is it possible that I was sexually abused? I had an Ashtanga teacher yell at me in class when I did a hip stretch out of sequence (Ashtanga has a proscribed set of poses that you do in a specific order.) I've had teachers try to muscle me into positions (My left side is very open so I can do a lot more on one side than the other.) and berate me for not trying certain poses.

I would add a couple of things to your excellent advice:

1. Start with beginner or Level 1 classes and stay with them until you really know your body. There is no shame in being a beginner. "All levels" classes are really "no levels."

2. When you find a teacher you connect with, stay with him/her. You want to be known so that you can be encouraged gently and not pushed. You need to practice safely.

3. At the same time, be open to trying new classes and teachers; just know yourself. Don't let anyone adjust you if you're not comfortable with them.

4. Practice regularly, but accept that every practice is different. Today you might do a headstand; tomorrow downward dog might be challenging. Listen to your body and respect what it needs. Don't ignore pain.

As for the article, I thought it was interesting, and that it clarifies that yoga, done improperly, can be as risky as other physical activities done improperly. Mindfulness is key. And that's the point of yoga, isn't it?

Namaste.

[Gael in Vermont]

I agree with Barbara's well-said comments above...especially her last point about mindfulness being key in any yoga practice. Those of us that practice yoga with physical/movement limitations from either previous injuries or, in my case, osteoporosis, have to be very careful with certain positions. Politely declining, as your wonderful yoga teacher mentioned, is taking care of yourself. I've said before, yoga is not a competitive sport..."I can outstretch the person next to me or hold the pose longer"...no way! Everyone's practice is different and, for me, every time I go to the mat can be a different experience as well. My best advice: it's worth it to have a private lesson or two or three with a certified teacher who can closely monitor your body as it goes into positions...being sure you are not over-doing or twisting the wrong way. It was the best yoga money I've spent and I intend to do it again as I add new poses to my practice.

[babs]

I committed to yoga classes 2-3 times weekly seven years ago. I
could barely bend over, I was so stiff. I was lucky that a studio specializing in Anusura was in my town, and I have a couple of instructors who really know my body and the physical limitations I have. They make a point of asking students if they have any injuries or issues, and are very attentive to offering modifications. Our classes are described as Levels 1, 2 and 3, and I never attend one that isn't geared to include the Level 1 practitioner. I look at this journey as a very personal one. I am so much stronger and flexible than I was seven years ago, yet someone who doesn't know me could easily label me a very new student. I don't care! I am in it for me and not to prove anything to anyone else. I steer clear of teachers who seem to have a one-class-fits-all mentality or try to coax me past my limits. Whether they are teaching a Level 1 class or a 2-3 class, they only have one routine and one speed. We students must do our homework before we commit to a class.
This is not the first time the New York Times has taken something out of context. They are desperately trying to sell papers, with slanted, sensational articles such as this and TPP's hatchet job on dieting. Thank goodness for our HHL who really does her homework!

[The Healthy Librarian]

@ Barbara. Fantastic, thoughtful addition to the discussion. Thanks so much for taking the time to share your valuable experience. Anusara certainly looks like one of the yoga stars. Don't know of any one who teaches it in my neck of the woods. Wishing you good luck with that hip.

@Gael, great additions--good suggestion about taking a few private lessons to make sure you're doing things correctly. Received a b-day present last year of a private lesson & it refined a lot of asanas for me--and the correct way to do chataranga (sp?)

@babs. Thanks so much for your comment. A real advertisement for the power & value of yoga taught in a small studio, where the teachers get to know you personally--and can gently help you to progress. I LOVE your studio--and the teachers I've met. I had no idea that they were practicing Anusara style--one of Dr. Fishman's recommended styles--along with Iyengar. I do envy you for having a such an excellent studio--so near by, too. And thank you for the compliment!!!

[Sue in Denver]

Hi HL,
This is off-topic, but I'm kind of in a quandry and have not been able to find an answer, even after googling for an hour. My question concerns supplements. I just found out that my D3 drops have a coconut oil carrier. The dose (2 tiny drops a day) is very small, but Esselstyn does advocate "no oil--not even a drop!" So I ordered some tablets that did not contain oil. I am considering taking something else that contains glycerol. I read here, on your blog, that glycerin is fat. I'm confused. I don't know if I should be concerned about these tiny amounts. Any thoughts you have on the subject would be greatly, greatly appreciated.
And I will say (since I know everyone else is thinking it), we are still looking forward to the seitan brisket recipe! :-)
Thank you so much for your blog! You are appreciated!

[The Healthy Librarian]

Hi Sue,

Most capsules of vitamin D have some kind of oil suspension---I really like my Rainbow Light Vitamin D3 Sunny Gummies-Sour Lemon. Yeah, there's a little sugar in them, but they taste so good, I never forget to take them. Found a good price on Amazon. Not cheap--but, it's about the only supplement I don't every skip.
Not sure if this helps. There are plain tablets--w/o any sort of oil, but I never took them regularly.

[Cynthia Bailey MD]

I love my yoga class and credit it with seriously rehabbing my fragile back. BUT I study Tri-yoga, a type of yoga where pose/flow complexity progresses very slowly and only as a student is ready. I study in a studio with small class size and a highly qualified teacher. Progressing to advanced poses prematurely and unsupervised in large classes is an accident waiting to happen for even the fit. Many of today's yoga classes do exactly that sadly. Your cautionary admonitions are well worth noting for all of us.