In my travels, I learned of an experienced yogi who was said to know the inside story on yoga injury. Prominent gurus had supposedly come to him for help in rehabilitation and recovery. One client was reported to have received a hip replacement before reentering the celebrity life. I decided to track him down.
Glenn Black had traveled to India, studied at Iyengar’s school in Pune, and, like the ancient yogis, spent years in solitude. He ran yoga intensives in the jungles of Costa Rica. In New York City, for a decade, he studied with Shmuel Tatz, a Lithuanian who devised a unique method of physical therapy that he dispensed from offices above Carnegie Hall to actors, singers, dancers, musicians, composers, and television stars. Black had settled down in Rhinebeck, New York, on the Hudson River. Honored as a master teacher and anatomist, he often taught yoga at the nearby Omega Institute, a New Age emporium. Black had a devoted following drawn to his earthy, no-nonsense style. He also had an elite bodywork clientele that included celebrities. Of late, he was said to have narrowed his client list down to a handful of billionaires.
One day I noticed that Black was scheduled to teach a master class in Manhattan. I hesitated but was told that resolve was more important than skill. I arranged to talk with him afterward.
On a cold Saturday in early 2009, I made my way to Sankalpah (aim, will, determination) Yoga, a third-floor walkup on Fifth Avenue between Twenty-Eighth and Twenty-Ninth. The room was filled with lean bodies, roughly half of the individuals said to be teachers.
The class was brutal. Black joked, walked around a lot, talked constantly, played jazz on the sound system, watched us like a hawk, and cajoled relentlessly. Beads of sweat turned into rivulets. He was highly demanding yet surprisingly gentle, having us do lots of stretching, limb movements, and pose holding but no inversions and few classical postures. His teaching was nothing like the regimented styles. Instead, he worked us from the inside out. His approach was almost freeform and it seemed as if he was making it up as he went along, switching gears every so often to better challenge the range of aptitudes in the room or to pull us back from what he perceived to be some kind of cliff. In so doing, he conveyed a sense of intelligent vitality.
Through it all, he urged us to concentrate and try to develop our sense of attention and awareness, especially to the risky thresholds of pain. “I make it as hard as possible,” he told us. “It’s up to you to make it easy on yourself.”
Playfully, he rejected any doubts about his style. “Is this yoga?” he asked as we sweated through an extremely unyogalike pose. “It is if you’re paying attention.”
Black told us a grim story. In India, he said, a yogi from abroad had come to study at Iyengar’s school and threw himself into a spinal twist. Black said he watched in astonishment as three of the man’s ribs gave way—pop, pop, pop.
After class, I joined Black and his companion, Evelyn Weber, on a cab ride back to their hotel. They said they were both born in 1949 and were turning sixty. Both looked much younger. “I am certified in nothing,” Black remarked at one point. “I have no degrees. All I have is a ton of experience.”
Discreet and luxurious, Hotel Plaza Athénée was located on the tree-lined Upper East Side at 64th between Park and Madison, with sister hotels in Paris and Bangkok. We went up to their suite. Daylight flooded the rooms. Weber served nuts and tea as we talked of yoga safety. Black sat on a couch, relaxed but serious.
He was amazingly blunt. My encounters with yoga denial and evasion had left me unprepared for such outspokenness and sweeping visions of better safeguards. It was radical. If Black ran the world, he would have many people—including many celebrities of the yoga circuit—relinquish not just difficult poses but the discipline itself. Students as well as celebrated teachers injured themselves in droves, he argued, because most were completely unprepared for yoga’s rigors.
Black said the vast majority—”99.9 percent”—have underlying physical weaknesses and problems that make serious injury all but inevitable. Instead of doing yoga, “they need to be doing a specific range of motions for articulation, for organ condition,” he said. “Yoga in general is for people in good physical condition. Or it can be used therapeutically. It’s controversial to say, but it really shouldn’t be used for a general class. There’s such a variety and range of possibilities. Everybody has a different problem.”
Black said he worked hard at trying to recognize signs of danger and knowing when a student “shouldn’t do something—the Shoulder Stand, the Headstand, or putting any weight on the cervical vertebrae.”
I asked if he ever modified poses to make them safer.
“Constantly,” he answered. Referring to our just-completed class, Black noted how we had done a standing pose where we had put our arms behind our backs, clenched our hands together, and stretched our arms up. “I could see people’s faces crunching, so I said, ‘Bend your elbows.’” It was, he said, a safety valve.
“To come to New York and do a class with people who have many problems, and say, ‘Okay, we’re going to do this sequence of poses today’—it just doesn’t work.” Instead, he said, all classes had to be tailored to the range of particular student abilities on that particular day.
Weber noted that she had been studying with Black for a decade and had never experienced the same class twice.
Black said his guiding principle in teaching yoga was to downplay the asanas and put the emphasis on awareness. “It’s harder to teach,” he said. “But the risk of not teaching it is very great. If you just teach people to do an asana without taking them into deeper states of realization, their asanas are always going to be a struggle.”
The superstars of yoga were so addicted to celebrity that they often overlooked the message of awareness and paying close attention to their bodies and anatomical limits, Black said. He told of famous teachers coming to him for healing bodywork after suffering major traumas. “And when I say, ‘Don’t do yoga,’ they look at me like I’m crazy. And I know if they continue, they wouldn’t be able to take it.”
He said yoga celebrities seemed to have a predisposition to engage in not only personal denial but social evasion. “A yogi I know was going to be interviewed by Rolling Stone and said, ‘I don’t want to talk about injuries.’”
I asked about the worst injuries he had seen, and Black rattled off a long list. He told of big-name yoga teachers doing the Downward Facing Dog so strenuously that they tore Achilles tendons. “It’s ego,” he said. “The whole point of yoga is to get rid of ego.” He said he had seen some “pretty gruesome hips. One of the biggest teachers in America had zero movement in her hip joint. The socket had become so degenerated that she had to have a hip replacement.”
Downward Facing Dog, Adho Mukha Svanasana
I asked if she still taught. “Oh, yeah. And there are other yoga teachers that have such bad backs that they have to lie down to teach. I’d be so embarrassed.”
Black said that he had never injured himself or, as far as he knew, been responsible for harming any of his students in thirty-seven years of teaching. “People feel sensations, sure, and find limitations. But it’s done with mindfulness, not just because they’re pushing themselves. Today, many schools of yoga are just about pushing people.”
He told of his students reporting back to him on the aggressive tactics of other instructors. “You can’t believe what’s going on—teachers jumping on people, pushing and pulling and saying, ‘You should be able to do this by now.’ It has to do with their egos.”
Black also chided students who practiced yoga for the excitements of status and cachet. “They take a class to show off their Missoni T-shirt or their leotards,” he said, scowling. I asked his opinion of Yoga Journal, which over the decades had gone from a geeky nonprofit published by the California Yoga Teachers Association to a glossy magazine filled with ads for sexy clothing, travel adventures, and miracle weight-loss drugs. He declined comment.
While many gurus and yogis over the decades had remained silent on
the threat of injury, or had denied its existence, or had grudgingly made limited concessions of danger, Black insisted that the threat was now indigenous to the discipline and just waiting to strike. He argued that a number of factors had come together in modern times to heighten the risk.
The biggest was the changing nature of students. The poor Indians of yoga’s past normally squatted and sat cross-legged, the poses thus being in some respects an outgrowth of their daily lives. Now yoga had become a Western fad, swelling its unskilled ranks. Urbanites who sat in chairs all day now wanted to be weekend warriors despite their inflexibility and physical problems. Amateurish teachers ruled like drill sergeants and pushed cookie-cutter agendas. Such factors became all the more deadly, Black argued, with the distractions of modern vanity, which kept students and teachers from focusing on the importance of the here and the now, from listening to their bodies and understanding when they were about to cross the line from a wholesome stretch to excruciating harm.
The result was an epidemic.
“There has to be a degree of seriousness and dedication,” he said. “Otherwise, you’re going to get hurt.”
The first scientific light on the topic of yoga injury fell decades ago. The reports appeared in some of the world’s most respected journals—including Neurology, the British Medical Journal, and The Journal of the American Medical Association. The high-level debut signaled that the medical establishment saw the findings as important information that practicing doctors needed to know if they were going to help patients. The reports began to emerge in the late 1960s, soon after the West had become newly interested in yoga.
A number of early findings centered on nerve damage. The problems ranged from the relatively mild to permanent disabilities that left students unable to walk without aid. For instance, a male college student had done yoga for more than a year when he intensified his practice by sitting upright for long periods on his heels in a kneeling position known as Vajrasana. In Sankrit, vajra means “thunderbolt.” The position, also called the kneeling pose, is sometimes recommended for meditation. The young man did the pose for hours a day, usually while chanting for world peace. Soon he was experiencing difficulty walking, running, and climbing stairs.
Thunderbolt, Vajrasana
In Manhattan, an examination showed that both of his feet drooped because of a lack of leg control, and doctors traced the problem to an unresponsive nerve. It was a peripheral branch of the sciatic, the longest nerve of the body, which runs from the lower spine, through the buttocks, and down the legs. The damaged branch ran below the knee, normally providing the lower leg, foot, and toes with sensation and movement. Apparently, the young man’s kneeling in Vajrasana had clamped his knees tight enough and long enough to cut the flow of blood to the lower leg, depriving the nerve of oxygen. The result was nerve deadening.
It was suggested that the young man simply give up the pose. Reluctantly he did so, opting instead to do his chanting while standing. He improved rapidly, and a checkup two months after the initial visit showed no lingering problems. In describing the case, the attending physician called the condition “yoga foot drop.” The name stuck. In time, a number of similar cases emerged.
One of the worst featured a woman of forty-two. She fell asleep in Paschimottanasana—the Seated Forward Bend, its Sanskrit name meaning “stretch of the West.” Upon awaking, she found her legs numb and weak. A medical team at the University of Washington, writing in The Neurologist, told of finding injuries to both her sciatic nerves that had crippled her legs. The scientists reported that the woman regained “some sensation” after three months of therapy but still displayed persistent foot drop.
Seated Forward Bend, Paschimottanasana
A half year after the mishap, the woman was still unable to walk without assistance. Her doctors said evidence of permanent nerve damage left them doubtful that she would ever recover full use of her legs.
If the first reported cases were relatively minor, a second wave soon emerged in which the consequences were little short of devastating. The reason was that the damage centered on the brain itself—not some peripheral organ or physiological subsystem. The news got worse. The blows to the body’s most important organ arose not from stretching too much or holding postures too long but from the skilled practice of poses that practitioners did routinely and tended to see as completely safe.
The situation was so ominous that a leading British physician issued a public alert. In the conservative world of medicine, it is a rare day when abstract theorization comes ahead of clinical reports. Usually it is the other way around—first observation, then efforts at explanation and generalization. But the physician had the requisite stature to issue a sharp warning even before his peers had published any reports that described particular cases.
At the time, in 1972, W. Ritchie Russell was an elder statesman of British medicine. The string of acronyms after his name bespoke his status: M.D. (Medical Doctor), C.B.E. (Commander of the British Empire), F.R.C.P. (Fellow of the Royal College of Physicians), and D.Sc. (Doctor of Science). A neurophysiologist, he had distinguished himself in a long career at Oxford University that showed, among other things, that brain injuries could arise not only from direct impacts to the head but from quick movements of the neck as well, including whiplash. He published his pioneering research in the early 1940s as war swept Europe and neck injuries grew rapidly in number.
His new warning centered on how some yoga postures threatened to reduce the blood flow to the brain and cause the cerebral disasters known as strokes. The second most important cause of death in the Western world, right after heart disease, strokes often strike older people whose arteries get clogged with fatty deposits. The risk of dying from them rises with age. In addition, Russell worried about a fairly rare type of stroke that tended to strike relatively young, healthy people.
The word “stroke” is a euphemism for a range of destructive nastiness that develops when the regular flow of blood to the human brain gets interrupted. In many cases, the symptoms arise on just one side of the body because the brain’s functional areas mirror the body’s bilateral symmetry. Most strokes start as simple blockages. The flow of blood through an artery gets reduced or blocked entirely by deposits of fat, clots of coagulated blood, or the swollen linings of torn or damaged vessels, robbing the brain of oxygen. By definition, strokes traumatize and kill brain cells, which are known as neurons. A renewed flow of blood can sometimes mend beleaguered cells. And over time, nearby neurons can sometimes replace the function of dead cells. But damage can also be permanent. Stroke victims thus experience disabilities that range from passing weakness to lasting neurologic damage to death if the destruction involves vital brain centers. (Fast treatment can limit the damage, which is why health professionals urge speedy evaluations of suspected stroke victims, preferably within sixty minutes.) The symptoms of stroke vary widely because of the brain’s highly specialized anatomy. For instance, conscious thought and intelligence arise in the outer layers of the brain, so strokes in those areas can affect speech and critical thinking.
Russell’s concern went deeper. He worried about the inner brain, in particular a functionally diverse region toward the rear. His concern was that yoga postures that involved extreme bending of the neck might compromise the region’s blood supply, destroying parts of the brain rich in primal responsibilities.
The human neck is made of seven cervical vertebrae that anatomists have numbered, top to bottom, C1 through C7. Their special shapes and compliant disks make the neck the most flexible part of the spinal column. Scientists have measured the neck’s normal range of motion and found the movements to be extraordinarily wide. The neck can stretch backward 75 degrees, forward 40 degrees, and sideways 45 degrees, and can rotate on its axis about 50 degrees. Yoga practitioners typically move the vertebrae much farther. For instance, an intermediate student can easily turn his or her neck 90 degrees—nearly twice the normal rotation.
Russell had long sp
ecialized in understanding how the bending of the neck could endanger the flow of blood from the heart to the brain. His concern focused mainly on the vertebral arteries. By nature, every tug, pull, and twist of the head rearranges these highly elastic vessels. But major activity outside their normal range of motion can put them in jeopardy in part because of their unusual structure.
In traversing the neck, the vertebral arteries go through a bony labyrinth that is quite unlike anything else in the body and quite different from the soft, easy path that the carotids follow to the brain. The sides of each vertebra bulge outward to form loops of bone, and the arteries penetrate these loops successively in moving upward. The left and right vertebral arteries enter this gauntlet at C6 and run straight through the loops until they reach the top of the neck, at which point they start to zig and zag back and forth as they move toward the skull. Between C2 and C1, they usually bend forward, and then, upon exiting the bony rings of C1, usually curve sharply backward toward the foramen magnum—the large hole at the base of the skull that acts as a conduit for not only blood vessels but nerves, ligaments, and the spinal cord. Anatomists describe the final journey of the vertebral arteries toward the brain as serpentine and report much variability in the exact route from person to person. It is not unusual for the tops of the vertebral arteries to branch out in a tangle of coils, kinks, and loops.
The Science of Yoga: The Risks and the Rewards Page 15
