The Science of Yoga: The Risks and the Rewards

by William J Broad

  100 published in 2010: Chris C. Streeter, Theodore H. Whitfield, Liz Owen, et al., “Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study,” Journal of Alternative and Complementary Medicine, vol. 16, no. 11 (2010), pp. 1145–52.

  101 her website advised: Liz Owen Yoga, www.lizowenyoga.com.

  101 reported in their 2006 paper: Sat Bir S. Khalsa and Stephen Cope, “Effects of a Yoga Lifestyle Intervention on Performance-Related Characteristics of Musicians: A Preliminary Study,” Medical Science Monitor, vol. 12, no. 8 (August 2006), pp. CR325–CR331.

  102 Khalsa and colleagues reported: Sat Bir S. Khalsa, Stephanie M. Shorter, Stephen Cope, et al., “Yoga Ameliorates Performance Anxiety and Mood Disturbance in Young Professional Musicians,” Applied Psychophysiology and Biofeedback, vol. 34, no. 4 (December 2009), pp. 279–89.

  IV: Risk of Injury

  103 “Real yoga is as safe”: Swami Gitananda Giri, “Real Yoga Is as Safe as Mother’s Milk,” Yoga Life, vol. 28, no. 12 (December 1997), pp. 3–12.

  104 challenged the reports as biased: See, for instance, Enoch Haga, “Yoga,” Journal of the American Medical Association, vol. 218, no. 1 (October 4, 1971), p. 98.

  104 feature lengthy addendums: Robin, A Physiological Handbook, pp. 511–18; Robin, A Handbook, pp. 833–41.

  106 “I make it as hard as possible”: Yoga class with Glenn Black, Sankalpah Yoga, New York City, January 24, 2009.

  110 reports began to emerge: One of the earliest, if not the first, is Gilbert E. Corrigan, “Fatal Air Embolism after Yoga Breathing Exercises,” Journal of the American Medical Association, vol. 210, no. 10 (December 8, 1969), p. 1923.

  110 an examination showed: Joseph Chusid, “Yoga Foot Drop,” Journal of the American Medical Association, vol. 217, no. 6 (August 9, 1971), pp. 827–28.

  110 in Vajrasana had clamped: Robin, A Physiological Handbook, p. 513.

  111 chanting while standing: Anonymous, “The Yoga Ailment,” Time, August 23, 1971, p. 52.

  111 similar cases emerged: See, for instance, Caryn M. Vogel, Roger Albin, and James W. Albers, “Lotus Footdrop: Sciatic Neuropathy in the Thigh,” Neurology, vol. 41, no. 4 (April 1991), pp. 605–6; Thomas G. Mattio, Takashi Nishida, and Michael M. Minieka, “Lotus Neuropathy: Report of a Case,” Neurology, vol. 42 (August 1992), p. 1636.

  111 One of the worst: Melanie Walker, Gregg Meekins, and Shu-Ching Hu, “Yoga Neuropathy: A Snoozer,” Neurologist, vol. 11, no. 3 (May 2005), pp. 176–78.

  112 published his pioneering research: See, for example, D. Denny-Brown and W. Ritchie Russell, “Experimental Cerebral Concussion,” Brain, vol. 64 (1941), pp. 93–164.

  112 His new warning: W. Ritchie Russell, “Yoga and the Vertebral Arteries,” British Medical Journal, vol. 1, no. 5801 (March 11, 1972), p. 685.

  113 typically move the vertebrae: Robin, A Physiological Handbook, pp. 72–75. Extreme movements of the neck can, short of strokes, also disrupt the flow of blood to the brain, causing dizziness and nystagmus, an involuntary jerking of the eye. See Judith Hanson Lasater, Yogabody: Anatomy, Kinesiology, and Asana (Berkeley: Rodmell Press, 2009), pp. 51–52.

  114 describe the final journey: Francesco Cacciola, Umesh Phalke, and Atul Goel, “Vertebral Artery in Relationship to C1-C2 Vertebrae: An Anatomical Study,” Neurology India, vol. 52, no. 2 (June 2004), pp. 178–84.

  114 feeds such structures: Adel K. Afifi and Ronald A. Bergman, Functional Neuroanatomy: Text and Atlas, 2nd ed. (New York: Lange Medical Books, 2005), pp. 352–54.

  114 recover most functions: Abdullah Bin Saeed, Ashfaq Shuaib, Ghanem Al-Sulaiti, et al., “Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients,” Canadian Journal of Neurological Sciences, vol. 27, no. 4 (November 2000), pp. 292–96; Wouter I. Schievink, “Spontaneous Dissection of the Carotid and Vertebral Arteries,” New England Journal of Medicine, vol. 344, no. 12 (March 22, 2001), pp. 898–906.

  114 a prominent type: Elisabeth Rosenthal, “Rare Threat of Stroke at the Beauty Salon,” New York Times, April 28, 1993, Section C, p. 11.

  115 “as far back as possible”: Iyengar, Light on Yoga, pp. 107–109.

  116 “The body should be”: Ibid., p. 211.

  116 a gruesome case study: Willibald Nagler, “Vertebral Artery Obstruction by Hyperextension of the Neck: Report of Three Cases,” Archives of Physical Medicine and Rehabilitation, vol. 54, no. 5 (May 1973), pp. 237–40; W. Nagler, “Mechanical Obstruction of Vertebral Arteries During Hyperextension of Neck,” British Journal of Sports Medicine, vol. 7, nos. 1–2 (1973), pp. 92–97.

  117 An intermediate stage: Iyengar, Light on Yoga, p. 358.

  118 according to a team in Chicago: Steven H. Hanus, Terri D. Homer, and Donald H. Harter, “Vertebral Artery Occlusion Complicating Yoga Exercises,” Archives of Neurology, vol. 34, no. 9 (1977), pp. 574–75.

  118 fascinated by the case: Interviews, Steven H. Hanus, June 9 and July 1, 2011.

  120 medical team at the University of Hong Kong: K. Y. Fong, R. T. Cheung, Y. L. Yu, et al., “Basilar Artery Occlusion Following Yoga Exercise: A Case Report,” Clinical and Experimental Neurology, vol. 30 (1993), pp. 104–9; see also Robin, A Physiological Handbook, p. 516.

  121 a common feature of medical concern: See, for example, W. Pryse-Phillips, “Infarction of the medulla and cervical cord after fitness exercises,” Stroke, vol. 20 (1989), pp. 292–94; Daniel J. DeBehnke and William Brady, “Vertebral Artery Dissection Due to Minor Neck Trauma,” Journal of Emergency Medicine, vol. 12, no. 1 (1994), pp. 27–31; Schievink, “Spontaneous Dissection.”

  121 Science of Flexibility: Michael J. Alter, Science of Flexibility, 3rd ed. (Champaign, IL: Human Kinetics, 2004), pp. 198–200.

  121 its surveys showed: Letter to author, Vicky B. Leonard, Technical Information Specialist, U.S. Consumer Product Safety Commission, March 20, 2008. The enclosed data sheets from Leonard showed the results of a search I had requested of the National Electronic Injury Surveillance System for records citing the term “yoga” for the years 1996 through 2006.

  122 An analysis of the information: By the author.

  122-13 found much of it fawning: Robert Love, “Fear of Yoga,” Columbia Journalism Review, November–December 2006, pp. 80–90.

  123 Stories appeared: For example, see Leslie Kaminoff, with Coeli Carr, “Mr. Fix It for Injured Yoga Enthusiasts,” New York Times, Aug 11, 2002, Section 3, p. 13; Stacey Colino, “The Wounded Warrior,” Washington Post, April 16, 2002, Section HE, p. 1.

  123 The rising public debate: During this period, the number of articles and scientific reports on yoga injury and safety approached two hundred. See Trisha Lamb, “Injuries from Yoga and Contraindications,” a bibliography by the International Association of Yoga Therapists, April 27, 2006.

  123 Body & Soul magazine recounted: Alanna Fincke, “Yoga Now: Bent Out of Shape,” Body & Soul, March–April 2003, p. 40.

  123 An article in The New York Times: Lorraine Kreahling, “When Does Flexible Become Harmful? ‘Hot’ Yoga Draws Fire,” New York Times, March 30, 2004, Section F, p. 5.

  124 “twist and stretch with less chance”: Choudhury, Bikram Yoga, p. 74.

  124 told of being filmed one day: Carol Krucoff, “Insight from Injury,” Yoga Journal, May–June 2003, pp. 120–24, 203.

  125 “Yogi beware”: Judith Lasater, “Yogi Beware: Hidden Dangers Can Lurk Within Even the Most Familiar Pose,” Yoga Journal, January–February 2005, pp. 110–19.

  125 told of how she had reinjured: Kaitlin Quistgaard, “Safety Dance,” Yoga Journal, March 2008, p. 12.

  125 began to run a legal proviso: See, for instance, Anonymous, “Letters,” Yoga Journal, February 2009, p. 16.

  126 “Proceed with Caution”: Catherine Guthrie, “Proceed with Caution: A Medical Review Points to the Potential Dangers of Sudden Neck Movements in Certain Poses,” Yoga Journal, December 2001, p. 33.

  127 no scientist had ever published: The studies lumped all
known causes together. See Schievink, “Spontaneous Dissection”; Ralf W. Baumgartner, Julien Bogousslavsky, Valeria Caso, et al., eds., Handbook on Cerebral Artery Dissection (Basel: Karger Publishers, 2005), pp. 12–29, 44–53; Kwan-Woong Park, Jong-Sun Park, Sun-Chul Hwang, et al., “Vertebral Artery Dissection: Natural History, Clinical Features and Therapeutic Considerations,” Journal of Korean Neurosurgical Society, vol. 44, no. 3 (2008), pp. 109–15.

  128 no general notice on the Internet: Author’s Google search, January 5, 2011.

  128 the Internet buzzed: www.yogaforums.com/forums/f18/yoga-and-stroke-604.html.

  129 states began their regulatory effort: A. G. Sulzberger, “Yoga Faces Regulation, and Firmly Pushes Back,” New York Times, July 11, 2009, Section A, p. 1.

  129 involved a woman of twenty-nine: Derek B. Johnson, Mathew J. Tierney, and Parvis J. Sadighi, “Kapalabhati Pranayama: Breath of Fire or Cause of Pneumothorax?” Chest, vol. 125, no. 5 (May 2004), pp. 1951–52.

  129 an emergency procedure: Polly E. Parsons and John E. Heffner, eds., Pulmonary/ Respiratory Therapy Secrets (Philadelphia: Hanley & Belfus, 2001), pp. 68–69.

  130 a joint letter: Deane Hillsman and Vijai Sharma, “Yoga and Pneumothorax,” Chest, vol. 127, no. 5 (May 2005), p. 1863.

  130 took to the pages: Vijai P. Sharma, “Pranayama Can Be Practiced Safely,” International Journal of Yoga Therapy, no. 17 (2007), pp. 75–79.

  131 they wrote in their 2007 report: P. K. Sethi, A. Batra, N. K. Sethi, et al., “Compressive Cervical Myelopathy Due to Sirsasana, a Yoga Posture: A Case Report,” Internet Journal of Neurology, vol. 6, no. 1 (2007).

  131 Even Iyengar got involved: At his institute in Pune, Iyengar admitted that some postures in Light on Yoga might threaten injury. He called it a “dead book” and, to his credit, took an active role in pose redesign. For instance, students of Iyengar tell me that he pioneered the use of folded blankets to ease neck strain in Shoulder Stand, introducing the precaution as long ago as 1975. For Iyengar being quoted on the dated nature of his book, see Pat Musburger, “A Note from the President: Teachers and Teaching,” Iyengar Yoga Association of the Northwest, IYANW Update, November 2007, p. 1. For his speaking openly of injuries and how to avoid them, see B.K.S. Iyengar, Yoga: The Path to Holistic Health (New York: Dorling Kindersley, 2007), pp. 7, 25, 194, 230, 243, 408.

  132 “The whole weight”: Iyengar, Light on Yoga, p. 187.

  132 called for exactly the reverse: Richard Rosen, “Taking the Danger out of the Headstand,” Yoga World, vol. 1, no. 9 (April–June 1999), pp. 3–4.

  132 “At this point in the game”: Yoga class with Mel Robin, Yoga Loft, Bethlehem, Pennsylvania, April 14, 2007.

  132 too dangerous for general yoga classes: Timothy McCall, Yoga as Medicine: The Yogic Prescription for Health and Healing (New York: Bantam, 2007), pp. 499–500; Timothy McCall, “Upside Downside?” Yoga Journal, September–October 2003, p. 34.

  132 led to a condition: McCall, Yoga as Medicine, pp. 89–90.

  133 “Knees are hinge joints”: Quoted in Martica K. Heaner, “Yoga’s Softer Side,” Health, vol. 15, no. 6 (July–August 2001), pp. 122–27. For a yoga anatomist who disagrees with the hinge metaphor, see Lasater, Yogabody, pp. 115–16.

  133 One of the most prolific: For a short profile, see Anne Cushman, “Science Studies Yoga,” Yoga Journal, August 1994, p. 43.

  133 spoken on yoga safety: Anonymous, “Yoga Should Heal, Not Hurt, Says ACSM Expert,” news release, American College of Sports Medicine, April 1, 2005.

  133 In one column: Roger Cole, “Keep the Neck Healthy in Shoulderstand,” Yoga Journal, www.yogajournal.com/for_teachers/1091.

  133 researchers in Europe: Jani Mikkonen, Palle Pedersen, and Peter William McCarthy, “A Survey of Musculoskeletal Injury among Ashtanga Vinyasa Yoga Practitioners,” International Journal of Yoga Therapy, no. 18 (2008), pp. 59–64.

  134 published a far more ambitious survey: Loren M. Fishman, Ellen Saltonstall, and Susan Genis, “Understanding and Preventing Yoga Injuries,” International Journal of Yoga Therapy, no. 19 (2009), pp. 1–8.

  135 trains its instructors for nine weeks: For a portrait of Bikram training, and a glimpse of compassion, see Jeanne Heaton, “Teacher: Experience Needed,” New York Times, March 13, 2011, Style section, p. 2.

  135 “It was a success”: Email, Glenn Black, September 30, 2009.

  135 caught up with him: Interview, Glenn Black, Plaza Athénée, October 9, 2009.

  V: Healing

  137 kept wanting to learn: Interviews and emails, Loren M. Fishman, Manhattan, August and September, 2007, February and March, 2008.

  137 knocked on Iyengar’s door: The story is recounted in Loren Fishman and Carol Ardman, Relief Is in the Stretch: End Back Pain Through Yoga (New York: Norton, 2005), p. 5.

  138 a large shelf of Fishman’s books: In chronological order, they are Loren Fishman and Carol Ardman, Back Talk: How to Diagnose and Cure Low Back Pain and Sciatica (New York: Norton, 1997); Fishman and Ardman, Relief; Fishman and Ardman, Sciatica Solutions: Diagnosis, Treatment, and Cure of Spinal and Piriformis Problems (New York: Norton, 2006); Fishman and Ardman, Cure Back Pain with Yoga (New York: Norton, 2006); Fishman and Eric L. Small, Yoga and Multiple Sclerosis: A Journey to Health and Healing (New York: Demos Medical Publishing, 2007).

  139 his explanation for what stretching did: Fishman and Ardman, Relief, pp. 18–21, 72.

  140 told of his therapeutic work: Interview, Loren Fishman, August 10, 2007.

  141 a key feature: Iyengar, Light on Yoga, p. 187.

  142 chronic pain in her right shoulder: Nora Isaacs, “The Yoga Therapist Will See You Now,” New York Times, May 10, 2007, Section G, p. 10.

  142 published them so other health professionals: Loren M. Fishman and Caroline Konnoth, “Role of Headstand in the Management of Rotator Cuff Syndrome,” American Journal of Physical Medicine and Rehabilitation, vol. 83, no. 3 (March 2004), p. 228; Loren M. Fishman, Caroline Konnoth, Alena Polesin, “Headstand for Rotator Cuff Tear: Shirshasana or Surgery,” International Journal of Yoga Therapy, no. 16 (2006), pp. 39–47; Loren M. Fishman, Allen N. Wilkins, Tova Ovadia, et al., “Yoga-Based Maneuver Effectively Treats Rotator Cuff Syndrome,” Topics in Geriatric Rehabilitation, vol. 27, no. 2 (2011), pp. 151–61. For a popular review, see Jane E. Brody, “Ancient Moves for Orthopedic Problems,” New York Times, August 2, 2011, Section D, p. 7.

  143 had written a book: Loren Fishman and Ellen Saltonstall, Yoga for Arthritis: The Complete Guide (New York: Norton, 2008).

  144 only rough outlines: For Fishman’s detailed prescription for treating spinal stenosis, see Fishman and Ardman, Relief, pp. 134–46.

  144 Fishman came in: Yoga class with Loren M. Fishman, Manhattan Physical Medicine, April 8, 2008.

  144 showed us a simple treatment: For a more detailed description, see Fishman and Saltonstall, Yoga for Arthritis, pp. 244–45.

  145 promoting a better quality of life: Fishman and Small, Yoga and Multiple Sclerosis, pp. 2, 112–26.

  147 a device worn inside the vagina: Medical regulators have questioned its safety after reports of injury and death. See Shirley S. Wang, “FDA Panel Takes Second Look,” Wall Street Journal, September 8, 2011, Section B, p. 6.

  150 regularly uses the phrase: See, for instance, Carol Krucoff, “Facing Cancer with Courage,” Yoga Journal, December 2004, p. 143.

  150 “sensitive to individual needs”: Anonymous, “New Yoga Classes, Beginners to Advanced,” Record, Montgomery County Recreation Department, Silver Spring, Maryland, vol. 1, no. 6 (March 2006).

  150 “30 years’ experience”: http://search.barnesandnoble.com/Yoga-and-the-Wisdom-of-Menopause/Suza-Francina/e/9780757300653.

  151 face no requirements: Michael H. Cohen, “The Search for Regulatory Recognition of Yoga Therapy: Legal and Policy Issues,” International Journal of Yoga Therapy, no. 17 (2007), pp. 43–50.

  151 Yoga Alliance: www.yogaalliance.org.

  151 “A growing number”: Georg Feuerstein,
“Editorial,” International Journal of Yoga Therapy, no. 12 (2002), pp. 3–4.

  151 used liberally and often interchangeably: Georg Feuerstein, “Editorial,” International Journal of Yoga Therapy, no. 13 (2003), pp. 3–6.

  152 Anyone can claim: For a discussion, see Lynn Somerstein, “Licensing is No Merry-Go-Round,” International Journal of Yoga Therapy, no. 18 (2008), pp. 15–16.

  152 “provides in-depth training”: Anonymous, “Yoga Therapist Training,” Namaste Institute for Holistic Studies, www.namasteinstitute.com/yogathera pist.html.

  152 “There is no such thing”: Email to author, John Kepner, International Association of Yoga Therapists, May 23, 2008.