Stretching has its limits

Injuries are on the rise as newcomers take up yoga
The Boston Globe, Jan. 8, 2003
By Alice Dembner

As millions of tightly wound Americans take up yoga in search of tranquillity, flexibility, and health, more and more are limping out of the lotus position, yoga teachers and doctors say. Injury is becoming a significant part of the yin and yang of yoga, particularly with the growing popularity of ”power” yoga, a more athletic style in which participants move rapidly from one pose to another.

For instance, a 30-year-old man from the western suburbs required surgery after he tore the cartilage in his knee doing a deep stretch. A Stoneham woman fell on her head in class, badly spraining her neck. And a Brookline man new to yoga ripped a sensory nerve that has left him without feeling in part of his right thigh.

”Yoga can be dangerous to some degree, especially for someone like me who doesn’t know what they’re doing,” said Steve, a Brookline businessman who tore a thigh nerve during a particularly intense stretch and asked that his last name not be published. ”While I’ve done all kinds of sports, I wasn’t prepared. Everybody was doing these double flips and I tried to keep up.”

Sports doctors, chiropractors, and physical therapists say the surge of muscle and ligament sprains, disk injuries, and cartilage tears is similar to the wave they saw when high-impact aerobics popularized by actress Jane Fonda was nearing its height in the 1980s. With 18 million Americans practicing yoga, by some counts, yoga is the fastest growing group fitness activity and is drawing an increasingly diverse group of devotees, many of whom seek out yoga to help manage existing injuries. This month, yoga studios are bracing for a new barrage of out-of-shape participants spurred by New Year’s resolutions.

”Yoga is low impact, but that doesn’t mean no impact,” said Dr. Nicholas DiNubile, a spokesman for the American Orthopedic Society for Sports Medicine who says he’s treating a yoga injury every week in his Philadelphia office, compared with five years ago when patients never even mentioned yoga. ”Not everybody’s a Gumby.

”It shouldn’t be a competition, but a lot of the type A’s who are running into these classes look at it as one,” he said. ”And many of the baby-boomer generation are bringing their weak links to the game – disks in their neck or back, for example, that are failing and with yoga become symptomatic.”

No one is yet tracking the number of injuries, but yoga teachers and doctors alike say much of the blame rests with participants driving themselves too competitively, in what some say is the antithesis of the true spirit of yoga. Even longtime yoga practitioners can get swept up in the frenzy.

Leila Tutela of Stoneham has been doing yoga every other day for 25 years, but says she got caught up ”in an ego thing” during a power yoga class in August taught by a visiting guru. In a partner stretch, a classmate was helping her stretch forward ”beyond my comfort zone” aiming her head toward the floor. ”His hands slipped and I went down on my head,” said the semi-retired real estate agent. ”Even the guru heard the thump. I’m still feeling it in my neck.”

But the ranks of the injured cut across all levels of yoga experience and fitness as a once-rare type of injury becomes common. At his Newton chiropractric office, Tom Michaud is treating two to three serious disk injuries a month caused by yoga, compared to none just five years ago.

”I haven’t seen anything like this since the old Jane Fonda days,” Michaud said. ”It’s a startling, disturbing increase in the last year and a half.”

Harlan Rieur, a chiropractor in Brookline who treats two or three yoga injuries a week, says most of the injuries are mild to moderate sprains of the knees, shoulder, neck, or back. But one physically fit patient tore the meniscus in his knee overstretching in a power yoga class, requiring surgery and months of physical therapy.

Meanwhile, Kennedy Brothers Physical Therapy, at its centers in Greater Boston, has seen a quadrupling of patients with soft-tissue and joint injuries from yoga in the last six months.

”In general, yoga is safer than most types of exercise,” said Jack Kennedy, who serves on the Governor’s Committee on Physical Fitness and Sports, and says yoga’s benefits of stress reduction and flexibility generally outweigh the risks. ”But when you have something trendy, you have people trying to take it to the limit. Any time you attract people who haven’t been exercising regularly, you see the typical overuse injuries.”

The growth in injuries is partly due to yoga’s soaring popularity, although no one is exactly sure how popular it really is. Yoga Journal estimates that 18 million people in the United States now practice yoga, up from 7 million in 1998. The Sporting Goods Manufacturers Association, which commissions an annual survey of Americans, says that 9.7 million Americans practiced yoga last year, up 31 percent from 7.4 million in 2001. Doctors continue to strongly recommend yoga for many of their patients.

Others say injuries are increasing because the demand has opened the door to poorly trained or overaggressive teachers. A few years ago, Elizabeth Bunker, a longtime yoga instructor in Concord, brought in a visiting teacher from India for an advanced workshop. During the session, to Bunker’s horror, the visitor sat on a student in a split position and broke her pelvic bone.

”There are some really bad teachers out there who have not had the proper training and don’t understand what the spine is about,” said Bunker, who runs Yoga for Life in Concord. ”We, as a yoga community, have to say to people you’ve got to look and find teachers who are qualified.”

While there is no licensing or official certification of yoga instructors, a group of longtime yoga teachers has formed the Yoga Alliance to promote a minimum of at least 200 hours of teacher-training for any instructor. Nearly 5,000 teachers have registered with the alliance as fulfilling that standard, but an untold number of others are teaching after completing correspondence courses or weekend trainings aimed at general fitness instructors.

In addition to yoga studios, about 86 percent of health clubs offer yoga, according to the International Health, Raquet and Sportsclub Association, based in Boston. Club officials say they’re careful to screen teachers and that patrons may be safer in those classes than at yoga studios because gym teachers often have a stronger background in exercise science.

At the Yoga East studio in Wakefield, Monica Veneziano requires students to fill out a medical questionnaire to help teachers determine how to modify yoga poses to accommodate students’ physical problems. Veneziano stresses adequate warm-up and proper entry and sequencing of the poses to work up to the more difficult ones. ”I err on the side of caution and patience,” she said.

But other instructors see pain and mild injury as a means to greater flexibility or ”openness,” a philosophy espoused by some yogi and challenged by others as a rationalization. George Whiteside, who teaches Ashtanga, or power yoga, in the Back Bay, is recovering from a disk injury suffered in his own advanced yoga practice and in helping his students execute difficult backbends. He also suffered wrist pain and a hamstring pull in recent years.

”Ashtanga yoga is very intense, rigorous, and this will happen,” he said. ”I was very inflexible and for my hips and back to open, I needed to go through a certain amount of painful stretching. While initially I was concerned about my back, I have faith it’ll be OK.”

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Religion News Blog posted this on Friday January 10, 2003.
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