The Wounded Warrior Pose Whether it's because they have tired of pounding their joints or wondered what the hype is all about, many fitness seekers have turned to yoga in the last several years. The ancient Hindu healing art has been shown to enhance flexibility, balance and strength, as well as soothe frazzled minds; it's also been touted as a powerful treatment for everything from hypertension and carpal tunnel syndrome to asthma and arthritis. But many practitioners are getting something they didn't count on -- injured. From doctors and others in the Washington area and across the country have come reports of dislocated ribs, strained backs or necks, and joints being jammed or thrown out of their natural alignment during yoga sessions. While statistics on yoga-related injuries aren't available -- largely because no organization collects them -- anecdotal reports by sports doctors, instructors and practitioners are proliferating. "We're seeing a lot more people experiencing sprains and strains and overuse of the muscles . . . after doing yoga," says Tyler Cymet, an osteopathic physician and assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore. "Yoga doesn't look strenuous, and sometimes people approach it as an exercise that needs to be done vigorously from start to finish instead of in a relaxation mode where they can do it in bits and pieces. And they're having the exact opposite effect of what they were hoping for: They end up with tightness and swelling in the low back, shoulders and neck because they're overdoing it." Says Gerard Varlotta, director of sports rehabilitation at the New York University/Rusk Institute in New York, "In the past two years, I've seen at least 50 yoga-related pain problems. Before that, I'd seen maybe 10 ever." To some extent, the reported rise in yoga-related injuries can be attributed to yoga's burgeoning popularity. Between 1998 and 2000, yoga participation increased by 30 percent, according to the Sporting Goods Manufacturers Association, bringing the number of U.S. practitioners to 7.4 million in 2000. Other surveys have put the number even higher. "It's natural that the more people that get involved, the more likelihood there is of injuries increasing," says Lynne Nemeth, a yoga instructor at Triumph Fitness Center in Howard County. On top of that, she says, there's the age factor: "More baby boomers are doing it, and they may already have back or knee problems, so they will be more prone to injury." This jibes with the observations of Brian Y. Kim, an osteopathic physician who specializes in sports medicine in Germantown: All of the yoga-related injuries he's seen have been in the age 40-plus crowd. "There are certain parts of the spine that degenerate as we get older," he explains. "Certain positions in yoga -- especially the extreme extension positions involving backward bending or neck bending -- can aggravate those processes or a preexisting injury." In addition, the changing nature of yoga -- from a predominantly solo meditative practice to a trendy gym offering -- may be leading to more injuries. A survey by the International Health, Racquet & Sportsclub Association (IHRSA) found that 74 percent of health clubs and fitness centers offered yoga classes in 1999, compared with 36 percent in 1994. Some gyms, seeking further novelty, offer athletic hybrids like Bikram or hot yoga (done in temperatures of 100 to 110 degrees), power yoga (moving continuously and quickly from one pose to another) and Ashtanga (which synchronizes breathing with a progressive series of postures meant to produce a sweat). Some say these faster, more vigorous forms may increase the risk of injury. But most yoga injuries occur, experts say, because the person has pushed muscles too far, hasn't modified poses to accommodate a preexisting condition or placed inappropriate pressure on the joints. "When you get into a position and you try to force yourself beyond your normal range of motion . . . you start to put excess pressure on the tendons and ligaments of the joints," Varlotta explains. "They don't want to be stretched that quickly." When they are, they tend to let people know. Last year, Gina Williams, 43, hurt her back in the middle of a 90-minute yoga session at a local gym. "I hadn't been to the class before, and there wasn't a lot of focus on stretching or centering yourself before the class," says the Columbia woman, who has been doing yoga for four years. "It was just a lot of moving from one position to another quickly." Going from an inverted pose to another challenging position, Williams experienced what she calls "a bad spasm" in her back that led to six months of pain during physical activity. While she blames the instructor partially -- Williams says some guidance for how to modify the moves during her first class might have prevented her injury -- she assumes much of the responsibility herself. "Sometimes at a gym, there's more of a mind-set of being competitive and pushing through pain," Williams says. "I think I fell into that because I could tell that a lot of the people had been coming to this class for a long time." (Williams has continued yoga and is now teaching classes.) Questioning the Teachers The apparent growth in the number of yoga injuries inevitably points to what some yoga insiders describe as a new generation of instructors who have received only cursory training. "Anyone can go teach yoga," says Nancy Ferguson, executive director of Yoga Alliance, a nonprofit organization based in West Reading, Pa. That's because there aren't any certification or licensing standards for yoga teachers. (Yoga Alliance is trying to change that by providing a voluntary registry of yoga professionals who meet certain education, training and experience criteria.) To meet the rising demand for yoga classes, some health clubs are relying on fitness instructors who have only recently added yoga to their teaching repertoire. Some instructors opt for quick training through weekend workshops, online courses or home study -- methods disdained by more experienced practitioners. "There is a scarcity of good teachers because we're not going to teach a class for the amount of money these gyms and health clubs want to pay," says Jenny Otto, a seasoned yoga instructor who teaches in Annapolis and Takoma Park. "The art of yoga takes years to study. Some of these instructors lack knowledge of what to do and how to instruct people. You might be flexible and be able to do the postures, but that doesn't mean you can teach." Trisha Lamb Feuerstein, director of research at the Yoga Research and Education Center, a nonprofit California group dedicated to preserving the traditional teaching of yoga, agrees. "There are people teaching yoga who have little or no knowledge of anatomy or physiology. There are lots of asanas [poses] that are contraindicated based on conditions people may have [such as prior hip problems or sciatica] -- you don't learn that in a weekend." Predictably, those offering shortcut training programs disagree. YogaFit Training Systems, based in Hermosa Beach, Calif., offers a variety of training programs for yoga instructors, including two-day workshops that cost $299. Following the workshops and eight hours of "community service" -- in which instructors teach yoga to those who might not otherwise have access to it (people in low-income neighborhoods, schools and prisons, for example) -- participants receive a "certificate of completion" that qualifies them to teach YogaFit-style classes. YogaFit says it has trained more than 6,000 U.S. instructors in the last six years. "If you're training fitness instructors who are used to moving large groups of people through various exercises, which is what we do, it's just another form of movement they're learning," says company founder and president Beth Shaw. "In my opinion, it's a lot easier to teach a fitness instructor how to teach yoga than it is to teach yoga instructors fitness guidelines. If it weren't for programs like ours, there would probably be more yoga-related injuries, because our program focuses on safety and modifications first and foremost." YogaFit isn't alone in taking a pragmatic approach to the ancient meditative practice. Integrative Yoga Therapy, of Hudson, Ohio, offers an online home study course in therapeutic yoga that "is completed at the students' own pace and time." At the end of 11 units, students receive a certificate of completion. YogaLink International, of San Diego, offers several correspondence courses -- including a basic introductory course, a "drills and skills" course and a course on yoga for specialty populations such as kids and pregnant women -- through its Web site. Such groups, says Shaw, are "responsible for building the yoga market." Getting Too Gung-ho The setting of yoga classes also may play a role in rising injuries, according to some yoga instructors. At fitness centers, says Nemeth, "the mind-set is very much no pain, no gain. . . . It's not an ashram. The attitude is punishing the body into shape. That's when you can hurt yourself -- and it can happen with yoga." Recently, Nemeth says, one of her students, a woman in her mid-fifties, pushed herself too hard in a class. The woman was doing a sideways plank, a strenuous posture that involves holding the body up with one arm, and she may have held it too long. "The next day, she had painful muscle spasms in her torso and she thought she was having a heart attack, so she called 911," Nemeth recalls. "The ambulance took her to the hospital, where she had lots of tests. The doctor told her to be careful while doing yoga." Was the class atmosphere a contributing factor in her injury? Some imagine it may have been. "Some students are competitive -- if the teacher is doing the pose or the person in front of them is doing the completed pose, they want to, even though their body may not be ready," Ferguson explains. "You just can't jump into yoga and do a completed pose. Yoga needs to be taken slowly." But the health club industry isn't buying suggestions that club settings produce more yoga injuries. "In the health club setting, I've never been in a yoga class where the instructor hasn't said, 'This isn't competitive. Do it at your own level,' " says Helen Durkin, director of public policy at the IHRSA, an industry group based in Boston. "If you decide to push yourself in a yoga class, then no instructor is going to stop you from doing that." Besides, she says, "You can't discount the fact that a lot of people who take yoga in fitness clubs have injuries and that's why they turn to yoga -- because something is wrong." For such people, as well as for those who aren't adequately trained, some positions are particularly risky, say yoga experts. Inverted poses such as the headstand and shoulder stand, for example, place considerable strain on the neck and spine. If the person doesn't have sufficient muscle strength to perform these poses, they can lead to neck or back strain, explains Timothy McCall, a Boston-area internist who has practiced yoga for seven years and often recommends it to patients for arthritis and other ailments. "The irony is that people read reports that yoga can help treat carpal tunnel syndrome; however, if you have incipient or late carpal tunnel syndrome and you go to a class where they have you doing weight-bearing poses on the arms with the wrists cocked at 90 degrees, you're very likely to bring on symptoms." While most of the reported yoga injuries involve strained joints or muscles, there's an additional concern with Bikram (or hot) yoga: that the intensely heated environment places added stress on the body, forcing the heart to work harder to cool the body down, Nemeth explains. This could be problematic for people with heart conditions or other medical problems. In the end, it's up to students to find yoga styles that match their abilities, experts say. McCall says, "Ideally, yoga should be personalized -- what's safe for a 20-year-old may not be for a 50-year-old with a history of arthritis or other injuries." Says Jill Abelson, a yoga instructor in the District who has been practicing yoga for 12 years, "It's important for people to understand their own bodies and to select an appropriate style and level that's right for them. If people use some general sense and pace themselves, they can reduce their risk of injury." --Stacey Colino is a Washington area freelance writer. (This article appeared in Washington Post ) [Home]  [Yoga]