Yoga Can Be Dangerous

Yoga is good for you, right? Not always. Troubling recent finding: For one year, researchers tracked more than 350 people who took yoga classes. Nearly 11% of the participants developed a new pain problem, often lasting a few months. And 21% reported that yoga had ­aggravated existing injuries.

What I tell my patients and clients: As a medical doctor and yoga instructor for more than 20 years, I know that the risk for injury from practicing yoga can be much lower than from many other forms of exercise such as running or tennis—if you avoid making common mistakes. And by staying injury-free, you will enjoy the many benefits of regular yoga practice—relaxation and stress relief…pain relief…a stronger, more flexible body…and a more peaceful mind.

Here’s how to bypass the injury-­causing errors people often make when they practice yoga…

Wrong Type of Class

There are many different styles and types of yoga—from the gentle and restorative to the intense and aerobic. Some of the styles investigated in the new study were intense types in which participants move quickly from pose to pose without stopping. (Examples: Vinyasa Flow, Power Yoga and Ashtanga Yoga.)

In my experience, most yoga injuries happen to people doing more vigorous and acrobatic styles of yoga. Vigorous, flowing styles of yoga such as Vinyasa can be challenging and invigorating and therefore appealing. But it is not always a safe choice for anyone middle-aged or older because it’s too fast and ­demanding, making injury more likely. Also, because the sequence of poses is quick, participants often do the poses incorrectly, with muscles and bones improperly aligned, increasing the risk for injury. The teacher may not notice these mistakes in alignment because students move so quickly from pose to pose.

My advice: If you are fit and under age 50, more athletically demanding yoga may be fine for you. If you are over age 50 and already practice flowing yoga without problems, you may be fine to continue, but the older you get, the riskier it becomes. If you are not fit or if you have a chronic health problem such as rheumatoid arthritis, poorly controlled high blood pressure or a degenerative disease of the nervous system such as Parkinson’s, choose a gentler style of yoga. Examples may be called gentle yoga, restorative yoga or yoga for seniors. Other good choices include Yin Yoga and beginning Iyengar Yoga classes. Helpful: If you want to practice a fast-paced Vinyasa-style yoga, first take a few classes in which you learn to do the poses slowly and correctly—and then speed up.

Red flag: Anyone who is pregnant, has multiple sclerosis or a chronic ­inflammatory condition such as lupus or inflammatory bowel disease should avoid hot yoga, including a type of hot yoga called Bikram Yoga—in which the room may be heated to 105°F. The intense heat can aggravate inflammatory conditions or harm a growing fetus.

Undertrained Teacher

All the yoga teachers in the new study had at least 200 hours of training—the amount required by the Yoga Alliance, a nonprofit association of yoga teachers and schools.

That might sound like a lot of training, but it’s nowhere near enough to ensure quality instruction. In some instances, much of that training happens online without direct supervision by a qualified teacher. Bottom line: You are more likely to be injured in a class conducted by a teacher who is undertrained.

My advice: If possible, find a teacher who has more training, say, 500 hours, or one who has many years of experience. To check the teacher’s qualifications, you can call a yoga studio, check online or ask the teacher directly.

If you have a serious medical condition, consider consulting a yoga therapist, a yoga teacher trained to work with students with a wide variety of illnesses. To be certified in yoga therapy by the International Association of Yoga Therapists (IAYT), a teacher needs at least 1,000 hours of training. The IAYT website (IAYT.org) has a search function for finding IAYT members in a growing number of locations.

Strained Breathing

In a good yoga class, you are taught to pay attention to your breath. And if you do that, the breath becomes an indicator of whether you are about to make a mistake and hurt yourself.

Often the first sign of an imminent mistake is strained breathing—gasping or holding your breath. If you maintain a discipline of breathing slowly and deeply, it’s much less likely that you will hurt yourself. Added benefits of attending to your breathing include a greater sense of calm and mindfulness (steady focus in the present).

My advice: Tune into the breath throughout your yoga practice. If it becomes strained or uneven, make an adjustment that corrects the problem or come out of the pose.

Trying Too Hard

A common cause of injury in yoga is what I call “over-efforting”—trying to stretch more deeply into a pose when your breath and body are telling you that the extra stretch is not a good idea. Sharp pain and/or strained breathing are sure signs that the deeper stretch is a mistake. Over-efforting often happens because of peer pressure—almost everyone else in class is doing the pose in a certain way, so you want to keep up, too.

My advice: A yoga pose should be a balance of effort and ease. If the pose is more effort than ease—get out of it. If you get a sharp pain, particularly one in a joint such as the knee—get out of it. Even if the rest of the class is doing the pose…and even if the yoga teacher is telling the class to stay in the pose…if your body is telling you to get out of the pose, get out of it.

Riskier Poses

There are several common yoga poses that are the most likely to cause injury, and they should be avoided by beginners and many people with chronic medical conditions. These poses include…

Headstands, which can damage the neck. When I attend a general yoga class, it often is the case that about half the class should not be doing a headstand—ever. While doing the pose, their faces are red and strained, and they obviously can’t wait for the teacher to tell them to come out of the pose. Upside-down poses also can be risky for those with eye problems caused by glaucoma, retinal disease or diabetes.

Shoulder stands and Plow pose. These poses can overstretch the back of the neck. If your neck feels tight or uncomfortable, you probably should not be doing the pose. My advice: It may help to put folded blankets under your shoulders (but not under your head and neck) to take the strain off your neck.

Lotus pose, a sitting pose in which you put the right foot over the top of the left thigh and vice versa. This pose is only for people with flexible hips. If you use your hands to force your legs into this position, you create tremendous torque on your knee joint and you could rip or otherwise injure a knee ligament.

Chaturanga (yoga push-ups), pictured at the beginning of the story. In many athletic yoga classes, students cycle through a series of 12 poses known as a sun salutation. One element is Chaturanga, where you lower your body from Plank pose to a low push-up position. Doing this repeatedly can be murder on your ­shoulder—particularly if you allow the top of your upper-arm bones to jut forward in the shoulder joint. My advice: If you can’t maintain good shoulder alignment, drop both knees to the ground in Plank pose, which takes some weight off, then descend the upper body to Chaturanga.

Deep back bends, twists or forward bends. When in doubt, favor less extreme versions of these poses. Surprising: Less demanding versions of poses confer most or all the health benefits of the deeper versions.

Aggressive Adjustment

Another potential cause of serious yoga injuries is when a teacher aggressively pushes on your body to take you more deeply into a pose (light touching to indicate how or where to move is fine). My advice: Do not allow an instructor to manually force your body into any yoga position. If you are in a class with an instructor who does that, find a new instructor.