Preventing Yoga Injuries vs Preventing Yoga – The Daily Bandha Weighs in on the Debate

Dr. Ray Long, author, yogi, and orthopedic surgeon, recently weighed in on the yoga injuries debate in his blog The Daily Bandha with a two-part post, entitled Preventing Yoga Injuries versus Preventing Yoga. A pertinent title, indeed.

Known to most yogis for his groundbreaking yoga anatomy books, including The Key Muscles of Yoga and The Key Poses of Yoga, Dr. Long has an impressive pedigree. In addition to his training as an M.D., he brings more then two decades of yoga training to the table, including extensive trainings with BKS Iyengar.

To those familiar with the yoga injuries debate (resurfacing recently with author William Broad’s recent blog post on yoga and hip injuries in the New York Times), it is a fascinating discussion, which perhaps says as much about the challenges facing yoga as a profession, as about the risk of injury itself. With the limited knowledge of anatomy many yoga teachers have, the claims of yoga injuries can be hard to evaluate. As a consequence, is easy, as Dr. Long points out in his title, to go to the extreme in erring on the side of caution.

To say that yoga carries risk of injury is, of course, stating the obvious. Any physical activity challenging the body comes with some degree of risk. A basic premise of exercise, and the key to many of its numerous beneficial effects, is to challenge the body to invoke a healing response. That, of course, involves some risk, if the challenge is overdone. As Dr. Long aptly points out:

[A part of yoga] practice involves poses that take some of our joints to the extremes of their range of motion (from a western medical perspective). Indeed, many of the benefits of Hatha yoga derive from moving our joints (carefully) within their range of motion.

Obviously, we want to avoid injuries when practicing yoga. One way to do that is to eliminate a bunch of the asanas on the grounds that they’re “too dangerous”. That approach also eliminates the benefits of those poses. Or, we can practice mindfully, using modifications where appropriate and working in a progressive manner towards the classical asanas that are appropriate for each of us individually. Knowledge of the body combined with awareness of mechanisms of injury aids in this process.

Rather than stating the obvious, to get traction for their claims, crusaders for the dangers of yoga argue that yoga is uniquely injurious. The evidence put forward for this claim has included certain conditions, such as (femeroacetabular impingement syndrome (FAI) and vertebral artery dissection supposedly caused by yoga. Never mind that the etiology of these conditions is poorly known and that they both appear to be triggered by a very long list of activities.

When trying to understand the risk of injuries in yoga, Dr. Long points out, it is key to not confuse correlation with causation. If five people with red hair in our circle of friends contract cancer, can we say that red hair causes cancer? Of course not.

If we have heard through the grapevine of five long-term yoga teachers who have gotten hip replacement, can we say that yoga puts one at higher risk for hip replacement? Again, of course not. There are numerous other possible factors that come into play, including as other physical activities (most yoga practitioners engage and many physical and athletic activities), heredity, childhood injuries, previous musculoskeletal imbalances, and so on. For this reason, without statistical evidence, it is impossible, and fool-hardy, to draw conclusions based on a few isolated cases.

As Dr. Long puts it.

Let’s look at the concept of association vs causality. Simply put, because some activity is associated with a problem does not mean it caused it. In medicine, we when we recognize that an injury is associated with a specific activity we then investigate whether there are factors associated with that activity that could cause the injury. An example would be anterior cruciate ligament (ACL) tears. 

A while back, we recognized that ACL tears were approximately five times more common in female athletes compared to males. Thus, investigators sought to identify circumstances that could account for this increased incidence. The risk factor thought to contribute most significantly to the higher rate of ACL ruptures in female athletes related to insufficient neuromuscular control of the knee joint in certain athletes. Accordingly, neuromuscular training regimens were devised that have reduced the incidence of ACL ruptures in this group. This approach to ACL injuries is an example of working with science to decrease the risk of an activity, not the activity itself.

In seeking to prevent yoga injuries, Dr. Long notes, let’s not get to the point where we are preventing yoga itself. As he notes,

“Hatha yoga wouldn’t have its beneficial effects without, you know, the poses of Hatha yoga.”

The majority of the two blog posts in the Daily Bandha are dedicated to understanding the biomechanical basis of what Dr. Long views as one of the key causes of injury in yoga: Joint hypermobility. The articles discuss the details of this issue in relation to the hip in details, as well as steps that can be taken to aid in prevention.

We applaud Dr. Long’s for showing us how to move the yoga injuries discussion forward in a constructive and positive manner.  Rather than spreading fear and misinformation in the interest of selling books. The Daily Bandha articles illustrate how an informed debate about yoga injuries and how to prevent them can help deepen the knowledge and sophistication of yoga as a profession in a way that benefits all. In the words of Dr. Long:

In medicine, we look for ways to eliminate the risks of a given activity, not the activity itself. To illustrate my point, check out this quote from one of the scientific articles that studied the effect of extreme hip motion in professional ballerinas: “These results do not mean that the dancers should stop executing these movements, but rather they should limit them in frequency during dancing class.”2

Wow. Think I’m down with that.

Indeed, so are we.

Read the full posts here:  
Preventing Yoga Injuries vs Preventing Yoga