Iyengar’s Roger Cole, Ashtanga’s Eddie Stern, and Others Including Medical Professionals Weigh In
With much ado and uproar over the latest Times article entitled ‘How Yoga Can Wreck Your Body‘ (actually an excerpt from a new book by science writer William J. Broad) reactions have ranged from cautionary told-you-so’s to frustration over facts to mixed feelings of head nods and shoulder shrugs.
The yoga community is strong-willed and strongly opinionated, so of course a story like this slapped in the Old Grey Lady with a head-turning title (pun intended) wouldn’t go without a response, including our own. So what happens when you go throwing around anecdotal examples of yoga’s injurious nature to a crowd of yoga practitioners, teachers, and tertiary supporters?
Read on for full responses and perspectives from Iyengar Yoga teacher Roger Cole (who was [mis]quoted in the article), Ph.D., NYC’s legendary Ashtangi Eddie Stern, followed by Physical Therapist Marshall Hagins and chiropractor Rick Bartz. [update: more from Perter Ferko,
Roger Cole on discrepancies in healthiness of shoulderstand via his facebook page:
The New York Times Magazine published January 5 contains a story by William Broad entitled "How Yoga Can Wreck Your Body." Although yoga injuries do occur, the article contains a lot of misinformation. Certain parts seem to imply that B.K.S. Iyengar teaches shoulder stand in a harmful way and that I am a "reformer" who introduced a better method. I wrote the following letter to the editor to set the record straight:
'The article incorrectly states that yoga master B.K.S. Iyengar “insisted” that students practice shoulder stand in a manner that dangerously hyperflexes the neck. In fact, he insists on exactly the opposite. Mr. Broad cites a Yoga Journal column I wrote describing a method of “reducing neck bending in a shoulder stand by lifting the shoulders on a stack of folded blankets...” This safer method was invented by B.K.S. Iyengar and he has long been adamant that all of his certified teachers must teach the pose this way. Mr. Iyengar, who recently celebrated his 93rd birthday, still maintains a vigorous yoga practice that includes long holds in headstand (without support) and shoulder stand with his shoulders lifted on a prop.
The column describing Mr. Iyengar’s safer shoulder stand technique, entitled “Keep the Neck Healthy in Shoulderstand,” is at http://www.yogajournal.com/for_teachers/1091. The original version of Mr. Broad’s article supplied an incorrect link
Eddie Stern's response and the following from AYNY.org:
The New York Times Magazine published an article this week entitled “How Yoga Can Wreck Your Body“, adapted from William Broad’s new book. The article quickly brought on rapid fire responses, and hundreds of online comments (many which are quite good).
Broad is a ‘senior science writer at The Times’, and though his article is heavy on anecdote and slim on science, I agree that the increasing occurrences of injuries in yoga should not be discounted or taken lightly, though the temptation to argue Broad’s article paragraph by paragraph is hard to resist. For example, yoga teacher Glenn Black’s repeated, incorrect use of the word ‘ego‘, (as if it is something that needs to be gotten rid of, which is not at all a yogic concept), or the need to go back to the 1970′s to find examples of strokes caused by yoga. The case of the college student who kneeled on his toes for hours ‘praying for world peace’, causing nerve damage, begs the question: who was he more influenced by, yoga, or Christian penitence? And does one need to inflict suffering on oneself in order to bring about peace? Yoga would claim just the opposite.
There are a couple of obvious reasons why there are so many injuries in yoga. First, perhaps, is overzealousness on the part of the student – this is a natural response for a particular type of person when it comes to any activity that has physicality associated with it – no matter what a teacher may caution.
The second is more troublesome, and that is the value system that forms the basis of the yoga ‘industry’ in America; a model that for all intents and purposes is based on economic incentive. Sounds cynical of me? As a five-billion-dollar-a-year product oriented industry, it would be hard to argue otherwise. America is good at jumping at opportunities – and when it comes to making the holy dollar, no cow is too sacred to be sacrificed in the West.
When there is a great potential for making money, quality is usually the first thing to be sacrificed. Fast food, anyone? It is unfortunate that this is exactly what we are facing now – yoga has been McDona-fied. It has been reduced from a practice that traditionally demanded dedication, discipline, sacrifice, humility, surrender, suffering, love, devotion, and rigorous self-investigation, to something that you can now learn to teach in a weekend. Or, more popularly, in a mere 200 hours you can become a bonafide, registered yoga instructor. 200 hours is spit. It is a joke. And it is a joke that is leading an entire tradition – that granted even in India was subject to ridicule – to an even greater harm. This is because we have an opportunity, in the West, to be leaders in the rising field of yoga, by bringing these transformative teachings to places where they will result in great good. Though it is true that this is already happening – in schools, prisons, hospitals, with veterans, and with everyday people who walk into a class off of the street – it is also true that a rotten apple can spoil the barrel, and this is what I fear is happening. And, it is a mighty big apple.
I miss the early days when I was first doing yoga in NYC, in the mid- to late 1980′s. The feeling of freshness, of being clean and free, of feeling that a whole, new world was opening in me. There were no products for sale, no fifty types of yoga mats, just a towel and some cut-off sweatpants to practice in, or a pair of white, cotton ‘yoga’ pants that I could buy on Bleecker St. for $5. I still feel that freshness when I practice, and I love that – but when I look around at what is happening with yoga in America, I can’t help but feel sad.
When I saw the title of Broad’s article, the first thing that came to mind was Ice Cube’s old hip-hop song ‘Check Yo’ Self’ (‘You better check yo’self before you wreck yo’self’) – pretty good advice for the over-enthusiastic in yoga or any physical endeavor. I was going to post it, but it is so inappropriate, and the issue of injuries is too serious an issue; I will not make light of anyone’s pain. But, searching out Ice Cube did lead me down the dark path of youtube, where two hours later, I found myself still trolling through videos that fill me with a happy nostalgia for the rawness of youth – of early punk rock, and the passion and energy that was being expressed through so many amazing songs.
Sanskrit means refined, and many of the yogis of India were extremely elegant, in a simplicity-filled way. The rishis, who became the world’s first yogis, purposely left society to meditate in the forests, turning their backs on the mundanity and suffering of the world. They discovered something that ultimately can be of great benefit to us all, if we use it wisely. This is quite the opposite of the rawness of music that I grew up with, like the Clash or Sex Pistols – but, still, listening to White Man (in Hammersmith Palais) still fills me with the same feeling of freedom I felt when I first heard it when I was probably about 14. And who can argue with this lyric: “The new groups/ are not concerned/ with what there is to be learned/ they put on suits/ they think it’s funny/ turning rebellion into money”. I always loved that line, and now it just makes me think of Lululemon.
Then I came across this video below – I have no idea if anyone will think it is as awesome as I do – but this girl is killing it. I love how every once in a while she cracks just a little smile; punk rock, a little bit humorous, as it was meant to be. You know, if we didn’t take ourselves all too seriously, maybe we would cause a lot less harm – to ourselves, and to each other.
From Marshall Hagins PT:
Apparently the Times believes that it needs to make yoga look “funny” to sell what is ostensibly a serious work of scientific reporting [“How Yoga Can Wreck Your Body” by William Broad in the NY Times Magazine on Jan 8th ]. But it is not the attempt by the Times to sell more papers that really concerns me, it is the lack of balance in a report of genuine importance—risk of injury while practicing yoga.
First, anecdotal reports, no matter how impressive the journal they appear in, does not a convincing argument make. Second, the issue is not whether some people get hurt doing yoga (no serious yogi thinks that yoga has zero risk) but injury rate. In other words, how many people are getting hurt doing yoga (numerator) compared to how many people are actually practicing yoga (denominator). Many common activities are inherently risky. Have you seen the statistics for playing basketball?—over 600,000 injuries per year in America (15% of basketball players get injured in the sport). Yet we continue to play basketball and other even more risky sports (football anyone?). Why? Because there are perceived benefits and we make the choice of risk versus reward.
Well…you may ask, then why can’t this piece be viewed as helping increase awareness of the risk of yoga so people can make informed choices? Because this piece fails to accurately describe the risk of yoga—it merely cherry picks a few extreme events and implicates the entire practice. (Is it really surprising that if you sit on your heels for “hours a day” that nerves will go to sleep in your legs?) A balanced, serious, and accurate scientific report on the risks of yoga would have, at a minimum, explicitly stated that no one actually knows the injury rates for yoga, as is actually the case. What is provided beyond anecdote to demonstrate the “growing body of medical evidence” is two numbers: 1) Emergency room injuries related to yoga increased from 13 to 46 in a two year period; 2) Yoga practitioners grew in number by 15 million in the last 10 years. While acknowledging that comparing risk between activities is ultimately much more complex than what I suggest here, it is still roughly reasonable to note that if you multiply the number of reported yoga injuries by 100(!) to account for under-reporting, the injury rate using the authors numbers is still exceedingly small and far less than what is known about most common sports activities.
And by the way, it is not true that the cervical spine can only rotate 50 degrees as suggested by the author. If you doubt this, turn your head as far as you can to the right or left. Is your nose almost pointing over your shoulder? Voila…80 degrees of rotation. Now you have the mobility of an “intermediate” yogi!
From Rick Bartz, D.C.
Mr. Broad makes a glaring error in reporting the extent of side to side rotation in a normal cervical spine. In stating range of motion for the neck, or cervical spine, the author gives 75˚ extension, 40˚ flexion, 45˚ left lateral flexion (LLF), 45˚ right lateral flexion (RLF), and 50˚ in both right rotation and left rotation. The normal range of motion for the cervical spine, according to most major references, including the AMA Guide to Impairment, is 70˚ ext, 50˚ flex, 45˚ LLF and RLF, and 80˚ L rotation and R rotation. So the author is a bit generous in neck extension, a little short on normal flexion, correct in lateral flexion, but seriously erroneous in rotation. Since most of his arguments linking yoga to cerebrovascular incidents are based on an assumption of hyper rotation, he is seriously at odds with the medical literature. For an “Intermediate student” to have 90˚ active rotation is only a small increase above normal, and no more than the passive rotation normally expected in a routine physical exam.
He then goes on to misidentify hyperflexion of the neck as encouraged by Iyengar in the cobra pose. In fact, in cobra pose the neck is in extension! This is a sloppy error that one hopes the author would have caught before going to print. As far as shoulder stand, where the neck is truly hyperflexed, some sources indicate that motion of the chin to the sternum is, in fact, the maximum accepted ROM of 80-90 degrees.
The primary focus of the article is, of course, stroke. As a chiropractor, my profession has been under relentless attack for years with the false accusation that chiropractic manipulation is a causative factor for VBAI. In fact, the most definitive paper on the subject published in 2008 by J. David Cassidy, was a meta-analysis of vertebrobasilar artery (VBA) stroke cases admitted to hospitals in Ontario over a 10 year period. The conclusion that Cassidy’s prestigious team reached was that “VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and primary care physician (PCP) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. They found no evidence of excess risk of VBA stroke associated with chiropractic care compared to primary care.” In other words, patients with acute headache and neck pain were already suffering symptoms of a stroke when they came into their doctor’s office with those complaints. The astute doctor would then refer the patient to the emergency room upon recognizing these and other related neurological symptoms during physical exam.
The human body provides a marvel of redundancy in it’s blood supply to the brain. there are two internal carotid arteries and two vertebral arteries providing circulation to the basilar artery, also known as the Circle of Willis, so that in the event that either the left or right is compromised or entirely occluded, the other side will provide the needed oxygen-rich blood supply, via the Circle, to the side that is deficient. Mr. Broad correctly identifies the anatomical problem area for the vertebral artery as C1-C2 in an earlier part of his article when he references the 1973 study of a 28 y.o. woman, but then goes on to describe a 25 y.o. man rushed to Northwestern Hospital in Chicago with “blockages of the left vertebral artery between the C2 and C3 vertebrae.” Incidentally, the C2-C3 section of the VBA is statistically less likely to be damaged by neck rotation. Even If he had suffered “total or nearly complete occlusion” in that artery, it is false to say that “no blood could get through to the brain.” There would certainly be at least three other arteries providing circulation, via the Circle of Willis, to his brain. Not to deny that the young man did indeed have a stroke, but that the causes are suspect. There are many cases of spontaneous dissection of the vertebral artery. There are cases of people with only one vertebral artery who had no neurological symptoms in their lives.
This is not to say that yoga practice is without risk of injury and that yoga teachers should be alert to signs of potential medical issues, such as acute, intense headache and unusual neck stiffness, that would affect a student’s ability to do practice safely.
Read more responses:
Peter Ferko: “I think the Times article goes too far, and will scare people away from yoga who would benefit from it tremendously. It is possible for anyone to practice yoga. From an ISHTA perspective, it would be more appropriate to tell students to expand their idea of what yoga is.” [peterferko.com]
Charlotte Bell: “We all know that yoga is not just poses, but asana remains the centerpiece of most Western practice. I wonder if the rise of yoga-related injuries might also be related to the fact that asana has been taken out of its original context. When the physical practice for its own sake becomes the be-all, end-all, it is much easier to become forceful and competitive, which IMO is the source of many yoga injuries. Consider how practicing the eight limbs tempers asana practice:” [huggermugger.com blog]
Have you read other great responses? Let us know.
- Rich, Possibly Befuddled Lululemon Founder Chip Wilson Resigns After Series of Controversies
- Yoga Injuries and Battered Egos, ‘How Yoga Wrecks the Body’ via The New York Times
- Significance of 108 Sun Salutations – DO
- Compass Yoga: A New Direction for Wellness
- Folk Legend Woody Guthrie’s ‘New Years Rulin’s’ and Yoga Resolutions, 1943