How the NYT Can Wreck Yoga

This article has been modified since it was first posted; I have added two responses below mine – the first is from my friend and colleague Marshall Hagins, PT, with whom I have worked with on a funded yoga study, and the second from Rick Bartz, a chiropractor in the Catskills. 

The New York Times Magazine published an article this week entitled “How Yoga Can Wreck Your Body“, adapted from William Broad’s new book.

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. Still, 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‘, 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 questions: what was he more influenced by; yoga, or Christian penitence?  And does one need to inflict suffering on oneself in order to bring about peace?  The teachings of Yoga would claim just the opposite.

There are a couple of obvious reasons why there are so many injuries in yoga (which we must acknowledge do on occasion occur, as they do in every physical activity). The nature of the injuries and the way that one responds to an injury also varies greatly. However, Broad did not address this issue, he addressed the most sensationalistic aspects of injury, and this is what I wish to respond to.

One reason that injury can occur in yoga is due to overzealousness, or even just plain enthusiasm, on the part of the student – I have of course experienced this myself – it 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. Of course, injuries can happen anytime we do physical activity, whether or not we are taking risks.

A more troublesome underlying cause that leads to injuries while doing yoga, I believe, is the value system that forms the basis of the yoga ‘industry’ in America, which is built largely on economic incentive. Sound cynical of me?  As a five-billion-dollar a year industry, it would be hard to argue that the values traditionally associated with yoga, such as simplicity, humility, and one-pointed focus could somehow coexist un-problematically in the midst of a product-oriented industry. 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, love, devotion, and self-investigation – and yes, suffering through rigorous practice – to something that one 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 a tradition – one which, granted, has even in India been subject to ridicule – to an even greater harm.  We have an opportunity, in the West, to bring these transformative teachings to places where they will result in the greatest good. It is true that this is already happening – in schools, prisons, hospitals, with veterans, and as well with people who simply walk into a class off of the street – but it is also true that a rotten apple can spoil the barrel, and the yoga industry apple 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.

It is not that the ‘olden days’ were better – every age has its challenges. But spirituality in America has become ‘easy’, and we are becoming dumbed down. It is not wrong to work hard and strive to understand something difficult and subtle, and then achieve an inner satisfaction that is the result of hard work, persistence and dedication – let’s not sweep that under the table. To live a life of self-examination is not always an easy thing. But that does not mean that it is not joyous, or have its own rewards, for it can be both of those things.

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 of 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 I trolled through videos that filled 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, hearing White Man (in Hammersmith Palais) now still fills me with the same feeling of freedom I felt when I first heard it when I was probably 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 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, Professor, Department of Physical Therapy, Long Island University:

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!

While reading the article “How Yoga Can Wreck Your Body” in last week’s NYT Magazine, I found several medical errors in William J. Broad’s writing and took issue with his contention that yoga could cause vertebral basilar artery injury (VBAI) in the course of an average practice.  I am a chiropractor with 16 years in practice and a student of Ashtanga Yoga and Iyengar Yoga for the past 25 years.

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.

Rick Bartz, D.C.

 

 

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