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Preventing Yoga Injuries

A strong and flexible body, a calm mind, increased concentration and focus, improved athletic performance, and a better quality of breathing are what you will reap if everything goes well when you practice yoga. However, yoga done wrongly can give you pulled muscles and aching joints if you are lucky, and surgery or a permanent disability if you are unlucky. Even if your injuries are minor, they may discourage you from continuing yoga and that's when you really lose out.

This is the third and last in this column's series on yoga injuries. Although I might sound like a doomsayer, I don't want to scare anyone from trying yoga. I love yoga. It was one of my first loves in fitness. But rather than deny that the potential for injury exists, it is better to confront it and warn people about the risks in the hope that impending injuries will be prevented, and that more people will learn about yoga and enjoy all the benefits I just mentioned and more.

Yoga-related injuries occur because the person is not yet strong or flexible enough to do the pose, is not doing the pose correctly, has an existing physical condition that is made worse by doing certain poses, or has pushed himself far beyond his capabilities.

Commonly injured joints of the body include the neck, shoulders, wrists, lower back and knees. Pulled muscles usually occur in the hamstrings (back of the thighs) and lower back.

Injuries can either be acute or chronic. Acute injuries happen right then and there like a knee "snapping" while doing the lotus pose. Chronic injuries happen overtime and are the result of repetitious microscopic trauma due to poor technique.

Here are some general tips on how to prevent injuries. This is by no means a comprehensive listing.

Neck
The plow, shoulder stand and headstand are the three most risky poses for the neck because of the extreme pressure put on that area. Beginners should not attempt these three poses and even intermediate students should only do them under the careful supervision of an experienced instructor.

The plow and shoulder stand force the natural curve in the neck to flatten and can irritate the spinal nerves or push a disk out of alignment. Roger Cole, yoga research scientist and instructor, recommends putting a folded blanket on the shoulders to relieve pressure on the neck.

The headstand is actually easier on the neck if done properly--meaning the student is using his arms and shoulders to carry the weight of the body. But if the student is not strong enough or does not know how to do the pose properly, then the head and neck partly carry the body's weight and the disks and vertebrae are compressed.

The New England Journal of Medicine recently published a study about the connection between certain yoga poses and a rare kind of stroke called "arterial dissection." The plow, shoulder stand and headstand were pointed out because of the extreme pressure they put on the neck, while the extended side angle and triangle were highlighted because they could result in sudden neck movements. Before you get terrified of doing these poses, yoga was not the only activity cited; so were chiropractic adjustments, hard sneezes or coughs, rapidly tossing your head back to swallow a pill or chug a shot of tequila, and getting a shampoo at the beauty salon sink. The study also reiterated that this kind of stroke was rare, and yoga was only involved in a small number of cases. But better to be safe than sorry, so make sure to practice good technique when doing these poses.

People who cannot straighten their arms over their head are at risk of shoulder injuries because this means that they have "round" shoulders that are rotated inward. This is due to right chest muscles and weak upper back muscles. Since many yoga poses require "open" shoulders or externally rotated shoulders, this misalignment can cause pinched nerves or irritated tendons.

If you have the rounded shoulder syndrome, concentrate on stretching your chest muscles while strengthening your upper back before you proceed on to more advanced yoga poses.

Wrists

Yoga can strengthen the wrists and prevent carpal tunnel syndrome (CTS), a painful nerve condition due to swollen wrist joints. However if you already have the early stages of CTS, your situation can get even worse by doing poses that require you to put your body weight on your wrists. Even if you don't have CTS, your wrist can still get injured if you don't apply equal pressure to all "four corners" of your palm in poses like downward facing dog or the plank.

Lower back

If forward bends, backward bends and twists are not done correctly, the lower back pays the price. Cole counsels students to elongate the spine before bending to maximize disk space between the vertebrae. Bend forward by tilting the pelvis bones at the hip joints, not by pushing or pulling on the spine. Bend backwards by lifting the chest and pushing the hips forward to prevent overworking the lower back.

When twisting, make sure the effort begins in your core muscles. Do not use your arms to bind you into the pose until your muscles have done the actual twisting first. The muscular effort to get into the twist is called your active range of mobility and flexibility. The little bit more that you can get into the twist after you have bound yourself is called your passive range of motion. There should not be a big difference between the two. If you use your arms first to pull you or another outside force like a teacher to push into position, you might go much beyond your active range and hurt yourself. The same thing happens when doing upward facing dog and cobra. Initiate the movement with your back muscles before pushing against the floor with your hands.

Knees

Cole says that the three most dangerous things you can do in yoga is to flatten the neck in a shoulder stand or plow, push or pull a stiff back into a forward or backward bend, and force the knees into a lotus position.

If you don't have the flexibility in the hip joint to bring your bent legs into a fully open position (soles of the feet together, knees touching the floor at the side of your hips), you can damage the knee joint when you try to maneuver your feet and ankles into the lotus. Specifically, you can tear the medial meniscus (cartilage on the inside part of the knee) and overstretch the lateral collateral ligaments (connective tissue at the outside part of the knee). You should definitely not be doing the lotus if you have a prior history of knee or ankle injuries.

Ligaments at the back of the knee can also be hurt if you try to over-straighten your knee to the point that it curves backward. When doing lunges, keep the knee in line with the ankle, not going past the toes.

Inverted poses

Any pose where the head is lower than the heart has the tendency to raise blood pressure. However, poses like downward facing dog, forward bend, expanded leg pose will only do so mildly, while shoulder stand and headstand will increase blood pressure the most. People with cardiovascular disease, hypertension, diabetes, glaucoma, detached retina, extreme nearsightedness, ear or sinus infections should definitely avoid doing the shoulder stand and headstand and should get their doctor's clearance about doing the other mild inversion poses.

If you keep on comparing your performance to that of other people, you are not doing yoga. You are doing what someone has called "sophisticated stretching." Remember this is supposed to be about the mind-body connection. How can your mind connect to your body when it is focused on someone else's body? That Ms Super Yoga, who is the object of your envy, probably has a rubber band for a spine courtesy of her genes, while you have inherited a spine that is less flexible. That doesn't make you less worthy a person than her. Also, she isn't getting more benefits than you.

According to Cole, "It is better to practice a partial pose with good alignment than a full pose with poor alignment."

Gary Kraftsow, author of "Yoga for Wellness" and head of the American Viniyoga Institute, puts it another way. "Adapt the form of the pose to the person and anyone can receive the functional benefits regardless of structural limitations." You are getting as much of a benefit from the modified pose that you are doing, as the human pretzel beside you who is doing the more advanced level.

Another yoga instructor once said, "There are no contraindicated poses in yoga, only contraindicated people," meaning that even the most convoluted pose can be safe if the person is anatomically suited for it. But a simple pose can do you harm if you have physical limitations.

Lawrence Biscontini, fitness and yoga instructor, says that a simple pose done with awareness of breath and proper mental attitude is more "yoga" than an advanced pose done mindlessly.

And while I am no yoga expert, I am going to throw in my two cents worth. If you never go slightly beyond your comfort zone, you'll never improve. But if you jump in head first, you can go way beyond what your body is used to and get injured. So I tell my students to "test the waters" just like they would proceed cautiously when entering a hot spring. Challenge yourself, but only a little at a time, and know when to back off when the water starts to get too hot.

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