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Tearing your Achilles tendon or hamstrings, dislocating your shoulder or injuring your lower back – these sound like type of injuries you'd expect after a game of rugby, right?
In actual fact, these injuries have also been associated with that most seemingly gentle of physical activities: yoga.
With yoga becoming ever more popular in Australia – at last count it was more popular in terms of participation than Aussie Rules football – stories of some pretty hair-raising injuries are emerging.
It makes a pretty good headline – but can yoga really be dangerous?
"Exercise itself is inherently risky," says Prof Marc Cohen from the School of Health Sciences at RMIT University. "Any time you engage in exertion, you run the chance of over-exertion."
Yoga, however, "has a safety aspect in that it encourages being totally mindful with your exercise, so in fact you minimize any chance of injury".
What this means is that done properly, yoga is less risky than other types of popular exercise, such as running, he says. There should be no pain, and you shouldn't be stressing your body at all.
"If you are, then it's not really yoga," he says.
While most of us practice yoga for fitness and to maintain flexibility, yoga also has a reputation for being able to treat an array of health problems, from carpal tunnel syndrome to managing pain during pregnancy.
Small studies have suggested yoga may be beneficial in managing pain, including lower back pain, and for mental health issues, such as stress, anxiety and mild depression.
It's also been shown to have a positive impact on risk factors for cardiovascular disease, such as hypertension and obesity, and to improve sleep problems in cancer patients. (Dr Norman Swan's Tonic program looked at some of the research into how yoga can help with serious side effects of cancer therapy.)
While it's difficult to find large, definitive studies on the effectiveness of yoga as a medical treatment (because its practice is so varied, yoga can be difficult to conduct large studies on), in a 2012 survey on yoga in Australia conducted by Cohen and colleagues, 80 per cent of people who used yoga to manage a health issue or medical condition reported their condition to be either better or much better after practicing yoga.
Yoga, along with meditation, is in fact one of the most commonly used complementary therapies in Australia. In a 2005 survey, around two thirds of GPs reported that they had referred to, or suggested that their patients use yoga or meditation in the previous 12 months.
But despite the benefits, yoga can be risky if you push yourself too hard or practice difficult poses unsupervised, says Cohen.
The 2012 Yoga in Australia survey found 1 in 5 survey respondents had incurred some sort of injury (or exacerbated an existing injury) in the previous 12 months by practicing yoga. The pose most commonly associated with injuries was the head stand, followed by shoulder stands, lotus and half lotus (seated cross-legged position), forward bends, backward bends and hand stands.
"People doing shoulder stands and head stands – inversions – can come down hard, they can fall," says Cohen.
"These poses need some level of expertise and guidance, and when you're doing them, you have to stay within your comfort range and ability."
If yoga class fires up your competitive streak, or your yoga instructor encourages you to do something that doesn't feel right, Cohen suggests you should listen closely to your body.
"You need to ask yourself, does this feel right for me, what I'm doing now? Part of yoga is being very attuned to the feelings that are coming from your body," he says.
A simple way to listen to your body, says Cohen, is to pay attention to how you are breathing.
"The breath is the link between the mind and the body. The breath gives you an indication of whether you're pushing yourself too hard. You shouldn't be holding your breath or catching your breath," he says.
It's also important, says physiotherapist Dr Neil Tuttle from Griffith University, to pace yourself – particularly if you're new to yoga.
"If you don't allow sufficient time for your body to accommodate changes [from a new activity], then you can be almost certain that you're going to have an injury," he says.
People who end up injuring themselves "do activities that are at the extreme of their ability, in awkward positions, and repeat those activities frequently, building them up as quickly as they can rather than building up slowly", he says.
Alarm bells should ring, says Tuttle, if pain or discomfort progressively increases either during the activity or when you repeat the activity on subsequent days.
If you still feel the urge to push yourself to your limits, just remember that flexibility is not the be all and end all, says Tuttle.
"It's not necessarily better to be more flexible than less flexible. People who are more flexible have a higher incidence of back and neck symptoms than people who are less flexible," he says.
This is because flexible people are more likely to control a pose or a movement by locking themselves in to the end of range of movement where it's easier to become injured, he says.
Furthermore, you need to find a style of yoga appropriate for your general health, age and ability, says Cohen.
"Yoga that's appropriate for a 20 year old will be different than yoga for an 80 year old. It doesn't mean [yoga is] not appropriate for an 80 year old, in fact it's very appropriate for an 80 year old, but they do different practices, modified practices."
And while injuries may seem more common in certain styles of yoga, Cohen says this is possibly because these styles appeal to people who want to push themselves and are therefore already at more at risk of injury.
"The more physical styles, such as Ashtanga and power yoga, that focus on the body may be considered to be more risky, but if they are done properly, they're probably not," says Cohen.
If you like to challenge yourself with yoga, then hot yoga may be your thing.
For instance, Bikram yoga involves a set sequence of 26 poses and two breathing exercises, which you practice in a room that is heated to about 38 degrees Celsius.
While Bikram practitioners and teachers say the heat promotes flexibility and helps flush toxins from your system, there are very few studies looking at the benefits of this style of yoga.
Tuttle says exercising in extreme heat may not be all it's cracked up to be.
"You don't need heat stress. Heat doesn't actually change the physiology of the connective tissues that much. To an extent, it decreases the pain sensation."
If you're a hot yoga fan and find it works for you, Tuttle suggests always warming down after a session.
"The transition from hot to going out into the cold I think is often problematic. People get injured [in these circumstances]," he says.
Not surprisingly, hot yoga makes you sweat – a lot. So you need to be well hydrated before and after your session. It's worth noting there's been at least one documented case of a woman ending up in intensive care with hyponatremia after doing Bikram yoga. (Hyponatremia is a life threatening condition that can occur when your body's sodium levels are thrown out of balance by drinking too much water for more see Can you drink too much water.)
Maryke Steffens spoke to Professor Marc Cohen, a medical practitioner and researcher from the School of Health Sciences at RMIT University, and Dr Neil Tuttle, a physiotherapist and lecturer in the School of Rehabilitations Sciences at Griffith University.
Published 02/05/2013
