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Injuries from Yoga

and Contraindications


























Compiled by: Trisha Lamb

Last Revised: April 27, 2006



2005 by International Association of Yoga Therapists (IAYT)






International Association of Yoga Therapists
P.O. Box 2513 Prescott AZ 86302 Phone: 928-541-0004
E-mail: mail@iayt.org URL: www.iayt.org

The contents of this bibliography do not provide medical advice and should not be so interpreted. Before beginning any
exercise program, see your physician for clearance.
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It is impossible to injure oneself practicing Yoga. It is very easy to do so performing a posture.
If one has injured oneself in practice then no Yoga was happening and one ought consider
modifying if not completely changing the sana or practice that caused the injury.

Jason Brown
yogibrown@aol.com

Remember, the harder you are on anything, the faster you wear it down, not build it up.
Exercise these days seems to be about making your body conform to certain standards of
strength, flexibility, size and appearance. It seems health is determined wrongly by appearance.
What Ive noticed is a lot of people are beating themselves up and even making themselves sick
trying to look good. It seems that mentality has been brought into yoga. Just remember the
purpose of this practice is not to become loose, strong, young, pretty or skinny. The purpose is
wellness, and its doorway is gentleness. Note, injuries occur when our practice is anything but
gentle. It will be extremely difficult to hurt yourself or others when gentleness is the priority!!
Also, nothing should ever be excruciating! Thats the body sending a clear message to back off.
This is the other barometer of whether you are practicing correctly.

Bryan Kest
http://www.myguruguide.com/yoga_articles/Quality-Practice-Quality-Results.asp

Lack of awareness, emphasis on exterior appearance, forcing, and a glamorization of pain
cause many people to tragically betray their bodies. And of course, yoga itself is not immune from
misuse and poor application either; students and teachers aspire to perfection and superiority
often at the expense of their own bodies integrity. Aspiring to an ideal is not yoga. Yoga is
union of the person with himself, with life. Yoga ceases to be yoga when it is used as a spiritual
whip. Yoga is compassion for the body, your body. Compassion for the body is compassion for
the spirit.

Kevin Kortan
http://www.evolutionaryyoga.com/articles/teaching.htm


Adamo, Richard. What is safe yoga? Spectrum: The Journal of the British Wheel of Yoga,
Winter 2003, pp. 12-13.

Aldous, Susi Hately. Anatomy and Asana: Preventing Yoga Injuries. URL:
www.anatomyandasana.com

From the website: Section 1 introduces the basics of anatomy as they relate to asana, including
skin, bone, muscle, nerve, connective tissue, fascia, blood and lymph vessels. Section 2 further
explores the language of anatomy and movement. Section 3 explores the 8 essential principles of
movement as they relate to Yoga. These principles can be applied to any style of yoga: Ashtanga,
Bikram, Iyengar, Viniyoga, Vinyasa Flow, Kripalu, Svaroopa, Anusara, etc. Section 4 applies the
8 essential principles to the specific groups of yoga asanas: standing poses, back bends, forward
bends, twists, and inversions. In each group, it is examined where there is a tendency for injury
and what can be done to instill space in the body and prevent injury from happening.

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Anderson, Erica. A world of yoga: Class to books, its taking over. J201, Spring 2004. Author
email: erkander@indiana.edu. Article available online:
http://www.journalism.indiana.edu/gallery/j201spring04/HealthWise/Casey/Index.html.

Dr. Mark Moseman, an Indiana University health center physician believes the attachment to
yoga can be attributed in part to proprioception; or, as some like to call it, the sixth sense.

Proprioception explains the phenomenon of how one can feel what position ones arms and
legs are in when moving. The exploration of that, he thinks, can be held partly accountable for
yogas use as a treatment to ailments.

As proprioception starts to communicate with the body, it starts to get more neurons involved.
In turn, the body is better at protecting it from damage, Moseman said . . .

Andes, Karen. Beware yogas dark side. Spirited Fitness. Article available online:
http://www.myprimetime.com/health/fitness/content/andes_yoga/index.shtml.

Cautions against holding postures too long and locking ones joints, and also gives specific
cautions for halasana, back-bending postures, and forward-bending postures. (Note: Some of
these cautions are not necessarily applicable to the experienced and well-trained Yoga
practitioner who can, for instance, hold postures for extended periods.)

Ashar, Hemal. Is too much yoga killing Khairnar? Mid-day.com, 2 Mar 2005. Article available
online: http://ww1.mid-day.com/news/city/2005/march/104687.htm.

Mumbais former demolition man, ex-deputy municipal commissioner G R Khairnar (63), has
succumbed to yogamania.

An obsession with yoga (averaging nearly 12 hours a day) has landed him at the KEM
Hospitals intensive care unit. He was admitted on Saturday.

The first danger signs came a fortnight ago when Khairnar felt discomfort in his nose.

I went to an ear nose and throat specialist and had a minor operation. The curtain and cartilage
in my nose had been affected because of jal neti and rubber neti. I had developed a monstrous
obsession with yoga, he confessed.

Then, last Friday, after an extensive yoga session, he asked to be taken to a doctor. He feared he
was about to die. I rushed him to Cooper Hospital; he was shifted to KEM the following day,
recalled his wife Ashalata.

She continued, His sodium level has dropped to a dangerously low level. He is under
observation for two days. Doctors at the KEM refused to comment on the matter, citing patient
confidentiality.

Khairnar began practicing yoga while on a rehabilitation drive in Kutch, around July 2004. He
started with free hand exercises and light yoga daily. On realising its benefits, he became a man
with a new mission.

I was bitten by the yoga bug, he said, from his hospital bed. The pain in my knee, little finger
and waist had disappeared, thanks to yoga. I have been allergic to a host of vegetables and dry
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fruits for 25 years. Yoga cured that too.

After that, there was no stopping. Recounted Ashalata, He practised jal neti (taking in water
from one nostril and passing from the other), rubber neti (inserting a rubber tube through the nose
and removing from the mouth) and pet neti (consuming water in abundance and flushing it out)
for several hours a day.

He used to practice yoga for 12 hours.

He would push back meal times to 11 pm and sleep for only three hours a day, not wanting to
miss his routine. He would sometimes lock himself up in the bathroom for six hours at a stretch,
busy with yoga inside.

I became greedy. If I were asked to consume a litre of water for cleansing, I would take 30. At
times, I would repeat an exercise 800 times, thinking that nothing succeeds like excess, said
Khairnar.

I did not speak to my wife for three months as I used to do yoga the whole day. Where was the
time to talk to her?

Henceforth, I shall practise yoga with expert supervision and stick to a time limit, he
concluded.

Bailey, James. Damage control: These herbs help heal and prevent common yoga injuries. Yoga
Journal, Jul/Aug 2001, p. 32.

Banslaben, John. Posted message on Yoga as a possible trigger for causing arterial dissection to
ESutra mailing list 8/13/02. To join ESutra, email the moderator, Leslie Kaminoff,
ESutra@aol.com.

John Banslaben posted a letter to ESutra that he had sent to Yoga Journal and which Yoga
Journal declined to publish. He states that there is no solid evidence, contrary to an article that
appeared in Yoga Journal and The New York Times, that Yoga can trigger arterial dissection. The
conjecture in the articles is based solely on anecdotal reports.

Barrett, Jennifer. The trouble with touch. Yoga Journal, Mar/Apr 2003. Article available online:
http://www.yogajournal.com/views/899_1.cfm.

Adjustments can help you to gain a deeper understanding of poses, but they can also be
misdirected and misunderstood. To get to the heart of this controversial topic, YJ talks to both
teachers and students about the trouble with touch.

Bell, Baxter, M.D. Yoga 911: How should you handle an in-class medical crisis? Yoga Journal,
Nov/Dec 2000, pp. 135-137.

Topics covered: Dizziness, fainting, epilepsy, asthma, and heart attack
Benitez, Denise. Drop and give me 10! To do Chaturanga Dandasana, a.k.a. the dreaded yoga
push-up, you need more than brute strength. Yoga Journal, Jan/Feb 2001. Article available
online: http://www.yogajournal.com/practice/208_1.cfm.

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Includes a discussion of injuries from performing this pose incorrectly.

Bhaktipoorananda Saraswati, Swami. Can Yoga help in injury? Yoga (Australia edition), May
1999.

Bhaskarananda, Swami. [Hazards of meditation.] In Swami Bhaskarananda, Meditation, Mind
& Patanjalis Yoga: A Practical Guide to Spiritual Growth for Everyone. Viveka Press, 2001.

Bogart, Greg. How to learn from an injury: A pulled muscle or torn cartilage can teach us a lot
about our yoga practiceor our life. Yoga Journal, May/Jun 1992, pp. 28-29.

Boyd, Lindsay. Kids are finding a place on the yoga mat. The San Diego Union-Tribune, 17 Jan
2004.
The American Academy of Pediatrics does not have an official stance on the issue, but some
doctors say the stretching and relaxation involved in yoga can be beneficial for children. As kids
get older and their bones grow, they lose flexibility, says Dr. Hank Chambers, director of Sports
Medicine at Childrens Hospital and Health Center in San Diego. This is one of the biggest
causes of growing pains. Chambers, a pediatric orthopedic surgeon, says he often recommends
yoga-like stretches to his patients. While yoga that is very physically demanding might not be
good for kids, stretching and relaxation, he says, is fine: Ive never seen one injury from yoga in
20 years.

Brown, Jason. Notes from a concerned practitioner/teacher. Article available online:
http://www.yogagoa.com/notes_concerned.htm. Author email: yogijbrown@aol.com.

Brundage, Sandy. Bad Vibes: Warning: Meditating may be hazardous to your health. SF
Weekly, 28 Aug. 2002.

Discusses work of psychologists dealing with meditation-induced problems.

Campbell, Denis. Bend it like the stars and risk wrecking your health. The Observer, 8 Sep 2002.
Author email: denis.campbell@observer.co.uk.

. . . An increasing number of yogas army of converts are finding that contorting themselves into
complicated positions can hurt their backs and knees, damage their groins, make them faint, bring
on splitting headaches and tear muscles and ligaments. One even ruptured his cruciate (knee)
ligament from attempting one of yogas simpler poses.

Devotees will be horrified to learn that many of yogas most popular positions, such as the
cobra, the plough and even touching your toes, are among those likeliest to cause injury.
Headstands, which students often try after only a few hours of tuition, are especially dangerous
because of the risk of neck damage.

Doctors and physiotherapists report seeing a sudden upsurge in patients suffering pain who
thought yoga would make them strong and flexible like the celebrities whose endorsement of
yoga has sent its popularity soaring . . .

Carrico, Marie. Contraindications of Yoga. IDEA Health & Fitness Source, Nov-Dec 1998, pp.
34-43.
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Carrington, Patricia. Some problems arise; The misuse of meditation. In Patricia Carrington,
Freedom in Meditation. New York: Anchor Press/Doubleday, 1977, pp. 241-260; 261-270.
Topics addressed: Refusal to learn meditation; Those who learn then quit; Resistance of self-
image to change; Depression and meditation; Fear of pleasure; Problems from overmeditation

Carter, Darla. Yoga safety: Pushing too hard, too fast can cause injuriesheres how to avoid
them. The Courier-Journal (Louisville, Kentucky), 5 May 2005.

Vulnerable areas of the body include the knee, particularly the cartilage of the inner knee; the
lower back; the hamstring muscles, especially near the buttocks; and the sacroiliac joints, where
the spine joins the pelvis, [Yoga teacher Roger] Cole said. Other injury-prone areas include the
neck and shoulders.

Chandra, F. J. [On fainting and Yoga postures.] A discussion in the article Yoga and the
cardiovascular system. The Journal of The International Association of Yoga Therapists, 1991,
2(1):7.

Chan-Ob, T., and V. Boonyanaruthee. Meditation in association with psychosis. Journal of the
Medical Association of Thailand, Sep 1999, 82(9):925-930. MEDLINE PMID: 0010561951.
Abstract: This study analyzed the correlation between contemplation and psychosis from three
cases of patients presenting psychotic symptoms subsequent to practicing meditation. Sleep loss
following a wrong doing in meditation was found to be the main cause in the first two cases, and
drug withdrawal was found to be the principal factor in causing a psychotic eruption in the third
case. In this last case, sleep deprivation subsequent to meditation was only a minor influence.
Discussion regarding the correlation between meditation and psychosis is presented in this study.

Chisholm, Bob. Injuryin yoga? Yoga & Health, Feb 1999, pp. 20-21,

Chusid, J. Yoga foot drop. Journal of the American Medical Association, 9 Aug 1971,
217(6):827-828.

Cleaves. Kundalini: (The Sublime Power). 15 Jan 2005. Article available online:
http://cleaves.zapto.org/clv/newswire.php?story_id=69&search_text=yoga.

As a result of the widespread commercialisation of Yoga in the US and the overnight
manifestation of numerous expert teachers, an alarming amount of misinformation and
misinterpretation of Yoga philosophy has occurred. Unlike other fanciful fads, which pose no
health hazard to participants, Yoga improperly taught could result in serious physical and
psychological injury to the student. This is particularly the case if advanced levels of Yoga are
pursued without proper preparation or expert guidance . . .

Cohen, Michael H. Ethics, adjustments, and carthartic release. My Yoga Mentor, May 2005, No.
18. Article available online: http://www.yogajournal.com/teacher/1565_2.cfm.

The owner of successful yoga studio in a major metropolitan city recently welcomed his new
yoga teacher with this advice: Our Power Practice is extremely rigorous and precise; therefore,
to ensure that all students are appropriately following the correct sequence of poses, be sure to
give each the same adjustment.

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Across the same city, the owner of a rival successful studio instructed his teachers as follows:
Adjustments should be correct, precise, standard. Teach every student the correct pose. He
demonstrated. Tailbone tucked in, shoulders back, like so. He added, Now you do exactly like
me.

In a third studio somewhere between the two, a student began crying during shivasana.
Process emotions through the breath, the teacher responded, and the student immediately stifled
her tears. In a fourth studio nearby, the teacher encouraged another students crying. These are
all of our griefs" he said. In response, many pent-up voices wailed at once.

Which of these practices are ethically and legally risky? And which could be justified as
essential components of yoga teaching? Would it make a difference if, in any of these studios,
one of the students claimed an injury (physical or emotional) from the recommended advice? If
your answer to each of these questions is it depends, you are well into the gray zone of ethics.
Like questions of liability, most ethical issues require analysis, call for a delicate balancing of
values, and cannot easily be answered with certainty. While at times academic, ethics discussions
are meant to be applied in practical situations, and the values that guide the discussion are quite
established, at least in the care-giving professions.

Colino, Stacey. The wounded warrior: As yoga classes attract a wider audience, some find they
come with a painful twist. The Washington Post, 16 Apr 2002, p. HE01. Article available online:
http://www.washingtonpost.com/wp-dyn/articles/A54763-2002Apr15.html. See also the follow-
up letter to the editor by Maureen Clyne, 23 Apr 2002, p. HE02, who, unlike the author of the
article, places most of the responsibility for the increase in injuries on the proliferation of
unqualified/underqualified Yoga teachers.

Corrigan, G. E. Fatal air embolism after Yoga breathing exercises. Journal of the American
Medical Association, 8 Dec 1969, 210(10):1923.

Dandy, Bill. Letter to the editor on the negative aspects of breath-holding from a conventional
point of view. Yoga Today, Feb 1981, 5(10):31. See the follow-up letters to the editor by Philip
Jones, Peter Longcroft, and Jo Hodby Holman bringing the yogic point of view in the Apr 1981
issue.

Dembner, Alice. Stretching has its limits: Injuries are on the rise as newcomers take up yoga.
The Boston Globe, 8 Jan 2003. Article available for purchase for $2.95 from The Boston Globe
archives: http://www.boston.com (use the Advanced search option, then the Click here to
search specific date range option; enter stretching has its limits in the search terms field and
set your date range to 1/1/2003 1/31/2003).

Doctor: Hot yoga may be harmful. The Washington Times, 30 Mar 2004. Article available
online: http://washingtontimes.com/upi-breaking/20040330-120151-9363r.htm.

U.S. doctors are beginning to question the potential for injury among those who practice Bikram
yoga, the New York Times reported Tuesday.

Participants typically spend 90 minutes doing 26 yoga posturespositions that some physicians
worry are harmfulin a very hot room.

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Heat increases ones metabolic rate, and by warming you up, it allows you to stretch more,
said Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical
Center in Manhattan.

But once you stretch a muscle beyond 20 or 25 percent of its resting length, you begin to
damage a muscle.

Each week, he sees as many as five yoga-related injuries to the knees or the lower back. Postures
that require extreme bending of the kneessquats and sitting backward on folded legs, for
exampleare the most likely to cause tears in knee cartilage.

In Bikram yoga, students practice the toe stand pose, a single-legged squat and the fixed firm
pose, sitting backward with bent knees.

Does meditation have detrimental effects? A thread in the Meditation in Psychotherapy online
forum. URL: http://www.behavior.net/forums/meditation/1998/msg3.html.

Dominguez, Richard. A surgeons warning: Dont do these stretches. Executive Fitness, 29 May
1982, 13(11):2-3. See the entry below for Dr. Swami Gitananda Giri, who replies to this article,
and also the detailed reply by Dr. Steven Katz in the 2003 issue of International Journal of Yoga
Therapy.

The stretches include halasana, uttanasana, virasana, paschimottanasana, stiff leg raise,
hurdlers stretch, and duck walking in a deep knee bend.

Dont let er rip when stretching. The Arizona Republic, 16 Apr 2004. Article available online:
http://www.azcentral.com/health/fitness/articles/0416stretching-ON.html#.

Esmonde-Whites integrated approach is time-consuming but effective and a workout in its own
right. She targets the entire body by combining dance, yoga, pilates and tai chi. She also utilizes a
system called proprioceptive neuromuscular facilitation, or PNF.

Essentially, PNF combines passive stretching with isometric stretching and involves contracting
a muscle, relaxing and releasing it. You cant just stretch one part of your body, she said. The
whole thing is linked.

I didnt figure that out until I tried yoga, a comprehensive system of stretching and strengthening
using physical poses and the breath. Once I finally learned how to stretch my hips and other hard-
to-reach areas, sitting at a desk all day became a breeze.

But yoga can be deceptively dangerous for the inexperienced and overzealous. Convinced that a
strained hamstring just needed to let go, I stretched my injured leg as much as possible. A year
later, not surprisingly, I was still hurt.

But yoga, done wisely, works well. So does NIA, or neuromuscular integrative action. The 20-
year-old method, which is popping up in health clubs, is a little more upbeat than yoga. The
choreographed routine, set to music, mixes jazz dance, aerobics, martial arts, yoga and other
movements.

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Do you have any injuries that hamper your yoga practice? Yoga Journal, Nov 2002, p. 28.
(Three practitioners respond.)
Dreyfuss, Ira. Yoga may bend some the wrong way. The Associated Press, 6 Dec 1998.

___________. Power yoga can cause powerful aches, pains. Los Angeles Times, 13 Dec 1998,
Bulldog Edition, Section: Part A, p. A-10.

Duval, E. L., R. Van Coster, and K. Verstraeten. Acute traumatic stroke: A case of bow
hunters stroke in a child. European Journal of Emergency Medicine, Jun 1998, 5(2):259-263.
Department of Paediatrics, University of Ghent, Belgium.

Acute traumatic stroke of the cerebellum is rarely seen in children. In adults, chiropractical
manipulation, yoga exercises, bow hunting and cervical trauma have all been associated with
vertebrobasillar damage and subsequent stroke due to cerebellar infarction.

Dworkis, Sam. Chronic injury and yoga rehabilitation. Article available online:
http://www.yogafamily.com/library/articles/dworkis_injury.shtm.
___________. No pain, no gain. Spectrum: The Journal of the British Wheel of Yoga, Summer
2002, p. 30.
On chronic injury and the fascia.

Dynek, Linda. One size does not fit all (letter to the editor). Yoga Journal, Jul/Aug 2003, p. 14.

On forced adjustments and the acceptance of pain as good by some Yoga teachers.

Edell, Dean. Was this yoga class unsafe? 18 Jan 2000. Available online at HealthCentral.com:
http://www.healthcentral.com/drdean/deanfulltexttopics.cfm?id=25760.

Editors of Yoga J ournal. [On avoiding injury in Yoga by warming up muscles.] Yoga Journal,
Nov/Dec 2000, p. 52.

___________. [On retinal detachment, glaucoma, and inversions]. Yoga Journal, Nov/Dec 2000,
p. 52.

___________. Dizzy over backbends. Yoga Journal, Jul/Aug 2001, p. 34. (On dizziness and
nausea while doing backbends.)

___________. The downside of inversions. Yoga Journal, Jul/Aug 2001, p. 34. (On why
inversions should not be practiced during menstruation and asanas to substitute.)

Epstein, M. D., and J. D. Lieff. Psychiatric complications of meditation practice. Journal of
Transpersonal Psychology, 1981, 13(2):137-147.

ESutra. Yoga injuries thread, Aug 1999. For information on joining the ESutra mailing list, write
to the moderator, Leslie Kaminoff, ESutra@aol.com.

Fields, Jonathan. Taking the shock out of chaturanga dandasana. Yoga International, Jun/Jul
2005, pp. 94-96.
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With the rapid proliferation of power/vinyasa yoga, chaturanga dandasana (four-limbed stick
pose) has become almost as popular as decaf latte. While much has been written about this
powerful posture, little has been said about the increasingly dynamic nature of the vinyasa
sequence that takes the practitioner from uttanasana (standing forward bend) through chaturanga
to urdhva mukha shvanasana (upward-facing dog). Performing this dynamic sequence
incorrectly, or while guided by ego, can lead to injury and frustration. With a few simple
modifications, practitioners at all levels can experience the power of this sequence with safety
and confidence.

Fincke, Alanna. Bent out of shape. Body & Soul Magazine, 2002. Article available online:
http://www.bodyandsoulmag.com/show_document.asp?iDocumentID=142&iBDC=1704&iPage
Number=1.

Holly Millea, a 41-year-old freelance writer living in New York City, was in enviable shape.
The petite, 108-pound runner had the body fat of a triathlete and had practically never been sick.
Two years ago, she started a vigorous Ashtanga yoga practice. Then, last August, she began to
feel numbness and tingling down her left arm and into her first three fingers. The pain intensified,
interfering with her ability to lie or sleep on her left side. At one point, she thought it was her
heart, or even multiple sclerosis, which has affected several family members.

Now, one emergency room visit and two MRIs later, Millea has a diagnosis: a bulging disk in
her cervical spine, which is causing an impingement to the root of a nerve in her neck. If the
numbness doesnt go away in a couple of months, her doctor wants to surgically remove the disk
and fuse two vertebrae together. I am sure this is yoga-related, says Millea. Its at the base of
my neck, and I was doing Shoulder Stand a lot. I was doing it wrong, and I was pushing myself
too hard . . .

Fong, K. Y., R. T. Cheung, Y. L. Yu, C. W. Lai, and C. M. Chang. Basilar artery occlusion
following yoga exercise: A case report. Clin Exp Neurol (Australia), 1993, 30:104-109.

French, A. P., A. C. Schmid, and E. Ingalls. Transcendental Meditation, altered reality testing,
and behavioral change: A case report. Journal Nerv Ment Dis, 1975, 161:55-58.

Funk, Leslie. Hot Yoga: Physiological concerns while exercising in the heat. Yoga World,
Apr-Jun 2001. Article available online: http://www.iayt.org/hotyoga.html.

Gilmore, Ruth. Answers the question: When I stretch my head back in postures like ustrasana
(camel), I feel dizzy, and once I nearly passed out. Why is this? Yoga & Health, Nov 1997, p.
11.

Gitananda Giri, Dr. Swami. Real yoga is as safe as mothers milk. Yoga Life, Dec 1997,
28(12):3-12.
Swami Gitananda replies to Dr. Richard Dominguezs ultracritical article on the dangers of asana
practice that appeared in the 29 May 1982 issue of Executive Fitness Newsletter. He gives
instructions on how to safely do halasana, paschimottanasana, paryankhasana, eka pada uttana
pada asana, and hurdlers stretch.
Dr. Steven Katz, an orthopedic chiropractor who specializes in treating Yoga injuries, will also
reply to the Dominguez article in detail in the 2003 issue of International Journal of Yoga
Therapy.
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Giubilaro, Gabriella. How to reinitiate yoga after an injury or after a period of inactivity. Article
formerly available online.
Hagen, Patricia. Take steps to avoid yoga injuries. The Indianapolis Star, 6 Apr 2004. Article
available for purchase from The Indianapolis Star archives: http://www.indystar.com.
Hanus, S. H., T. D. Homer and D. H. Harter. Vertebral artery occlusion complicating yoga
exercises. Archives of Neurology, 1977, 34(9):574-575.

Abstract: Vertebral artery occlusion developed in a young adult shortly after he hadperformed
neck manipulations during yoga movements. Yoga exercises are a

rare cause of acute medullary
or cerebellar infarction.

Heide, F.J., and T. D. Borkovec. Relaxation induced anxiety: Mechanisms and theoretical
implications. Behav. Res. Ther., 1984, 22:1-12.

Heredia, Christopher. No pain, no gain mantra wont work with yoga:
Injuries on the rise as practice goes mainstream. San Francisco Chronicle, 3 Aug 2003. Article
available online: http://sfgate.com/cgi-
bin/article.cgi?file=/chronicle/archive/2003/08/03/LV82589.DTL.

Hillsman, D., and V. Sharma. Yoga and pneumothorax. Chest, May 2005, 127(5):1863. Author
email: deane.hillsman@ieee.org. This is a response to Johnson, Tierney, and Sadighi, which is
cited in this bibliography.

Honebrink, Andrea. Meditation: Hazardous to your health? Dont overlook the side effects of
this powerful transformative technique. Utne Reader, Mar/Apr 1994, p. 26.

Hutchinson, Ronald. How not to cripple yourself doing Yoga. In Ronald Hutchinson, Yoga: A
Way of Life. London: Hamlyn, 1974, pp. 39-41.

Stop competing against the clock. Stop competing against yourself. You get no halos for a
rushed virtuoso performance. A few asanas slowly learned and performed gracefully and gently
every day will lead you into the Yoga way of life. Trying to be a virtuoso is just an ego-trip . . .
Ego trips take you nowhere. How can they if everything is centred round you personally? . . .
Whether you gain benefit or whether you damage yourself by doing Yoga postures depends
largely on the state of mind in which you approach them. This is why before anything else chelas
[students] are taught an understanding of what is meant by the yamas [moral disciplines] and
niyamas [self-restraints] . . .

Ikemi, Y., H. Ishikawa, J. R. Goyeche, and Y. Sasaki. Positive and negative aspects of the
altered states of consciousness induced by autogenic training, Zen and yoga. Psychother
Psychosom (Switzerland), 1978, 30(3-4):170-178.

Immune system and Yoga. Because of Yogas immune-enhancing effects, it may be
inappropriate for someone taking immune-suppressant drugs, such as an organ-transplant patient,
to do Hatha-Yoga. The advice of the patients physician and a qualified Yoga therapist should be
sought.

Its own-up time: Im a hardcore yoga fan. Health.Telegraph, 6 May 2005. (On Bikram Yoga.)
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. . . one doctor from the Beth Israel Medical Centre in New York . . ., earlier this year, told a
British journalist that he saw up to five Bikram-related injuries a week, a result, apparently, of
stretching muscles too far beyond their resting lengths.

Iyengar, Geeta. Practice of inversions during & after menstruation. Yoga Rahasya, 1997,
4(1):30-31.
Jameson, Marnell. In over their heads: Americans competitive nature and a dearth of seasoned
instructors mean more injuries on the yoga mat. Los Angeles Times, 13 Aug 2001. Article
available online: http://www.latimes.com/features/health/la-081301yoga.story. Also available
under the title: In a bad position: Yoga may be soaring in popularity, but the lack of seasoned
instructors puts students at risk, Detroit News, 5 Sep 2001. URL:
http://www.detnews.com/2001/health/0109/05/h06-285621.htm.
Johnson, Andrew, and Marged Richards. Celebrity power yoga: the new craze from over there
causing bad karma over here. The Independent (U.K.), 30 Jan 2005.

On the opening of a Jivamukti Yoga studio in London and concerns about potential injuries.

Its hard, its fast and it tones tired bodies. But, Andrew Johnson and Marged Richards ask, was
yoga ever supposed to be a competitive sport?

. . . Gary Carter, who runs the Natural Bodies yoga centre in Brighton, recently named one of the
10 best centres in the country by The Independent, said: We tend to see people coming in with a
number of injuries from these newer forms of yoga, which we have to unravel. Injuries are to the
neck, shoulder, toes, knees, hips and lower back. They are pulling their bodies into positions they
are not ready for.

For some, aerobics has been replaced by the hardcore branch of yoga and the attitude is the
same as going into a gym, he said.

John Stirk, one of Britains leading yoga teachers, who is also an osteopath, said: Ive seen
many people who have injured themselves by pushing themselves too hard and too far. A lot of
bodies dont need things done to them, they need things undone. They should follow the body,
not work against it.

Yoga generally has an enormous amount to offer. Its a shame that people who take this on
often dont take the maximum benefit. They do incur injuries. Everyone should do yoga, but at
their own pace.

Jackie Barker, a yoga teacher from Oxford with more than 30 years experience said: This is a
young persons yoga. There are a lot of malesits a bit egotistical. What is dangerous is that
people arent aware of what they are doing. You can quite easily end up getting injured . . .

Johnson, Derek B., Mathew J. Tierney, and Parvis J. Sadighi. Kapalabhati pranayama: Breath
of fire or cause of pneumothorax? Chest, May 2004, 125(5):1951-1952. Author email:
dakotaderek@yahoo.com. Author email: dakotaderek@yahoo.com. See also response by
Hillsman and Sharma cited in this bibliography.

Abstract: Spontaneous pneumothorax is the most common cause of pneumothorax.

We report a
case of a 29-year-old healthy woman who presentedto the emergency department with a
13
spontaneous pneumothoraxcaused by a yoga breathing technique called Kapalabhati pranayama,

or breath of fire. Yoga breathing exercises are commonly practiced,

and a limited number of
studies have shown various physiologic

benefits of yoga breathing. This is the only known report
of

spontaneous pneumothorax caused by pranayama, but some other

rare causes are noted. This
case should illustrate that adverse

side effects can occur when one pushes the body to physiologic

extremes.

Jollymore, Amy Eden. Emotional ambush: Surprisingly, the most tranquil of therapies
acupuncture, meditation, and massagecan incite extreme emotions. Natural Health, Nov/Dec
1999, pp. 87-89.

Jordan, Thea. You cant be Bruce Lee in a day. As more people take up martial arts [and
Ashtanga Yoga], the number of related injuries is rising. Thea Jourdan reports on the importance
of proper training. The Daily Telegraph, 21 Sep 2000.

Kaminoff, Leslie, with Coeli Carr. Mr. Fix It for injured yoga enthusiasts. The New York Times,
11 Aug 2002.

On injured Yoga students, Yoga teachers, and others that Yoga teacher Leslie Kaminoff has
helped.

Katz, Steven. Rebuttal to a surgeons warnings. International Journal of Yoga Therapy, 2003,
no. 13, pp. 43-44.

Kennedy, R. B., Jr. Self-induced depersonalization syndrome. American Journal of Psychiatry,
1976, 133(11):1326-1328. (On possible negative consequences for the novice meditator.)

Kohli, Anu. Interview with Dr. Suhas Kate, orthopaedic surgeon: Clarification on an article on
Yoga. Yoga and Total Health, Dec 2000, pp. 7-8. (Indicates that there should be no negative
consequences from performing classical asanas, such as padmasana, if done properly.)

Kreahling, Lorraine. When does flexible start to mean harmful? Hot yoga draws fire. The New
York Times, 30 Mar 2004. Article available online:
http://www.nytimes.com/2004/03/30/health/30YOGA.html.

As more and more people take up Bikram to lose pounds and gain strength, however, medical
professionals are expressing concerns about the demands of yoga contortions performed in
extreme heat.

Heat increases ones metabolic rate, and by warming you up, it allows you to stretch more,
said Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical
Center in Manhattan. But once you stretch a muscle beyond 20 or 25 percent of its resting
length, you begin to damage a muscle.

Each week, Dr. Gotlin said, he sees as many as five yoga-related injuries to the knees or the
lower back. Postures that require extreme bending of the kneessquats and sitting backward on
folded legs, for exampleare the most likely to cause tears in knee cartilage. In Bikram yoga,
students practice the toe stand pose, a single-legged squat and the fixed firm pose, sitting
backward with bent knees.

14
Basically, the knee is a piece of bone with two strings of muscle on the top and bottom, and you
can only tighten those strings so much, Dr. Gotlin said. The more you flex the knee under load,
the more pressure is exerted on the kneecap.

Bikram advocates maintain that the immediate warmth and simple movements at the start of
each class are safer than traditional yoga.

The heat helps people work slowly and safely into the postures and makes injuries infrequent,
said Jennifer Lobo, an owner of Bikram Yoga NYC.
But David Bauer, a physical therapist in New York who also teaches yoga, said the enthusiasm
and competition among participants could contribute to injuries.

When you are in a hot studio filled with hard-core Type A personalities, and everyones
adrenaline and endorphins are pumping, youre not feeling any pain, he said, and it may mask
how far you can go.

The mirrored walls in Bikram studios may encourage students to concentrate on outward form,
Mr. Bauer said. In contrast, more traditional yoga emphasizes an inward focus on breathing and
individual limitations, possibly helping to curb injuries.

Learning where your body is and what your body can do is what yoga is about, not reaching for
an ideal or modeling yourself after a picture in a book, Mr. Bauer said. If you are just flexible
and not strong, at the end of your range you are going to tear a muscle.

Indeed, part of the Bikram yoga philosophy is the push to go a little farther every time a posture
is performed. Each pose is done two times per class. Participants arch backward and bend to the
side in the half-moon pose, for example, and then do the movement again, trying to bend the
spine even more.

Practitioners maintain that the spinal flexibility and strength cultivated in Bikram yoga can be
vital in warding off the effect of aging on posture. Some physical therapists, however, question
the value of excessive joint flexibility, saying it can lead to inflammation and pain.

The extreme range of motion yoga develops does not necessarily have an advantage, and it may
be counterproductive, said Dr. Shirley Sahrmann, a professor of physical therapy at the
Washington University School of Medicine in St. Louis.

Like dancers, practitioners of yoga cultivate overly flexible spines, which often cause problems
in resting posture.

In my business, Dr. Sahrmann said, I have more problems with people who have excessive
mobility than limited mobility.
The thigh socket, or ball-and-socket joint, at the top of the leg is another overworked joint in
yoga. Bikrams tree pose requires standing on one leg and drawing the opposite foot to the top
of the thigh. The point is to rotate the joint of the drawn-up leg outward as far as possible; but
what looks good may not be what is best for the body.

More is not always better when it comes to joints, said Lee Staebler, a licensed physical
therapist on the North Fork of Long Island, who is studying movement impairment syndromes at
the State University of New York at Stony Brook.

15
Warmer tissues will yield more easily, but stretching beyond optimal limits can compromise
joint tissue, Mr. Staebler said.

Ligaments, tough bands of fibrous tissue that connect bones or cartilage at a joint, do not regain
their shape once they are stretched out, Mr. Staebler said. A loose joint can be like a loose door
hinge that prevents the door from closing tightly . . .

Still, warnings about torn cartilage or painful wobbly joints are unlikely to keep Bikram
devotees out of the saunalike studio they claim to find as pleasant as the beach.

People either cringe when you describe the heat, or they come and get addicted to it, said
Christina Ha, a New York television reporter who first took up Bikram three years ago. On her
doctors advice, Ms. Ha has now stopped doing Birkam because she is pregnant.

Physicians caution that exercising in heat 2 to 7 degrees above the bodys core temperature of
98.6 can be dangerous.

Dr. Nieca Goldberg, chief of womens cardiac care at Lenox Hill Hospital in New York, said
that because of the stress that extreme heat places on the heart through the demand for increased
circulation, people with medical disorders should not do Bikram yoga.

If you smoke, are overweight or have high blood pressure, this is not the exercise for you, she
said.

Some practitioners of Bikram report dizziness, nausea, muscle weakness and cramping.
Dehydration is the most probable cause, said Dr. Catherine Compito, an orthopedic surgeon
specializing in sports medicine at New York-Presbyterian Hospital.

In extreme cases, losing electrolytes through perspiration can cause cardiac arrhythmia.

Your body can only tolerate so much fluid loss, Dr. Compito said. She added that in high heat,
the normal mechanisms for restoring the bodys optimal core temperature cannot function.
Evaporation cannot cool the skin. Cool air currents cannot move the hot air away from the body.

Over time, Dr. Compito said, adherents of hot yoga may be able to condition their bodies to
work out safely in the heat, but she questioned whether the practice offered any advantages over
other types of exercise. For stalwart Bikram devotees, however, she recommended drinking more
water than the single bottle most take to class.

Drinking before, during and after is really the way to go here, Dr. Compito said.

Krucoff, Carol. Insight from injury: If the practice of hatha yoga was meant to heal, why are
there so many yogis getting hurt? Yoga Journal, May/Jun 2003, pp. 120-124, 203. Article
available online: http://www.yogajournal.com/views/908_1.cfm.

___________. Yoga does every body good. Yoga Journal, Jul/Aug 2005, pp. 64-71, 110-111.

Injury, illness, or age can alter your asana practice dramatically, but you can still reap benefits.

Kugler, J. Neurologische Storungen nach Yogaubungen. [Neurologic disorders following yoga
exercises]. Med Klin. (West Germany), 15 Sep 1972, 67(37):1195. [In German.]
16

Lasater, Judith. Yogi beware: Hidden dangers can lurk within even the most familiar pose. Yoga
Journal, Jan/Feb 2005, pp. 110-119.

Covers the safe practice of padmasana, paschimottanasana, marichyasana III, and chaturanga
dandasana.

Lazarus, Arnold A. Psychiatric problems precipitated by Transcendental Meditation.
Psychological Reports, 1976, 39:601-602.

Little, Tias. Answers the question: Im naturally very flexible. But a teacher once told me that
flexible people are more likely to become injured than people with stiff muscles. Why is this
true? If Im naturally flexible and the asanas require flexibility, then how do I prevent injury?
Yoga Journal. Article available online: http://www.yogajournal.com/practice/753_1.cfm.

Lukoff, D., F. Lu, and R. Turner. From spiritual emergency to spiritual problem: The
transpersonal roots of the new DMS-IV category. The Journal of Humanistic Psychology, 1998,
38(2):21-51.

Machander, A. R. Comments on the increase of intrathoracic pressure in the practice of
pranayama. Jgov Cvicen, 1982, pp. 65-70. [In Czechoslovakian.]

Summary: Both intrathoracic and intraabdominal pressure can be increased during yogic
practice. Abhyantara kumbhaka . . . during pranayama can increase intrathoracic pressure in
different degree[s], according to the technique used. The increase of thoracic pressure elevates
venous pressure with consequent venous blockade and the increase of pressure both in
cerebrovascular fluid and intracranially. If the breath-holding with increased intrathoracic
pressure lasts 45 seconds, it causes stagnant hypoxy of the brain with metabolic changes . . .
Thanks to limited venous return, minute heart volume is decreased to one-half with consequent
disturbance of cardiac rhythm. Therefore the breath-holding with increased thoracic pressure is
not without danger (cerebral stroke, collapse, paroxysm of epilepsy, coronary infarction).

Pronounced increase of thoracic pressure can be caused by [the] following conditions: 1) if
tension of expiratory thoracic muscles is increased after glottis is closed, 2) if uddiyana bandha is
practiced incorrectly, causing abdominal press[ure], 3) if there is relaxation of diaphragm during
breath-holding and increased abdominal pressure expands over it to thoracic cavity. Increased
intraabdominal pressure can have negative effect also during asanas, if they are practice with
longer breath-holding and with activation of expiratory muscles (e.g., mayurasana, backward
bending).

As a consequence we can state that incorrect practicing of certain yogic exercises can endanger
especially disposed persons and regular incorrect practice could negatively influence even healthy
people.

Mahabir, Deolal. Yoga: Hints and cautions. Available online:
http://www.mindexplorer.com/Hints%20and%20Cautions.htm.

Includes cautions regarding 1) postures that increase abdominal pressures, 2) inverted postures, 3)
hypertension, and 4) low back problems.

17
Mangla, Divay. Meditation is not free from side-effects. Article available from Dr. Ananda
Balayogi Bhavanani, ICYER, yognat2001@yahoo.com.

Some of the negative effects of meditation that have been noted in different scientific studies:

Boredom, impaired reality testing
Less motivation in life
Relaxation-induced mild-to severe anxiety
Paradoxical increases in mental tension
Confusion and disorientation
Feeling of being spaced out
Depression, increased negativity, being more judgmental
Feeling addicted to meditation
Psychosis-like symptoms
Appearance of hidden memories from the past, such as incest, rejection and abandonment
Other adverse effects are uncomfortable bodily sensations, feelings of guilt, grandiosity, elation,
destructive behavior and suicidal feelings

Manheim, Allison. Ouch! Learning from pain in my asana practice. Yoga International,
Apr/May 2003, pp. 36-40.

Margo, C. E., J. Rowda, and J. Barletta. Bilateral conjunctival varix thromboses associated with
habitual headstanding. American Journal of Ophthalmology, Jun 1992, pp. 726-727.

Mattio, T. G., T. Nishida, and M. M. Minieka. Lotus neuropathy: Report of a case. Neurology,
1992, 42:1636.

McCall, Timothy. Doctors call: Should you discuss your yoga routine with your physician?
Yoga Journal, Jan/Feb 2004, p. 30.

Discusses a lot of contraindications for Yoga and the possible restriction of movement that may
be necessary following injury.

McClanahan, Amrita, M.D. Yoga 911 workshop. 5
th
Annual Integral Yoga Teachers
Conference, 30 Aug - 3 Sep, 2001, Satchidananda Ashram - Yogaville, Buckingham, Virginia.
Email: iyi@yogaville.org.

Workshop description: As the popularity of Yoga grows, and more students are being referred to
Yoga classes by their health practitioners, the possibility of an emergency health situation in your
Yoga class increases. As a Yoga teacher, you can take steps to prepare for future unexpected
events. This workshop will focus on some of the possible scenarios that may [arise], such as
dizziness, fainting, seizure, asthma, and heart attack.

McGonigal, Kelly. Nursing an injury or illness. Article available online:
http://www.openmindbody.com/nursing_an_injury.htm.

Its the reality of living in a physical body in a complex world: sometimes we hurt, and
sometimes we are ill. Maybe your yoga practice has reduced the frequency of everyday aches or
illnesses, but even the most dedicated yogis get injured or sick sometimes. Sometimes, the
practice of yoga produces an injury. A yoga injury can seem like a betrayal: How could
something so good have hurt us? Whether you have a mild injury caused by carelessness or
18
ambition in your yoga practice, or are recovering from an illness that makes your regular
strenuous yoga practice seem like torture, write yourself an individualized yoga prescription . . .

McKinney-Vialpando, Kaylan. Yoga injuries: The real problem. Yoga Studies, May-Aug 2003.

Meditation can damage your health. SF Weekly (San Francisco), 28 Aug 2002. Article
available online:
http://www.psychiatrymatters.md/index.asp?sec=mag_article&mag_id=1001&article_id=1041.

Usually described as a technique for self-improvement and even healing, meditation is generally
presented as suitable for everyone. Just as some people are allergic to penicillin, however, some
people react badly to meditation. These harmful effects are not limited to one form of meditation,
or to long retreats rather than short sessions, and have been known for 30 years. Adverse health
effects include psychologic and physical problems ranging from muscle spasms to hallucinations,
facial tics, insomnia, spacing out, anxiety, and even psychotic breakdowns. These effects have
now been shown to have a physiologic basis, as blood flow to the brain is redistributed and brain
neurotransmitter release alters . . .

Miller, Tim. Answers the question: I practice Ashtanga Yoga and have developed a very painful
ache around my sit bone area. Ive tried to bend my knees in forward bends, but this makes the
pain worse. Now even walking can set off the ache. Can you suggest anything? Yoga Journal.
Article available online: http://www.yogajournal.com/practice/764_1.cfm.

Moulinjeune, [first name unknown]. Les vritables dangers du Yoga. Paper given at a
conference in France, probably in the late 1960s. No further information available. [In French.]

Mulcahy, Lisa. Heal smart. Yoga Journal, Jul/Aug 2005, p. 26.

Suffering from a pull, pain, or strain but still want to practice? Its possible, but only if you do it
right . . . A chart is provided that outlines poses that can help or hurt when recovering from a
sore hamstring attachment or a rotator cuff strain or tear.

Murphy, Michael, and Steven Donovan. Negative experiences. In Michael Murphy and Steven
Donovan, The Physiological and Psychological Effects of Meditation: A Review of Contemporary
Research with a Comprehensive Bibliography 1931-1996. 2d ed. Sausalito, Calif.: The Institute
of Noetic Sciences, 1997, pp. 143-145.

Negative experiences reported include: For Transcendental Meditation: anxiety, confusion,
depression, emotional instability, frustration, physical and mental tension, procrastination,
restlessness, suspiciousness, intolerance of others, withdrawal; For meditation in general: can
encourage some individuals to become more obsessive-compulsive and dwell on trivia or
nonessentials; can cause anxiety, tension, anger; can precipitate a psychotic
episode/schizophrenic breakdown; dissociative semi-trance states can upset some individuals; can
cause body pain, insomnia, severe depression, suicide attempts, and withdrawal and concentration
on the internal to the neglect of the external.

In addition to research citations, other texts that warn of the difficulties of meditation/spiritual
practice and how to deal with them are cited. The latter include the Katha-Upanishad, The
Collected Works of St. John of the Cross, Sri Aurobindos Collected Works, Aldous Huxleys The
Perennial Philosophy, and William Jamess The Varieties of Religious Experience.

19
Murphy, T., and M. A. Persinger. Complex partial epileptic-like experiences in university
students and practitioners of Dharmakaya in Thailand: Comparison with Canadian university
students. Psychological Reports, Aug 2001, 89(1):199-206. PMID: 11729543.

Abstract: We tested the hypothesis that individuals who frequently practice meditation within
another culture whose assumptions explicitly endorse this practice should exhibit more frequent
and varied experience associated with complex partial epilepsy (without the seizures) as inferred
by the Personal Philosophy Inventory and Roberts Questionnaire for the Epileptic Spectrum
Disorder. 80 practitioners of Dharma Meditation and 24 university students in Thailand were
compared with 76 students from first-year courses in psychology in a Canadian university.
Although there were large significant differences for some items and clusters of items expected as
a result of cultural differences, there were no statistically significant differences between the two
populations for the proportions of complex partial epileptic-like experiences or their frequency of
occurrence. There were no strong or consistent correlations between the history of meditation
within the sample who practiced Dharma meditation and these experiences. These results suggest
complex partial epileptic-like experiences may be a normal feature of the human species.

Nagarkatti, Shantanu. Does meditation have detrimental effects? Article available online:
http://www.behavior.net/cgi-bin/nph-
display.cgi?MessageID=173&Top=172&config=meditation&uid=nC1M8.user&new=0&adm=0.

Nespor, Karel. Yoga and health. Article available online:
http://www.geocities.com/health_yoga_poetry/phys.html. Dr. Nespors email address:
nespor@plbohnice.cz.

Discusses contraindications in general and also includes an extensive section on contraindications
listed alphabetically by disorder.

Oakes, Stephanie. Answers the question: I injured my knee in a yoga class (it might be the
tendons or ligaments around my kneeI cant really tell). Since then, Ive continued with my
yoga class and golfing but have stopped running. Im trying to be careful about putting pressure
on the knee. It sometimes pops when I walk, like its out of joint or something. Theres no
swelling and no visible change in the muscle. What should I do to heal this injury? USA
Weekend, 15-17 Nov, 2002, p. 14.

Otis, L. Adverse effects of meditation. In D. H. Shapiro, and R. N. Walsh, eds., Meditation:
Classic and Contemporary Perspectives. New York: Aldine Publishing, 1984, pp. 201-208.

Palkhivala, Aadil. How to teach peace. My Yoga Mentor, Nov 2004, no. 12. Article available
online: http://www.yogajournal.com/teacher/1409_1.cfm.

. . . as teachers, we must be very careful with certain pranayama practices. Bhastrika pranayama
(often known as Breath of Fire) can damage or even destroy the nervous system. Ill never
forget a woman who came to me for legal advice when I was practicing law. She was extremely
agitated, constantly distracted, and couldnt finish a thought or a sentence. I learned that her
nervous system was burnt out from years of practicing pranayama improperly, specifically
bhastrika and kapalabhati (Skull-shining breath). When an excess of pranic energy floods the
nervous system, it is like a balloon thats filled with more air than it has the strength to contain.
The nervous system is shattered and severe mental trauma can result. The body must be properly
prepared with years of asana (especially backbends) to safely receive and contain the power of
prana.
20

And there are other ways to harm our students with the practice. For instance, the nervous
system is agitated by jerky movements. This includes trembling during a pose by working too
hard. Remind your students that there is no virtue in holding poses too long, for the benefits
quickly unravel and turn into detriments. I have heard some teachers say to their students, Shake
it out! and encourage their students to shake themselves after intense poses to release tension.
This misses the point. It is far better to be still and melt the tension with awareness.

Parr, Sandra. Yoga in a rehabilitative environment. Reaching Out with Yoga, no. 6, p. 8.

The Millar Rehabilitation Centre in Edmonton, where I work as a contract yoga teacher,
provides rehabilitation programs for a wide variety of seriously injured people and has just begun
a program for fibromyalgia . . .

Persinger, M. A. Transcendental meditation and general meditation are associated with enhanced
complex partial epileptic-like signs: Evidence for cognitive kindling? Perceptual Motor Skills,
1993, 76:80-82.

Peterson, Anthony. Video yoga a health hazard. The Daily Telegraph (Australia), 28 Jun 2004,
Edition 1, Page 004.

Yoga exponents are being caught out by the activitys relaxing and low impact image with more
than one in four injured during sessions.

A failure to warm up and prepare adequately for the exercise has been identified as causing the
surprising injury rate.

The risks of yoga are contained in a sports injuries report to be released today.

The research, commissioned by Medibank Private, found sports injuries cost the Australian
community more than $1.8 billion in the past year. The medical bill was $300 million more than
the previous year.

Footballers were the most likely to be hurt and those aged between 18 and 24 were at greatest risk
of breaking down.

Sports physician Dr Peter Larkins said yoga was not inherently dangerous but the injury rate
showed many participants were not doing it correctly.

You have to get the correct program and advice. There are a lot of stretching manoeuvres and
maybe some are trying it at 38 thinking there are 18, he said.

Yoga has become the new aerobics and some people are getting it out of a book or video.
Participants need to ensure that they don't overdo it, particularly when starting a new health and
fitness regime' Yesterday at Body Mind Life yoga studio in Surry Hills owner Nicole Walsh said
she had not experienced the injury rate found in the survey.

She said students of Bikram yoga complete warm up breathing and stretching exercises before
progressing. The increased room temperature also made injuries less frequent.

21
I would have thought one in 10 [injured], she said.

It depends on the kind of injuries. Some people have old injuries and do yoga and the old
injuries flare up. The report found 5.2 million injuries were incurred on Australian sporting
fields and courts in the past 12 months requiring almost 25,000 hospital admissions and 250,000
emergency department presentations.

An alarming 3.6m injuries were untreated.

Ankle, foot and achilles injuries are the most common accounting for 20 per cent of all sporting
injuries.

Knee (13 per cent), back and spine (9 per cent), shoulder (8 per cent) and wrist or forearm (5 per
cent) followed.

The warning from fitness experts to warm up and cool down had failed to reach the masses with
only 38 per cent of survey respondents saying they regularly completed pre and post sport
regimes.


Regimbeau, Charles, and Josette Regimbeau. Manuel Pratique de Gymnastique Posturale:
160 Postures dont 80 Asanas avec Leurs Indications et Leurs Contre-Indications: Le Livre Clef
Du Hatha-Yoga. Paris: Maloine, 1976. [In French.]

Robin, Mel. Injuries incurred by improper yogasana practice. In Mel Robin, A Physiological
Handbook for Teachers of Yogasana. Tucson, Ariz.: Fenestra Books, 2002, pp. 511-518.

Contents: Practicing yogasanas from a book, without a teacher; Being too tried can lead to injury;
Being too ambitious can lead to injury; Congenital weaknesses; Specific case histories:
Neurological damage, Vascular damage, Muscular damage

Rose, Tracy. The injury is the practice. Article available online:
http://www.practiceashtanga.com (click on Archived Articles).

On the extensive number of injuries experienced by Ashtanga Yoga practitioners.

Rosen, Ellen. Trying a new sport? Sign a waiver, then hope for the best. The New York Times, 13
Aug 2005.

Waivers of varying form and complexity are popping up everywhere, from parents like Ms.
Salazar to companies offering extreme sports like heli-skiing to those running petting zoos. Even
yoga centers, which promise a place of calm, often require them.

A sample release, found at the Web site for the Yoga Alliance, states that the individual
practicing yoga understands certain poses may in fact pose some risks. The waiver offers this
instruction: If I experience any pain or discomfort, I will listen to my body, adjust the posture
and ask for support from the teacher. I will continue to breathe smoothly . . .

Russell, W. R. Yoga and the vertebral arteries. British Medical Journal, 1972, 1:685.

Safe yoga. 26 Sep 2000. Article available online: http://www.zenyoga.co.uk/yoga/health.htm.
22

Saraydarian, H. The dangers of meditation. In H. Saraydarian, The Science of Meditation.
Agoura, Calif.: The Aquarian Educational Group, 1971, pp. 198-239. (On the wrong use of
meditation.)

Satyananda Saraswati, Paramahansa. People who should not do inverted poses; Inverted poses
should not be done under the following circumstances. In Paramahansa Satyananda Saraswati,
Health Benefits of Inverted Asanas. 2d ed. Munger, Bihar, India: Bihar School of Yoga, 1992, pp.
32-33.

___________. Who should not do forward bending poses? In Swami Satyananda Saraswati,
Health Benefits of Inverted Asanas. 2d ed. Munger, Bihar, India: Bihar School of Yoga, 1992, pp.
19-20.

Schenk, Stephanie. Avoiding injury (letter to the editor). The New York Times, 14 Jan 2001.
Article available online: http://query.nytimes.com/search/article-
page.html?res=9D04EFDB143DF937A25752C0A9679C8B63.

Schneide r, Carrie. Ouch! If yoga is such a gentle practice, why are so many people getting hurt?
Yoga Journal, Jul/Aug 1999, pp. 36-43, 121. Article available online:
http://www.yogajournal.com/views/287.cfm. See also follow-up letters to the editor in the
Sep/Oct 1999 issue of Yoga Journal, pp. 8-9.

Schorr, Melissa. Preventing yoga injuries. Lifetime Television for Women. Article
available online:

Yoga has a reputation for being super-gentlebut thats not always the case. Heres
how to stay injury- free.

Schultz, Larry. Coming back from injury [or surgery] through Ashtanga. Article available
online: http://www.itsyoga.net/us/articles_read.asp?id=7.

Schumacher, John. [Contraindications for] Astavakrasana. Yoga Journal, Jul/Aug 2000, p. 124.

___________. [Contraindications for] Eka Pada Sirsasana. Yoga Journal, Sep/Oct 2000, p. 120.

___________. [Contraindications for] Eka pada rajakapotasana. Yoga Journal, Nov/Dec 2000, p.
112.

Sethi, Sujata, Subhash C. Bhargava. Relationship of meditation and psychosis: Case studies.
Australian and New Zealand Journal of Psychiatry, Jun 2003, 37(3):382ff.

Shapiro, Deane H., Jr. Adverse effects and contraindications. In the article by Deane H.
Shapiro, Jr., Overview: Clinical and physiological comparison of meditation with other self-
control strategies, American Journal of Psychiatry, Mar 1982, 139(3):270-271.

___________. Adverse effects of meditation: A preliminary investigation of long-term
meditators. International Journal of Psychosomatics, 1992, 39:1-4, SI:62-67.

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Sims, Amy C. Treading into fitness trends with care. 22 Oct 2002. New York: Fox News. Article
available online: http://www.foxnews.com/printer_friendly_story/0,3566,66012,00.html.

Exercise fads infiltrate gyms faster than you can say cardio strip, but these new routines can be
dangerous for people hopping on the fitness bandwagon.

Jumping on something too fast can be a mistake, said David Kirsch, owner of the New York
gym Madison Square Club. Tae Bo was once the latest and greatest craze, but where is it now?

Yoga is one trend that seems far from extinction. Approximately 15 million people practiced
yoga in the United States, a figure that has almost doubled in the past five years, according to
Yoga Journal.

But the rush in popularity has led to some cases of novice instructors teaching the masses,
according to Leslie Kaminoff, a yoga therapist who has treated many injured yoga enthusiasts.

And as people push themselves to keep up with advanced classes, they get hurt. Ive had clients
whove been injured by domino effect, he said, which happens when students fall into each other
while doing inverted positions like headstands.

He compares the yoga trend to the aerobics craze in the 1980s. If you look at Jane Fondas first
tape, its like, How to injure yourself to music, he said.

But chronic injuries are more pervasive than acute ones, he said. One such chronic injury is what
Kaminoff calls yoga butt.

Its a pain that starts in the butt and goes down back of the leg, he said. It develops over time
because the sequencing used in some classes involves long extended periods of time sitting on the
butt . . . then twisting and bending into positions.

But chronic pain can come in many forms. Meyung Kim, 31, who began practicing yoga four
months ago has already gotten hurt. I pulled the muscle underneath my shoulder blade,
performing a shoulder stand during a class, she said. It started feeling better and I went back and
now it hurts again.

Kim said she works out regularly, but started taking yoga at the gym to try something new.
These days, people looking for the latest fad will likely come across kettlebells, a trend just
hitting the U.S. . . .

Smith, Susan J. Pregnancy Todays advisory panel answers: What yoga positions should I avoid
during pregnancy? Available online at: http://www.pregnancytoday.com/experts/posavoid.htm.

Spira, Jim. What about depersonalization/derealization [during meditation]? 11 Jun 1999. Article
available online: http://www.behavior.net/forums/meditation/1998/msg114.html.

Stott, Sharon. Glaucoma, detached retina. In Sharon Stott, Sarvangasana (shoulderstand) or
candle pose, Yoga & Health, Dec 1997, p. 21. (On contraindications for sarvangasana.)

Stovsky, Jill. Yoga during pregnancy. Available online: http://
www.babycenter.com/expert/5699.html.

24
Stretched to the limit. Dr. Andrew Weils Self Healing, Jun 2003, p. 1.

On the increasing number of injuries in Yoga classes.

Teutsch, Danielle. Yoga positions that pregnant women should not consider. The Sydney
Morning Herald, 19 Jun 2005. Article available online:
http://www.smh.com.au/news/National/Yoga-positions-that-pregnant-women-should-not-
consider/2005/06/18/1119034104294.html.

Pregnant women are hurting themselves and risking their unborn children by practising some
common yoga poses, experts say.

An informal committee including midwives and obstetricians has been set up to develop
guidelines for safe practice of the popular activity.

Royal Prince Alfred Hospital childbirth educator Enid Guthrie, who is spearheading the
committee, said she had seen women with ruptured membranes, and there was a risk of
miscarriage for women who did inappropriate poses.

Mrs Guthrie said she did not let her pregnant yoga students do inversions - including the
downward facing dog and shoulder stand - partly because the hormone relaxin causes the
ligaments that hold the uterus to soften during pregnancy. Other "no-no" positions were intense
twists, sit-ups and strong stretches.

Mrs Guthrie said that, while she had no scientific evidence that yoga could cause miscarriage,
her concern was based on her experience as a midwife, theatre nurse and prenatal yoga teacher of
13 years.

She said many women signed up for yoga classes when they fell pregnant, thinking it was a
gentle activity.

Its the women who have never done yoga before they get pregnant who I am most concerned
about, she said.

She warned pregnant women should not rely on yoga DVDs, unless they already knew the yoga
practitioner and had been to their classes.

Generally, they should not be doing yoga in the first trimester because of the danger of
miscarriage. Women's health physiotherapist Julia Schwarz, who is also on the committee, said
prenatal yoga teachers needed to have some obstetrics training to understand the particular
changes in a pregnant woman's body.

With pregnant women you need to be careful. You are not dealing with a normal body, she
said.

Ms Schwarz said women with pubic symphysitis, which causes groin pain and can occur after 20
weeks of pregnancy, should not be allowed to squat, sit cross-legged or do one-legged poses.

She also said pregnant women with sacroiliac joint dysfunction needed to avoid lying on their
backs.

25
Prenatal yoga teacher Sally Molineaux said if women were very fit and experienced in yoga, she
allowed them to do inverted posesbut only at their own risk: I tell them they can only do
certain poses if they take responsibility for it themselves, she said.

I do not think women should be doing inversions and strong twists during pregnancy.

Sports Medicine Australia director Anita Green said anyone teaching an exercise class or yoga
to pregnant women required additional expertise.

Yoga is good, but it needs to be modified accordingly for each stage of pregnancy, Dr Green
said.

AMAs obstetrics spokesman Andrew Pesce said there was no evidence that yoga was anything
other than beneficial and safe in pregnancy. However he said women should listen to their bodies.

Specific contraindicated poses demonstrated in this article: boat pose (can cause a miscarriage),
downward facing dog pose, shoulder stand, a seated closed strong twist, camel pose (and other
strong abdominal stretches).

The various implications arising from the practice of Transcendental Meditation: An
empirical analysis of pathogenic structures as an aid in counseling. Bensheim, Germany:
(Institut fur Jugend und Gesellscaft, Ernst-Ludwig-Strasse 45, 6140): The Institute for Youth and
Society, 1980.

Vogel, C. M., R. Albin, and J. W. Alberts. Lotus footdrop: Sciatic neuropathy in the thigh.
Neurology, Apr 1991, 41(4):605-606.

Walker, Melanie, Gregg Meekins, and Shu-Ching Hu. Yoga neuropathy: A snoozer. The
Neurologist, May 2005, 11(3):176-178. Author email: MWalkerMD@aol.com.

Abstract: Sciatic nerve compression very rarely occurs bilaterally. The authors present a woman
[on psychoactive medication] with profound lower extremity weakness and sensory abnormality
after falling asleep in the head-to-knees yoga position (also called Paschimottanasana). Clinical
and electrodiagnostic findings are discussed in detail and a brief review of the literature is
presented.

From the article: Exercise-induced injuries are not uncommon, but some may have dramatic
consequences. Patients in high-risk categories or those who are dependent on psychoactive
medications should be counseled on the dangers that might be associated with their activities . . .

The practice of yoga by a person with an altered mental status is dangerous, more so than many
other exercise regimens, because sustained postures may result in nerve compression and
impairment. Physicians prescribing sedative or hypnotic medications should advise patients of the
risks that are associated with otherwise benign activities like yoga. This report serves to illustrate
the risk of overdosing routine medications, and the dangers that heavy sedation may present.
Adjustments in medication dosage or timing, such as avoidance of sedating medications
immediately prior to exercise, might prevent precarious situations and lead to less exercise-
induced injury. Discussing side effects of medications and establishing regular follow-up for
patients taking neuroactive medications cannot be overemphasized.

26
Walsh, R., and L. Roche. The precipitation of acute psychotic episodes by intensive meditation
in individuals with a history of schizophrenia. American Journal of Psychiatry, Aug 1979,
136:1085-1086.

Watt, Laura. As temps rise, so do yoga injuries, medical experts say. Seattle Post-Intelligencer,
6 May 2004.

Weiler, Linda-Christy. Yoga and contraindications. In Linda-Christy Weiler, Yoga Solutions:
for Poor Posture and an Aching Back! Linda-Christy Weiler, 2001, pp. 65-72.

Topics addressed: extension/hyperextension of the neck, inversions, unsupported forward flexion,
and weight-bearing poses

Westring, Jonas, and Magagie Hopson. The Biomechanics of Yoga: Understanding &
Preventing Yoga Injuries workshop. Offered at Kripalu Center for Yoga and Health,
www.kripalu.org. For more information about Jonas Westring, see www.ThaiYogaHealing.com.

When your practice is a pain, part 1: Yes, you can hurt yourself during yogaheres how
to avoid injury. Article available online:
http://allspiritfitness.com/library/features/aa020701a.shtml.

When your practice is a pain, part 1: Pain without gain. Article available online:
http://allspiritfitness.com/library/features/aa020701b.shtml.

Williams, Cheryl. Alignmentlittle things mean a lot. Australian Yoga Life, 2004, no. 8, pp. 42-
44.

The body, like the mind, can unconsciously fall into bad habits. If these habits are repeated on
the yoga mat, we run the risk of aggravating injuries, or even creating new ones. But a fresh
approach to our practice is often all we need to get the body and the mind into correct alignment.

Wray, Elizabeth. Yoga matters: Esprit de core: Being flexible isnt everything. A floppy body
that lacks core strength can be easily injured. Body & Soul, Jul/Aug 20032, pp. 38-43. Article
available online:
http://www.bodyandsoulmag.com/show_document.asp?iDocumentID=160&iBDC=1920&iPage
Number=1.

Yoga Abuse Forum. Established 30 May 2005. URL: http://p097.ezboard.com/byogaabuse.

A forum for discussing self-inflicted and teacher-inflicted injuries, injuries pertaining to specific
styles of Yoga, etc. The admininstrators of this forum do not identify themselves.

Yoga and pregnancy. Available online: http://www.zenyoga.co.uk/yoga/pregnancy.htm.

Yoga injuries increasing. BBC News World Edition, 9 Sep 2002. Article available online:
http://news.bbc.co.uk/2/hi/health/2245807.stm.

. . . doctors and physiotherapists are reporting an upsurge in the number of inexperienced
studients getting injuries after straining to get into difficult positions.
The British Wheel of Yoga, the governing body in the UK, has blamed a lack of properly trained
instructors.
27

It believes that only half the estimated 10,000 people who now teach yoga in the UK are
properly qualified.

The BWY recommends that instructors should complete a four-year training course before they
start to school others in the ancient discipline.

However, it says that some sports centres are employing trainers who have completed just a
month-long course.

The most common yoga injuries are caused by repetitive strain or overstretching and occur at the
wrists, shoulders, neck, along the spine, and at the sacroiliac joint (which links the spinal column
and pelvis), hamstrings, and knees . . .

Keith Waldon, vice chair of the Society of Sports Therapists, told BBC News Online that yoga
should be tightly regulated . . .

Yoga injuries on the rise. Health24.com, 2005. Cape Town, South Africa. URL:
www.health24.com.

As the popularity of yoga rises to new heights, so are the injuries attributed to the ages-old
practiceespecially among newbies.

Along with the surge of people practising yoga, doctors, physical therapists and chiropractors
are also seeing a rise in muscle and ligament sprains, neck and back problems, and cartilage tears.

And the trend has strengthened with the recent advent of power yoga, a more athletic style in
which participants move rapidly from one pose to another.

Some experts say a growing number of untrained teachers may be to blame.

An American teacher-organised group called the Yoga Alliance recommends at least 200 hours
of expert training, but since there is no licensing or official certification required, untold numbers
of teachers may have done little more than complete a week-end training or correspondence
course.

Yoga should heal, not hurt, says ACSM expert. Medical News Today, 8 Aug 2005.

Yoga should heal, not hurt, according to Roger Cole, Ph.D. In his presentation at the ninth-
annual American College of Sports Medicine (ACSM) Health & Fitness Summit & Exposition,
Cole reviewed the injuries most often suffered by yoga practitioners and recommended ways to
avoid them.

Many injuries-such as those to the knees, back, neck, shoulders, wrists and ankles-occur when
practitioners try to force themselves into difficult postures, Cole said. The first rule of safety is
to avoid forcing your body. Instead, practice with awareness, common sense and self-respect.
Yoga is supposed to teach us not to compete or show off, but to use focused attention, conscious
effort and relaxation to achieve results.

Cole also emphasized the importance of learning proper technique to keep safe in yoga.
Specific poses carry the risk of injury if you do them incorrectly. Its easy to avoid problems if
28
you know what you are doing. For example, forcing the lotus position can damage cartilage in the
knees, but you can prevent this by learning ways to redirect the force away from the knees to the
hips, where it is needed.

In addition to the knees, bodily sites most prone to yoga injuries include the lower back,
hamstring and sacroiliac, according to Cole. While the latter two are more commonly injured,
problems with the knees and lower back tend to be more serious.

Many common yoga injuries occur during straight-leg forward bends from a standing or seated
position, said Cole. He recommends stretching moderately in such poses; bending from the hip
joints and elongating the spine, and taking days off from these postures.

Yoga System. Yoga practice contraindications: by yoga technique and by disease. Falls
Church,Va.: Yoga System, www.yogasystem.com, 866-880-4008, 703-578-4008.

Yoshikawa, Yoko. When not to invert. Yoga Journal, Sep/Oct 2000, pp. 98, 174-177. (See also
pp. 94-97 on a Yoga practitioner who suffered possible injury from long-term practice of
inversions.)

Zarthosht imanesh, Zubin. The 10 don ts of yoga. Mid-day.com, 3 Mar 2005. Article
available online: http://web.mid-day.com/news/city/2005/march/104768.htm.


Of Related I nterest
Clark, Walter Houston. Fear & terror in religious experience: A theoretical commentary.
Journal of Religion and Psychical Research, Apr 1980, 3:134ff.

Cohen, J. A., D. H. Char, and D. Norman. Bilateral orbital varices associated with habitual
bending. Arch Ophthalmol, Nov 1995, 113(11):1360-1362.

Edell, Dean. Answers the question: Didnt I hear you say that bending the head back can cause
a stroke? Available online at HealthCentral.com.

Exercise, Stop, Danger: 30 Exercises to Avoid Plus 100 Safer and More Effective Alternatives.
A British-Australian Fitness Leader Network Publication, 1994.

In the Autumn 1994 issue of Yoga Biomed News, Robin Monro writes: [This book] does give
sensible and valid information on the right and wrong way to exercise . . . but even though the
book is addressed to aerobic or dynamic-type exercises . . . it contains exercises that bear a
relationship to yoga postures [standing straight-leg toe touch, seated toe-touch, banana bends,
cobra, and plow] . . . We say bear a resemblance to yoga postures because although they may
look similar, in essence they are not . . . Central to yoga practice is body and breath awareness.
The mind is fully involved in every movement, and this attitude of constant, gentle vigilance
provides both effectiveness and safety. The same postures practised in a mindless way in the
context of aerobic and fitness groups can indeed be dangerous . . . At a time when the medical
profession is at last becoming more open to alternative treatments for chronic health problems,
publications of this sort which insidiously link yoga to other forms of exercise can do little to help
further its cause.

29
Green, Lauriann. Injury prevention for massage practitioners. Article available online:
http://www.positivehealth.com/permit/Articles/Massage/green58.htm.

___________. Save Your Hands! Injury Prevention for Massage Therapists. Fort Collins, Colo.:
Gilded Age Press.

The first comprehensive injury prevention manual written for massage therapists.

Nagler, W. Vertebral artery obstruction by hyperextension of the neck. Arch Phys Med Rehabil,
1973, 54:237-240.

Pryse-Phillips, W. Infarction of the medulla and cervical cord after fitness exercises. Stroke,
1989, 24(6):355-359.

Smith, Timothy. Is it time to hang up your spikes? Joint and muscle strain [and the boomer
generation]. Business 2.0, Jan 2002.

Xu, S. H. Psychophysiological reactions associated with qigong therapy. Chinese Medical
Journal (English), Mar 1994, 107(3):230-233. PMID: 8088187.

Abstract: Qigong as a part of the traditional Chinese medicine is similar to western meditation,
Indian Yoga or Japanese Zen, which can all be included in the category of traditional
psychotherapy. A series of physiological and psychological effects occur in the course of Qigong
training, but inappropriate training can lead to physical and mental disturbances. Physiological
effects include changes in EEG, EMG, respiratory movement, heart rate, skin potential, skin
temperature and finger tip volume, sympathetic nerve function, function in stomach and intestine,
metabolism, endocrine and immunity systems. Psychological effects are motor phenomena and
perceptual changes: patients experienced warmness, chilliness, itching sensation in the skin,
numbness, soreness, bloatedness, relaxation, tenseness, floating, dropping, enlargement or
constriction of the body image, a sensation of rising to the sky, falling off, standing upside down,
playing on the swing following respiration, circulation of the intrinsic Qi, electric shock,
formication, during Qigong exercise. Some patients experienced dreamland illusions, unreality
and pseudohallucination. These phenomena were transient and vanished as the exercise
terminated. Qigong deviation syndrome has become a diagnostic term and is now used widely in
China.

Zetaruk, M. N., M. A. Violn, D. Zurakowski, and L. J. Micheli. Injuries in martial arts: A
comparison of five styles. British Journal of Sports Medicine, Jan 2005, 39(1):29-33. Author
email: mzetaruk@shaw.ca.

Abstract: Objective: To compare five martial arts with respect to injury outcomes. Methods: A
one year retrospective cohort was studied using an injury survey. Data on 263 martial arts
participants (Shotokan karate, n = 114; aikido, n = 47; tae kwon do, n = 49; kung fu, n = 39; tai
chi, n = 14) were analysed. Predictor variables included age, sex, training frequency (3 h/week v
>3 h/week), experience (<3 years v 3 years), and martial art style. Outcome measures were
injuries requiring time off from training, major injuries (7 days off), multiple injuries (3), body
region, and type of injury. Logistic regression was used to determine odds ratios (OR) and
confidence intervals (CI). Fishers exact test was used for comparisons between styles, with a
Bonferroni correction for multiple comparisons. Results: The rate of injuries, expressed as
percentage of participants sustaining an injury that required time off training a year, varied
according to style: 59% tae kwon do, 51% aikido, 38% kung fu, 30% karate, and 14% tai chi.
30
There was a threefold increased risk of injury and multiple injury in tae kwon do than karate
(p<0.001). Subjects 18 years of age were at greater risk of injury than younger ones (p<0.05; OR
3.95; CI 1.48 to 9.52). Martial artists with at least three years experience were twice as likely to
sustain injury than less experienced students (p<0.005; OR 2.46; CI 1.51 to 4.02). Training >3
h/week was also a significant predictor of injury (p<0.05; OR 1.85; CI 1.13 to 3.05). Compared
with karate, the risks of head/neck injury, upper extremity injury, and soft tissue injury were all
higher in aikido (p<0.005), and the risks of head/neck, groin, and upper and lower extremity
injuries were higher in tae kwon do (p<0.001). No sex differences were found for any of the
outcomes studied. Conclusions: There is a higher rate of injury in tae kwon do than Shotokan
karate. Different martial arts have significantly different types and distribution of injuries. Martial
arts appear to be safe for young athletes, particularly those at beginner or intermediate levels.