William Broad, the New York Times writer who brought us The Science of Yoga in 2012, recently reported that orthopedic surgeons around the U.S. and Europe are seeing an increase in hip injuries and hip replacements among women practicing yoga. The injuries, collectively called FAI (femoral acetabular impingement) injuries, are caused by impingement of the hip socket from repeated jamming or grinding by the upper thigh bone. Offending poses—according to Broad—appear to be Paschimottanasana, Uttanasana and Deep Low Lunge (Anjaneyasana). Women yogis are disproportionately affected because of their wide range of motion and flexibility.
Like the dork who farts in a crowded hot tub at Wanderlust, William Broad returns to crash our beloved yoga party.
As a yoga teacher and author with an obsessive passion for alignment and injury prevention, I have to wonder why three of our most fundamental poses are landing devoted practitioners in the hospital for hip replacements. And alarmingly, our industry’s response to the news seems to blame the victims, implying that it’s reckless students—not teachers or the practice—who are to blame.
I see several problems with this point of view. First, it avoids accountability on the part of yoga professionals. Second, it’s not true. And third, it’s not helpful.
Yet, it’s also not surprising. As yoga becomes more popular and mainstream every year, we're seeing a progression:
The economics of yoga are trending away from traditional, individualized instruction toward big, sweaty, often impersonal classes at time when droves of newer, less experienced teachers are entering the workforce. In a typical large public class, it’s common see a handful of students with very little grasp on the fundamentals and how to safely move through poses.
With the right intentions but no grasp of the basics, these students are working earnestly under the nose of teachers whose focus is simply not on alignment. Worse, as Broad’s article pointed out, many of these teachers are not trained enough in the human body’s normal range of motion to decipher whether a student is just fine or headed straight toward a progressive injury.
The demographics of students are changing fast, with people coming to yoga from all walks of life, all ages and stages—some of them already injured or impaired when they begin their practice. According to Yoga Journal, twenty million Americans practice yoga today, almost half of whom consider themselves beginners.
The no pain, no gain mentality is poisoning our industry. Push to the max! Push through pain! Push toward an ideal! If this sounds similar to other sports, it is.
Yoga isn’t the only arena in which the rate of injuries is increasing at an alarming rate lately. A 2012 study from the Western Michigan University School of Medicine found that the number of head injuries among skiers and snowboarders in the U.S. went up 60 percent in a seven-year period, even as helmet use increased by an almost identical percentage over the same period. A University of Washington study found that the overall snow-sports injury rate among young athletes increased 250 percent from 1996 to 2010. Why is this happening?
Well, experts believe that the snow-sports industry has embraced risk-taking behaviors by promoting bigger features in terrain parks and improved access to off-trail skiing, just as advances in equipment are making it easier to ski faster, perform tricks and venture out of bounds. In a recent article on ski helmets, Nina Winans, a sports medicine physician at the Tahoe Forest MultiSpecialty Clinics, noted a push toward faster, higher skiing and snowboarding and an attitude where pushing the limits has become “the norm, not the exception.”
Then there’s hockey. Ten former NHL players sued the league in November 2013 for negligence and fraud, saying the sport’s officials should have done more to address injuries but instead celebrated a culture of speed and violence. Over three decades of professional playing, the players sustained repeated hits to the head and now are reporting such things as depression, headaches and memory loss.
The hockey suit came about three months after the NFL agreed to pay $765 million to settle hundreds of cases brought by more than 4,000 retired players who said the league knew about the dangers of repeated head hits but failed to properly warn the players. Similar suits have been filed against the NCAA.
Following suit, major league baseball is also now considering a ban on contact hits at home plate, ending the allowable (and at times encouraged) practice of runners barreling over the catcher to score at all cost. Two years ago, in a game between the San Francisco Giants and the Florida Marlins, SF catcher Buster Posey was taken out for an entire season as a result of an infamous play by the Marlins.
Is there an American sport where taking things to the extreme is not celebrated? The rugged mentality of contact sports like football, hockey and baseball is now creeping into the yoga world. But it has no business here.
The refrain we often hear is that yoga injuries happen because students aren’t “listening” to their bodies. But of the twenty million people practicing yoga, half are beginners, according to Yoga Journal.
How on earth would nearly ten million people know what to listen for in the first place? Putting pressure on students—let alone beginners—to be entirely in charge of their bodies lets teachers and studio owners off the hook, avoiding responsibility for students’ safety.
Master teachers like Bryan Kest often point out that too much flexibility creates instability; too much strength creates a tighter, more rigid body. The former typically leads to joint-related injuries: wrists, shoulders, lower back and the hip-joint injuries reported among flexible students who push too far. Students who are stronger and less flexible, on the other hand, are at risk for soft-tissue injuries like muscle or tendon pulls or strains.
As a teacher myself, the most common injuries I’ve seen by far are progressive injuries of the wrists, shoulders and lower back, correlating to Sun Salutations overdone and executed incorrectly over a long period of time. On occasion, I also see hamstring-related injuries from overstretching.
A common perception is that more flexible is better in yoga, and that flexible students don’t need as much help. But as these women with shiny new hip sockets would probably admit, hyper-flexible students actually need more attention, not less.
Too often, bendy students are ignored because they look more advanced. Only a teacher who knows each student’s normal range of motion can help gauge how much is too much on any given day. When I hear about all these women with hip injuries, I can't help but wonder where their teachers were while they cranked away at Paschimottanasana for months or—God forbid—years at a time.
The other problem with putting the onus on students to “listen to their bodies” is that there’s a fine line between intense feeling and actual pain, and sometimes it’s hard to tell the difference. As a student’s practice advances, he learns to discriminate. Intensity feels like working at his edge; his muscles may be burning, but he’s not risking injury. Any discomfort stops when he releases the pose.
Actual pain, on the other hand, registers as a severe, sharp, throbbing, pulling, pinching or tearing sensation. Tell-tale signs of physical pain are pretty obvious: a student’s breath changes significantly; he gets a bulging, tense or panicked expression in his eyes; he appears to be “white knuckling” his way through a pose with his hands or feet; he is grimacing with pain.
Those of us who’ve been practicing for a while know that pushing through pain is never worth it. But to beginners—especially those well-versed in sports culture and America’s fixation with “no pain, no gain”—it seems natural to push it.
My teacher, Jivamukti Yoga’s David Life, says that when a pose starts to deteriorate, a student has gone too far. Like a collapsing soufflé, the asana starts to deflate, losing its foundation, form and alignment. Educated eyes should definitely know the difference. If they don't, they have no business teaching yoga asana. Studying yoga with a teacher who doesn’t know how to properly keep an eye on or assist students’ form is like taking tennis lessons from a pro who doesn’t know a proper forehand, or music lessons from a teacher who is tone deaf.
Except, unlike in music class, you could get seriously hurt in yoga. Three neck injuries received from incompetent teachers and/or their assistants were the subject of my rant last year. I’m just now getting back to Headstand after a long hiatus. I’m still petrified if someone comes near me in Child’s pose.
Instead of blaming the victims, here are a few solutions I’d like to propose to our industry and its leadership:
Let’s stop glorifying ginormous classes and the idea of “perfect” poses and always going “deeper.” Let’s get back to yoga’s healing roots. Asana has to fit our bodies, not the other way around.
Let’s demand continuing education requirements and continue to encourage rigorous teaching standards from the Yoga Alliance, training programs and studios for all new teachers.
The Yoga Alliance is currently revamping standards for certifying teachers. This is a wise idea, in my mind.
Let’s get off our collective high horses. Yoga is not holier than thou. Face it: Many practitioners approach yoga like other fitness routines. We need to meet our students where they are at.
The bottom line is that yoga should have a culture of acceptance, where anyone who decides to join in the fun should feel empowered and supported to create a healthy and safe practice for a lifetime. This idea starts with us, the teachers and leaders.