This is the last video in a six-part series on yoga.
If you missed any, check out the links in the description below.
You'll also find a link to the webinar that I did on the subject,
which includes a Q&A portion.
"The Side Effects of Yoga"
Even though for certain health conditions
we have not reached a point where we can say
there's good scientific evidence that yoga is beneficial,
many patients do seem to benefit.
And isn't that what matters?
I mean even in the studies that show the benefit
is mainly a placebo effect, does this really matter?
I mean, after all, this editorial asserted,
yoga therapy has never been shown to have adverse effects.
But that's simply not true.
About 2,000 yoga-related injuries have been seen
in hospital emergency rooms every year from 2001 to 2014.
It looks like only one fatality has ever been reported
in the medical literature, but if you look at the case report,
a 16-year-old girl collapsing with a ruptured lung
following voluntary mouth-to-mouth yoga breathing exercises
with a teen-age boy in the hall ---
that can hardly be characterized as a typical yoga practice.
There are tragic rare cases tied to actual yoga,
like this quad rupture in a young woman, or God, a femoral fracture.
The femur is the bone in your thigh --
longest, strongest and heaviest bone in the body.
Typically, you only see femur fractures
with trauma such as car crashes,
but here it was just a guy practicing this yoga posture
when he heard a large cracking sound and felt immense pain
because, yikes, this is what happened.
Now two weeks earlier he had felt pain in his thigh
that he just thought was muscle strain,
but bone biopsies showed evidence of previous microfractures.
So it sounds like he had been overdoing it,
weakening it before the final crack.
So I guess the bottom line is that people should listen
to their bodies and not push themselves too far.
Now, in my last video I talked about the risk
of spinal compression fractures, particularly those
with weakened bones, osteopenia or osteoporosis.
Poses causing hyperflexion and hyperextension of the spine
should probably be avoided.
These were the poses tied to injury in a few dozen cases
of musculoskeletal injuries described at the Mayo Clinic.
But case reports and series of case reports
are really just kind of glorified anecdotes.
I mean, they don't give you an overall sense of the safety of yoga.
If you look at randomized controlled yoga trials,
there's actually no significant difference in injury rates
between the yoga groups and the control groups
that used some other sort of exercise intervention.
Now, this may not necessarily translate out
into real-world experience, given the short duration
of yoga in these clinical trials -- as little as a single day --
and the fact that they may be more closely supervised
with more highly trained teachers.
That's why large-scale surveys like this can be helpful,
looking at thousands of people taking yoga classes.
Looks like about 30% of yoga class attendees had experienced
some type of adverse event,
most commonly just something mild like muscle aches,
but some individuals did experience more severe events
which caused them to stop going.
Many causes were associated with overexertion and overdoing
and starting out in poor physical condition.
This systematic review included nine observational studies
with 9000+ yoga practitioners and 9000+ non-yoga practitioners
from the US, Europe, Asia, and Australia.
A considerable proportion of yoga practitioners experienced injuries
or other adverse events;
however most were mild and transient
and risks were comparable to those of non-yoga practitioners.
The risk of yoga-associated injuries was estimated
as 1.45 per thousand hours of yoga practice,
much lower than in higher-impact sports activities such as soccer.
Compared to 1.5 for yoga,
runners have like 2.5 injuries per thousand hours,
soccer 3.7, 5 for tennis,
and an hour of yoga is more than 5 times safer than skiing.
Here's where yoga falls on the spectrum.
Yoga appears much safer, for example, than aerobic funk.
On the other hand, yoga practitioners may suffer
an increased risk of meniscus injury,
the main stabilizing and cushioning cartilage in the knee.
Yoga was found associated with significantly higher risk
of meniscus injury compared with activities such as badminton,
jogging, and climbing hills.
Some fundamental yoga postures, like the lotus position,
can be hard on the knees.
Yes, yoga poses can undoubtedly improve the flexibility of the knee,
but immoderate joint movement can pose a serious threat.
The bottom line is like any other type of physical activity:
yoga carries a risk of injury.
Exercise is indeed medicine,
but like any medicine, it must be prescribed appropriately.
Many patients rely on their yoga practice for stress reduction,
so it's important to be mindful
that being injured is the last thing you need.
The higher-risk yoga poses appear to include
headstands, shoulder stands, lotus and half lotus,
forward bends, backward bends, and handstands.
And so beginners should beware,
with particular attention paid to the spine
as this is where the highest numbers of injuries occur.
Hot yoga deserves special mention.
The extreme heat and intensity of Bikram yoga
may make it inappropriate
for older adults and people with medical conditions.
But there are case reports like this one of sudden cardiac arrest
even in a healthy 35-year-old.
Pregnancy is an especially vulnerable time for heat exposure.
With the increased risk of spinal defects
and possibly other birth defects
among fetuses exposed to excessive heat,
pregnant women should avoid practicing hot yoga during pregnancy.
Maternal hyperthermia, whether from a sauna or electric blankets,
had nearly a 2-fold increased risk of spinal and brain malformations.
For example, pregnant women who use hot tubs
increased the risk of bearing babies
with their intestines outside their bodies
or being born without a brain.
As any other physical or mental practice,
yoga should be practiced carefully
under the guidance of a qualified instructor.
Beginners should avoid extreme practices
such as headstand, lotus position, forceful breathing.
Individuals with medical preconditions
should work with their physician and yoga teacher
to appropriately adapt postures.
For example, patients with glaucoma should avoid upside-down positions,
and patients with compromised bones should avoid forceful yoga practices,
and practices like voluntary vomiting
should perhaps be avoided completely.
What?
It's evidently a common practice in traditional yoga.