How safe is yoga? Can it “wreck your body?”

So if you haven’t already seen the article by WILLIAM J. BROAD in the New York Times, here is a link. Interesting reading.

And be sure to read Dr. Timothy McCall’s rebuttal below (taken directly from his web site)…equally interesting reading.

For those of you who aren’t interested in taking the time to read both articles, i’ll provide some cliff notes: if you practice yoga and you want to continue practicing and remain injury-free…listen to your body as you move and check your ego at the door. Go figure.

How to Not Wreck Your Body Doing Yoga or: How I Really Feel about Headstand

Timothy McCall, MD

By now most of you will have heard about if not yet already read
the article in last Sunday’s New York Times Magazine, entitled, “How Yoga Can
Wreck Your Body.” My email box has been lighting up. One message, from Colleen Duggan, read: I have gotten so many email inquiries from students
that I am having to field because of this article, I thought I might
write to you to find out what you really think. As you know, I am an Iyengar
certified teacher, and take inversions pretty seriously. A lot of people after
reading the article are concluding that across the board inversions are
unsafe and unwise to be doing. While, for many people I think inversions
might not be a good idea for many reasons, I believe if a student is ready
for inversions and well instructed by a proper teacher, they are fine, and
the benefits make doing them worth it. What do you think? I want to be
clear that I understand your position.

The buzz over the Times’ science writer William Broad’s
article, has been spreading around the yoga world and in the media. One article in London’s Daily Mail, stated that, “physician Timothy McCall, medical editor of Yoga Journal, told Mr Broad that the commonly-practiced headstand is ‘too dangerous’ for most yoga classes.” Did I really say that? Well, not exactly. Actually, the Daily Mail has it
wrong. I never told Broad anything because we never spoke. He seems to have read an article I wrote around 2003 for Yoga Journal and based part of his article on that. And since the impression conveyed in the Times piece doesn’t accurately represent how I
feel, I thought I’d review headstands, and the general topic of avoiding yoga
injuries. While most of us disagree with many of Broad’s conclusions, the
fact is he is highlighting an important issue: Some people are seriously injured
doing yoga. For that, we owe him and the Times our gratitude. As many of you know, I’ve
been writing about the issue of safety in yoga for years, in Yoga Journal and elsewhere, and included a long appendix in Yoga as Medicine on Avoiding Common Yoga Injuries. I’ve also been concerned that the problem has not being discussed more openly in the yoga world. So here’s a quick list of my central thinking on headstands and yoga safety, as well as links to various articles I’ve written on the subject:

1. Some poses like headstand, shoulder stand and lotus are
inherently risky if not done with good anatomical alignment.

2. Some people have contraindications to doing certain poses. So,
for example, someone who has poorly-controlled high blood pressure or diabetic
retinopathy should avoid headstand and other inversions as they could
precipitate a retinal hemorrhage. I do not think that people who lack such risk factors
need to worry that going upside down is going to cause retinal problems.

3. Some people who will eventually be able to do headstand without
problems are not ready for it when they first come to yoga. Even though the
pose is fairly easy to get into, they should wait until they’ve developed the strength
and flexibility to do it safely.

4. Some public yoga classes are strenuous, regularly including
many of the more acrobatic asana, which require considerable strength, balance and
flexibility to do safely. Other classes are gentle, and injuries in them are rare.

5. In some classes, particularly large ones, students don’t get
much individual attention when doing potentially risky poses, increasing the
likelihood of dangerously poor alignment.

6. Many of the students drawn to vigorous styles of yoga are
highly competitive, like to push their limits, and may ignore signals from the body — like
pain or erratic breathing — that suggest they are doing too much. From an Ayurvedic
standpoint, most of these yoga overachievers have a lot of either vata or
pitta (or both) in their constitutions. When I lived in New York City in the late
90s, I regularly saw these folks roll up their mats and leave when the teacher called
for Savasana. They weren’t going to waste their time relaxing, when they could
be accomplishing something!

7. Just because some people get hurt doing particular practices –
usually due to poor alignment, over-efforting, or a failure to modify their
practice in light of contraindications — does not mean that people who are doing them
with more skill and mindfulness are at risk.

8. Yoga can be adapted to meet the needs of just about anybody.
They might not be doing headstand or Chaturanga Dandasana, but bedridden cancer
patients, those with debilitating arthritis and children with developmental
disabilities, for example, can do modified practices with great benefit. And don’t
forget that yoga isn’t just asana. There’s visualization, pranayama, meditation,
chanting, selfless service and countless other yogic tools.

9. Krishnamacharya called headstand and shoulderstand the king and
queen of the asanas for a reason. They are, according to the yoga tradition,
powerful practices that over time profoundly change the nervous system and the mind.
If you are able to do these poses comfortably and with good alignment, the
benefits almost certainly outweigh the risks.

10. Even though in rare circumstances practicing yoga might
precipitate a heart attack or stroke, yoga – via its effects on stress hormones, blood
pressure, cholesterol, blood clotting, etc. — greatly lowers the likelihood
of your having either. Author Jim Fixx might have died of a heart attack while
jogging, but this does not mean that on balance running is bad for your heart.

11. Beyond citing a few dramatic cases of yoga injuries, and
making, to my mind alarmist calls to avoid inversions or yoga entirely, those making
such suggestions need to provide a sense of how common these problems are in yoga
compared to other activities. What would those who are injured in kick-butt
classes have been doing instead of practicing yoga? Skate-boarding? Jogging in
Central Park? Sitting on the couch?? All of those may be quite a bit riskier
than practicing yoga, particularly if you’re doing your yoga in a smart way!

The Times article correctly mentions that I developed (in late
2001) a case of thoracic outlet syndrome (TOS), in which I believe headstand, plow pose and shoulder stand played a role. But part of it could also be blamed on my own stubbornness (I’ve got a bit of pitta myself). Just before I developed intermittent numbness and tingling in my right arm, I’d been increasing my headstands up to 10 minutes a day, even though that was more than I could comfortably do. I was allowing an external goal suggested by someone else — not my own body’s feedback — to dictate when I
came down. I now believe that at the moment (or just before) you lose that balance
of effort and ease in the pose, if your breath is rough, or if it just doesn’t feel
good, you need to come out. What’s noteworthy is that I also used yoga to heal from the TOS. For three years, I refrained from standard versions of all three poses. When I had
access to wall ropes or the pelvic slings you can hang from, I would do headstand that
way. Instead of doing the full shoulder stand with the feet directly over the shoulders
(which despite the impression you get from the article, most people do with blankets
or other support under the shoulders), I did chair shoulder stand (see photo). Indeed,
chair shoulder stand, which allows you to use your arms to gently coax more opening in
the thoracic spine, was probably the single most useful thing I did to overcome the
TOS. After 3 years of refraining from these poses, in 2004 I began to slowly reintroduce them, first shoulder stand, then headstand, and finally plow pose. By that time, the therapeutic yoga I was doing, along with Ayurvedic treatments and other
bodywork, had opened my thoracic spine and shoulders enough that the poses were no longer contraindicated. I now do both poses almost every day, and they feel wonderful. Yes, I had a satisfying yoga practice without the poses, but am very happy to be able to
do them again.

So my answer to Colleen’s email was that I agreed with every word
she wrote. Not everybody should be doing the poses like headstand, but if you don’t
have a contraindication, you’re getting good instruction, and you’re
paying attention to the feedback your body is giving you, you’re unlikely to do harm.