Puzzled by a Yoga Contradiction. ~ William J. Broad

Via William J. Broadon Dec 28, 2013

lululemon athletica

Many teachers praise yoga as a smart way to fight degeneration of the hips and promote joint health.

But I kept hearing of women practitioners—including stars of the yoga circuit—who found themselves in urgent need of hip repairs. I followed the clues and put my findings in The New York Times. Here, I flesh out the story with new information, including how to reduce the danger.

I first became aware of the issue when I heard that Glenn Black, a prominent yoga teacher and body worker in the New York City region, had treated a famous yogi recovering from hip surgery. I interviewed Black, as The Science of Yoga recounts (pages 105 to 109).

After the book came out in February 2012, yoga insiders wrote to say it was not uncommon for hip troubles to strike leaders of the community and that a number of stars had undisclosed repairs. The claims were impossible to verify.

In late 2012, Michaelle Edwards, a popular yoga teacher in Hawaii, wrote to say that dozens of students she knew—mainly women—were suffering groin pain and hip injuries. Unlike sources who wanted anonymity, she said she was happy to speak out and, in the interest of preventing new injuries, go public with her information. We discussed the issue for months.

Edwards described how the elasticity of women became a liability when extreme bends resulted in chronic wear and tear on their hips. Over time, she said, the damage could develop into agonizing pain, and, in some cases, the need for hip repairs.

She sent me her book, YogAlign. It described her own hip pain long ago and how she eliminated it by developing a gentle style of yoga.

In July 2013, Edwards made her analysis public in elephant journal. She recommended that women whose hips felt tender when walking, or who experienced sharp pain when doing postures like the triangle, should consider easing up on their practice.

Despite the growing evidence, and Edward’s article, I was skeptical. After all, dozens of books and articles hailed yoga as great hip therapy. The titles include: Heal Your Hips, Easy Yoga for Arthritis, and Therapeutic Yoga for the Shoulders and Hips.

Finally, in late summer, when the news business slows, I made some calls.

To my astonishment, top surgeons declared the problem to be real—so real that hundreds of women yogis were coming to their offices in debilitating pain and undergoing costly operations to mend or replace their hips.

I spoke to surgeons in Atlanta, the Mayo Clinic, and the Hospital for Special Surgery in New York City, one of the world’s leading centers for orthopedic repair.

Bryan T. Kelly, a surgeon there, said yoga postures were well known for throwing hips into extremes of motion and rotation. “If that’s done without an understanding of the mechanical limitations of the joint, it can mean trouble,” he told me.

The same kind of damage, Dr. Kelly added, can strike dancers who push their legs to extremes, such as ballerinas. He said each year he operated on roughly fifty to seventy-five patients—mostly women—who danced or did yoga.

The surgeon at the Mayo Clinic, Michael J. Taunton, told me that a team of medical investigators in Switzerland had pinpointed the problem. They discovered that arthritis—the painful inflammation and stiffness of the joints usually associated with old age—could also strike the young.

The Swiss investigators found that extreme leg motions could cause the hip bones to repeatedly strike each other, leading over time to damaged cartilage, inflammation, pain, and crippling arthritis. They called it Femoroacetabular Impingement, or FAI, in medical shorthand.

The name spoke to how the neck of the thigh bone (the femur) could swing so close to the hip socket (the acetabulum) that it repeatedly struck the socket’s protruding rim.

In 2008, the Swiss team published a lengthy study of FAI’s etiology, or cause. It noted that women between thirty and forty years of age whose activities made “high demands on motion” tended to show the hip damage more often. The paper specifically cited yoga.

On YouTube, I found animations (for instance, herehere, and here) that showed how leg motions could throw the femur’s neck into the socket’s rim. The visualizations made it easy to see how yoga could do likewise.

If you watch these animations, or look for similar ones on YouTube, note that the type of FAI that preferentially strikes women is known as “pincer,” alluding to how the hip bones can interact in the same way as the common tool. Pincer jaws come together like those of pliers.

The New York Times published my findings in the Sunday Review section in early November 2013 under the headline “Women’s Flexibility Is a Liability (in Yoga).”

The article quoted Edwards as warning practitioners to be cautious when doing seated forward bends (like Paschimottanasana), standing forward bends (like Uttanasana) and forward lunges (like Anjaneyasana)—moves that when done forcefully can push the neck of the femur into the socket’s rim.

My article noted that yoga was just one of many culprits. Medical experts pointed to such contributing factors as bone misalignments, excess body weight and subtle deformities of the hip joint that differ from person to person. It said the variations make it hard to predict who was most at risk.

The story also observed that yoga probably does help many people who suffer from arthritis, which can strike not just the hips, but fingers, knees and shoulders. It apparently does so by fighting inflammation.

Gentle yoga probably helps the hips, too, but, as Dr. Taunton of the Mayo Clinic observed, the bending can become “too much of a good thing.”

For days, the story topped the paper’s most-emailed list. Along with denunciations, I received lots of positive feedback, including from yogis who had suffered hip damage and replacements. “Thanks so much,” wrote a yoga celebrity, calling the article balanced and “very helpful.”

A physical therapist in Los Angeles wrote to propose a contributing factor hidden in the hip’s welter of muscles, tendons and ligaments.

She suggested that, over years of practice, an individual who followed yoga’s emphasis on forward bends could develop joint imbalances in which the hip’s rear area became flexible even as the front remained relatively tight. The result, she said, was that some poses could readily pull the femoral head forward, causing impingement.

“Many of these women can be helped,” she wrote. “If evaluated properly and given the tools and knowledge regarding what is causing their pain, what imbalances they have and how to work on correcting them, they can use yoga to correct the problem.”

My science guru, Mel Robin, sent a note full of good information. Mel is an Iyengar teacher and a chemical physicist who worked for decades at Bell Labs when it excelled at innovation. I studied yoga with him in Pennsylvania and, in The Science of Yoga (pages 91 to 95), spoke of his illuminating classes.

In his note, Mel said that his Handbook for Yogasana Teachers, published in 2008, discussed a number of postures than can throw the hip bones into conflict (pages 341 to 345). He called it bone-on-bone contact.

The book explained how subtle body adjustments can avert the strikes, giving particular attention to Trikonasana (the triangle pose) and Anantasana (the side-reclining leg lift). In his note, Mel called bone conflicts “largely an unrecognized aspect of our practice” and said the problem can be avoided “if we practice in a more mindful way.”

Edwards, the Hawaiian yoga teacher who helped me understand the problem, said she had been besieged by reporters and people around the globe with hip troubles. In a follow-up piece for Elephant Journal, she faulted yogis who, when facing the topic of injury, run in the opposite direction. “It may be time to get informed, not defensive,” she wrote. “Broad is on our team.”

From my own practice and research, I know that yoga can heal, calm, renew, strengthen, lift moods, lower the risk of heart disease, increase flexibility and balance, counter aging and improve sex and intimacy.

Hip awareness can only reduce yoga’s risks and help us better enjoy its many benefits. I wrote this account in that spirit. I’m grateful to all who helped me understand the issues and hope the information helps you improve your own practice.

Onward to better yoga!

Relephant Reads:

3 Common Yoga Injuries & How to Avoid Them.

Yoga Injuries: Waves of Compassion.

3 Tips to Prevent Common Yoga Injuries.

Want 15 free additional reads weekly, just our best?

Get our weekly newsletter.

Assistant Editor: Steph Richard/Editor: Bryonie Wise

Photo: elephant journal digital archives

About William J. Broad

William J. Broad has practiced yoga since 1970. A bestselling author and senior writer at The New York Times, he has won every major award in print and television as a science journalist. With colleagues from The New York Times, he has twice won the Pulitzer Prize, as well as an Emmy and a duPont. He is the author or coauthor of eight books, which have been translated into dozens of languages. His journalism has twice been featured in The Best American Science Writing. He earned a master’s degree in the history of science from the University of Wisconsin. The father of three adult children, he lives with his wife in the New York metropolitan area, where he enjoys doing Sun Salutations.

9,251 views

Comments

28 Responses to “Puzzled by a Yoga Contradiction. ~ William J. Broad”

  1. Mary says:

    Great article, Bill! I’ll pass it on to my yoga teacher who just bought your book. She is a fabulous, gifted teacher, about to become even more so, thanks to you!

  2. Joe Sparks says:

    Thanks Willam Broad and Michaelle Edwards for your courage, curiosity, persistence, intelligence and devotion to helping shed the light on the current blind spot in the yoga world. Your efforts are preventing injury and bringing awareness to the healing powers of yoga.

  3. Kim says:

    As a physician. I would like to applaud Mr. Broad. On of the few in the science world who is open to yoga….and one of the few in the yoga world who Is not reactionary and threatened by science. He is making a sincere attempt to yoke the ancient with the new. A scientifically literate yogi. We need more like him.

  4. @TifanyLee says:

    This must be the New York Times article that Waylon Lewis mentioned in a Walk the Talk video that I just saw recently. I understand the defensive backlash on the part of the yoga community in their desire to protect a practice that seems to stay under scrutiny, but I would like to retain the use of my hips for a lifetime! Triangle is a pose that I have always avoided as I find it highly uncomfortable and unnatural, but the forward bends are some of my favorite poses! I will take caution. Could the danger inherent in the forward bends possibly be offset by counterbalancing with backbends? Do we stay too long in these forward poses or is it simply the range of movement?

    Thanks for a great article!

  5. Louise Brooks says:

    Thank you, William, for your diligent research on this often ignored subject in yoga. As a yoga teacher and practitioner, I too have experienced hip-related issues. My hips have always been quite flexible and without any knowledge of the chance of injury I spent a large amount of time in Pigeon pose (yin style) and was the envy of many of my students. Unfortunately, I now have severe Pudendal Neuralgia (mostly on the right side). For those not acquainted with this nerve, the pudendal nerve runs from the sacrum through the anal and vaginal area, the urethra, clitoris, labia (all the extremely sensitive spots!).

    This has been the most excruciating pain I have ever encountered. I am blessed to have a specialist in my area who is aware of this type of injury. I have had nerve blocks done which have helped quite a bit. I have now had a further minor surgery call "radio-frequency ablation" in which the ends of the nerve a burned. This has been very successful and has allowed me to have a life again. Causes of this include a severe fall which can lead to the nerve being "trapped", over-stretching, and inflammation.

    I now do only very gentle yoga and leave out pigeon pose, triangle, deep forward bends, and squats. I urge all women (and men) to be mindful of their bodies and research anatomical issues. William Broad's book is a great place to begin. More information and awareness needs to enter the yoga field before we see yoga related injuries begin to sky-rocket.

  6. I think as both a yoga practitioner and a yoga teacher, I find it hugely important to always keep asking the important question "why are we getting into these poses in the first place if they aren't optimizing our health?"

    Thanks for choosing to share this article on elephant journal.

  7. karen katz says:

    As a nurse, an older woman (57) and a relatively new practitioner of Yoga (2years), I also say thanks to Mr. Broad. I have found the most yogic thing I have done lately is check my ego and accept that despite the wonder, power and beauty of Yoga, it is not without risk, especially to aging bodies. I have modified some positions, skip others, and listen very carefully to my body. One of my most favorite teachers, who is a few years older than I, had a hip replacement a few years ago! I actually have more problems with my wrists, hands and knees, but have felt the occasional twinge or soreness, especially in my left hip. I also still practice bedside nursing-and hope to be able to keep it up, at least a few more years!

    I will say that most teachers I have met seem pretty mindful and careful-being older, I am very confident in my judgement, and just say "no" to certain poses and adjustments. Actually, I have seen more bad yoga taught in "Body Flow" classes at my local community center-a teacher once taught chair position with a deep squat, butt stuck way out, upper torso leaning crazily forward, no attempt to keep the shoulders over the hips, open the heart, or extend the crown towards the ceiling….last time I went to that class!

    The yoga community needs to be open to what science can offer-and vice versa-both disciplines and can learn and benefit from each other….I have seen the same in the last decade with mainstream and alternative medicine-a more complementary and less adversarial relationship. Best of everything to you, Mr. Broad, keep up the good work!

  8. Sara Young sara says:

    This came in the nick of time! I have been starting to have pains in my hips over the last few months. So happy that I read this. I went to my chiropractor and he told me that one of my legs was longer and my pelvis was tipped forward to an extreme point. He fixed it, and I feel much better now. I thought the culprit was my futon!

  9. bradd graves says:

    More nails in the coffin for modern yogic systems and studios that have a "syllabus" based on ever-increasing levels of flexibility. Anusara and Jois' Ashtanga, are you listening? Of course, classical yoga has always been individualized and never used acrobatic syllabi as a measure of success.

  10. sacredsourceyoga says:

    I'm a Doctor of Physical Therapy and a long time yoga teacher, as well as an anatomy instructor for teacher trainings. Although I appreciate the article as written above, the very reason for its existence is to clarify Mr Broad's recent NYT article on yoga's danger to the hip socket as well as your other articles that (whether meaning to or not) come across as recklessly anatagonistic to the practice. Many of my patients and acquaintances have developed the impression that yoga is dangerous because of his sensationalist headlines and incomplete or inaccurate framing ("How Yoga Can Wreck Your Body", "The Perils of Yoga for Men", "Womens Flexibility is a Liability in Yoga"). Many people (majority of my patients in a large public teaching hospital) could use yoga, or movement of any sort, and frankly, frequently more than they need physical therapy or other medical services. They need breathing and variation in movement, and exploration of stretch and time to get to know their ever-changing bodies. From a science-based perspective, there is ample evidence many of those same people could experience significant healing with the addition of yoga to their lives. Unintentionally as far as I can tell, Mr Broad has given many a reason not to try. Secondarily, there have been so many generalizations in his articles that do not consider the overall prevalence of the medical issues at hand. Ex: When more than 300K individuals receive hip replacements a year (this does not include other types of surgeries such as labral repair) you are ignoring real big-picture contributions to the challenge. I would like to see you highlight what *IS* healing and therapeutic from the world of yoga in the NYTimes, not just here preaching to the yoga-loving choir here. Elephant Journal, though a conveniently targeted population (the same population that would be likely to buy your book), is not a platform with comparable readership numbers as the New York Times, and we are not the ones who will benefit from this anomaly of a yoga-positive, yoga-thoughtful perspective. How about you highlight yoga teachers who ARE healing, who ARE teaching skillful alignment, injury prevention, who are earning medical degrees, who are integrating yoga in their medical practices? (I can think of many in my own neighborhood). Researchers who are uncovering observable evidence that yoga heals…Lots of ways to guide the masses toward safer yoga asana as opposed to fear tactics that make for flashy headlines. (Forgive me if I'm responding more to the new york times pieces than the above, but I want to communicate with my yoga-loving peers more of the context of this article.)

  11. Erica Mather says:

    There are many ways that a person can use a tool incorrectly–no need to use a sledgehammer to ring a doorbell. In the case of yoga mis-use of all kinds happens too often. It's not the fault of yoga, but rather of the people wielding the tool–in this case, teachers and practitioners.

    A better analogy for Yoga is medicine, and as we're well-aware, a person can take the wrong dose of the wrong kind.

    Yoga is also a powerful tool/medicine for healing, when in the correct hands. It's important that we give venue to honest discussions about all aspects of this tool, and absolve it itself of any blame for wrongdoing, and educate teachers and practitioners about correct use of this powerful tool/medicine.

    I've written further about these ideas in my article here. I would be honored by any further discussion.
    http://www.elephantjournal.com/2013/01/injury-as-

    warm regards,

    Erica

  12. Here is a website with hip replacement statistics. Women do get the majority of the surgeries and often need repeat surgeries too. http://www.cbsnews.com/news/hip-replacements-more….

    Also a Mayo clinic study shows serious dangers for people who do forward bends with osteoporosis. http://www.ncbi.nlm.nih.gov/pubmed/22448849

    Also see the prevent yoga injury blog about forward bends http://preventyogainjury.blogspot.com/2013/02/ost….

    The truth be told. Yoga teachers are getting hip replacements. You may use logic to state that there is no scientific proof that yoga caused it. But yoga did not prevent it either. In my world, nobody should be getting hurt doing yoga and the fact is people are getting hurt and we are not able to see reliable scientific statistics on the numbers because yoga is not regulated and only acute injuries usually wind up at the emergency rooms. Statistics on chronic injuries are not available or reported which is why there is a serious denial in the yoga community about yoga injuries.
    I feel and my body tells me that the dangers of yoga asana are getting in positions that do not simulate how the body is designed to move. ( for instance bending over with straight knees) Here is where repetitive strain and excessive joint actions create issues in the long term.
    People talk about bone differences and how we need to move our spine. Agreed our spine actually gets moved every time we inhale or exhale but there is no need to bend the spine excessively when bending forward. Any back doctor will tell you, bend your knees.
    Check out the posture gurus here. http://www.youtube.com/watch?v=jCXohKKyuZI&fe….

  13. Broad and Edwards are courageous, intelligent and caring visionaries who see that hatha yoga needs to evolve so that it can help more people and hurt fewer people. Edwards has demonstrated in her YogAlign program how to improve upon the physical postures so that all people can benefit from a simple, natural, sustainable practice.

  14. DrGrace G says:

    Intelligent people will listen to their body. Yoga is Not about being a contortionist. Some people take it too far, because they are competitive even though yoga is not a competitive discipline. Some do yoga for the wrong reasons. Do not blame the "discipline" for someones irresponsible behavior.

    People get injuries in every sport. Boxers and fighters have brain damage and other injuries. Ice skaters get injuries, sometimes so bad it ends their career. People are not listening to their own bodies. If they are being irresponsible and push their body too far, because they want to win a competition, or to impress, or want to show off, it is not the fault of the activity, but of the person themselves.

    Should everyone stop exercising, doing sports, or doing any type of physical activity, because they may get injured?

  15. Mr. Broad and I are not in any way advocating that people stop the practice of yoga; we are trying to help yoga be safer and smarter. The comment that you can get hurt doing anything is not a good reason to dismiss the discussion on yoga injuries. Why are they happening at all? Certainly people can get injured doing anything however yoga is considered to be a healing practice based on ridding ourself of the obstacles, and practicing ahimsa towards self and others. I get letters from intelligent people every day with yoga injuries and they were not being competitive or negligent in their practice; in fact many of them are teachers and experts in the physical practice of yoga. As a bodyworker, YogAlign creator, and posture educator, I feel a responsibility to help people avoid yoga injuries. People are seeking tools to help them evaluate their practice and safeguard their structure so that yoga heals and does not hurt them. Many are learning to avoid yoga poses that cause over-stretching of ligament forces needed to keep the joints strong and stable for life.
    Most of the injured yogis who contact me have never reported their injuries and because yoga is not regulated by the US government, reliable statistics for the numbers of yoga injuries do not even exist. Yoga poses need to evolve to simulate how the body moves in real life and yet many yoga poses are static and 2 dimensional. This is the blind spot in yoga poses that is not being clearly seen at this time.

  16. Dr. McGill is a spine expert who explains scientifically why one should not do exercises that keep the navel pulled in and why having a flexible spine or doing body movements that flex the spine is dangerous.
    see this short You Tube clip about back pain and spine physiology. https://www.youtube.com/watch?v=033ogPH6NNE

  17. The other day, while I was at work, my sister

    stole my apple ipad and tested to see if it can survive a 25 foot drop,

    just so she can be a youtube sensation. My apple ipad

    is now broken and she has 83 views. I know this is totally off topic but I

    had to share it with someone!

Leave a Reply