Skip that Yoga Class

Don’t feel bad about skipping that yoga class, truth be told, it most likely is bad for you anyway.  Contrary to popular belief, injury rates in yoga have been showing an upward trend for some time now.  I recently ran across a resurfaced New York time article from 2012 that substantiated my long-time belief that yoga is indeed placing undue mechanical stress on the joints in your body.  The New York Times article, “How Yoga Can Wreck Your Body” written by William Broad (https://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html) was encouraging for me to read, because I have been telling people for years to stop doing yoga. Author, William Broad, writes about his encounters with a yoga teacher, Glenn Back, with 40 years of experience; whom he met after re-rupturing a disc in his back doing an “extended-side-angle-pose”.  He had thought the use of yoga was going to be helpful for preventing any future incidents of his back pain. However, he found out personally that he was indeed incorrect.

William Broad (the author and yoga student) goes onto write in his article and cite multiple conversations with his yoga teacher Glenn Back (a well-known instructor in the area). The conversations were about the instructor’s other clients and collogues with whom he had worked with that had similar misfortunes.  One such example was the description of another distinguished yoga teacher doing a downward dog who ruptured an Achilles. Another example was of a teacher that developed such bad osteoarthritis in her hips that her range-of-motion got so bad she has to have joint replacement.  In the NY times article, the examples continued of even another yoga teacher having such a bad back she had to lie down to teach her classes. In fact, this Glenn Back, the instructor that William Broad interviewed for his article, had his own back surgery due to spinal stenosis. The cause of the spinal stenosis, according to Back himself, was due to his 40 years of back bends in yoga.

Those are just a few examples in William Broad’s article.  I myself have personally had many of the same or similar stories.  Stories of patients coming into my office from neurosurgeons with herniated and ruptured discs after doing years of yoga in attempts to alleviate back, neck, and/or hip pain.  A recent example was a patient of mine that had suffered a torn hip labrum.  She had been repeating a pose for years that placed her hip into maximal hip external rotation in an attempt to alleviate her hip pain.

So, why do these examples happen.  The answerer is fairly complex, but I will attempt to explain it for us.  I believe it is the same reason you see people standing at the airport or in a line at the amusement park twisting their back so aggressively to pop it.  Initially, someone will have an onset of some sort of localized back pain or referred pain that may start as low-grade – maybe like an ache or a pulling sensation.  In response to this – a person might try yoga or some sort of stretching.  Those movements may actually at first seem to help alleviate the ache, pain or pulling; however, the relief is usually only temporary.  The temporary relief many times is long enough to last several hours or days, but eventually the pain comes back, so they will do the stretching or yoga class again with similar results. The cycle thus continues and continues.

To this fact I would like to make two separate points.  First, I would like to explain why someone would have pain relief with a particular stretch or movement, if that stretch or movement may not be helping them in the long-term. When an anatomical structure is painful that means there is some sort of strain, micro-strain, tear or micro-tear in that specific structure. Resulting in an onset of inflammation within that particular structure whether it be a disc or ligament in your back, cartilage in your hip, or maybe even the facet joint tissue in your neck.  That inflammation most likely would be low-grade in this scenario due to the nature of the fact that the person can do these stretches and classes.  If the pathology were more severe, then that particular person would have much more restricted functional ability and movement.

Moreover, when the particular structure is inflamed as described above the inflammation tends to pool in the injured tissue especially when a person becomes more stagnant, like sitting at a desk for hours or waking after a night’s sleep.  It is kind-of like a leaky faucet with a stopped-up drain. The inflammation accumulates in the tissue and causes pain. With that, when the stretching movement is performed it will cause the inflammation to flush through the tissue and decrease the pooled inflammation in the tissue to some extent.  The products of inflammation are what cause the nociceptor (the nerve endings) to send the pain signals to your brain and give you the sensation of pain.  So, when the inflammation in the area is decreased then the pain signals to the brain are reduced. However, even though the movement causes the reduction of the pooled inflammation to diminish, the movement itself is traumatizing to the strained, micro-strained, torn or micro-torn tissue.

What happens at this point is twofold.  Frist, a chemical called Substance P is released from the tissue and, second, the tissue is re-aggravated to cause a delayed onset of inflammation.   Let’s look at Substance P first.  Substance P is a chemical that blocks the nociceptor and creates a temporary anesthetic effect giving the person a sense that there is relief of pain.  Thus, allowing the person to continue to perform the stretch, which is even more traumatizing to the tissue.  Therefore, this Substance P is blocking the fact that the tissue is being traumatized.  Secondly, this process will cause a delayed onset of inflammation and thus will cause even more pooling of inflammation in the tissue.  This delay can sometimes take up to 12 to 24 hours or more to onset.  This delayed onset of inflammation is really a delayed onset of pain and most of the time the person is unable to ascertain that the stretching and/or yoga has actually re-aggravated the tissue.

I run into this phenomenon all the time.  It is very challenging for a person to recognize this pattern especially if they perceive a movement and stretch is helpful.  It is unfortunate, as well, because many people are being misled to think that what they are doing is helping them.  Well intended yoga teachers are not aware of what is happening, primarily because their knowledge and education did not include high level biomechanics and physiology.  The combination of biomechanics with application of physiology and the injury response is what gives a physical therapist the understanding needed to make these assessments.

In summary, if you have been trying yoga and some stretches that you think might be helping in the short term but don’t seem to helping in the long-term, then be might want to call a fellowship trained physical therapist.  Keep in mind not all physical therapists are the same.  Unfortunately, there are some PTs that are infusing yoga into physical therapy.  If you run into a PT that is using yoga in their practice, then just kindly let them know you would prefer not to do that and run as fast as you can to find a therapist with more sound ideas.