The Science of Yoga: The Risks and the Rewards (23 page)

During the physical examination, the doctors noticed on the man’s back a series of bruises. The bluish discolorations ran down his lower neck across the C5, C6, and C7 vertebrae. Apparently, the team wrote in the
Archives of Neurology
, “these resulted from repeated contact with the hard floor surface on which he did yoga exercises.” The bruises, the doctors added, were a sign of neck trauma.

Hanus focused on assessing the inner damage. Diagnostic tests revealed blockages of the left vertebral artery between the C2 and C3 vertebrae. The team found that the blood vessel there had suffered “total or nearly complete occlusion.”

During the man’s first week in the hospital, the left side of his face developed Horner’s syndrome—the constricted pupil and drooping eyelid. Slowly, he regained his ability to walk, though his gait remained clumsy. Two months after his attack, and after much physical therapy, the man was able to walk with a cane. But the team reported that he “continued to have pronounced difficulty in performing fine movements with his left hand.”

Hanus and his team concluded that the young man’s situation was no anomaly or medical oddity but instead a new kind of danger. Healthy individuals can seriously damage their vertebral arteries, they warned, “by neck movements that exceed physiological tolerance.” And yoga, they stressed, “should be considered as a possible precipitating event.” In its report, the Northwestern team cited not only Nagler’s account of his female patient but Russell’s early warning. The concern was beginning to ripple through the world of medicine.

The next case showed its global spread. In Hong Kong, a woman of thirty-four practiced yoga faithfully. One day, shortly after doing a Headstand for five minutes, she developed a sharp pain in her neck and numbness in her right
hand. A surgeon made an incorrect diagnosis and prescribed neck traction and physical therapy. Her symptoms got worse. The attacks of nausea and dizziness grew in severity. Eventually her troubles came to the attention of a medical team at the University of Hong Kong and Queen Mary Hospital.

By this point—some two months after the neck pain—the doctors found that the woman showed signs of disorientation and paralysis on the left side of her body, as well as an inability to feel sensations of touch. Her eyes displayed the jerky movements typical of a rear-brain stroke, and the physicians made that the provisional diagnosis.

The doctors repeatedly scanned the woman’s brain with imaging devices over the next few days. But they found nothing, even as her consciousness began to ebb. Finally, the team located a region of tissue that appeared dead from lack of blood. It ranged over the pons, the thalamus, and the occipital lobe. The doctors sought to pinpoint the cause of the stroke by injecting dye into the woman’s neck arteries and taking X-rays. The diagnostic images showed no problems in the vertebral arteries but a severe blockage in the basilar artery.

The doctors had put the woman on blood thinners and clot-dissolving drugs after the provisional diagnosis. Eventually she underwent intensive physical therapy as well. After a year, she regained strength on the left side of her body. But she still exhibited clumsiness in her left hand.

Jason K. Y. Fong, a young neurologist, led the analysis. In 1993, he and his colleagues reported that the woman’s problems had probably begun when vertebral arteries in the C1–C2 region suffered a tear or a severe reduction in blood flow. That produced a clot, the doctors wrote in
Clinical and Experimental Neurology
, that eventually worked its way into the basilar artery and blocked the blood supply to her inner brain. They attributed the lack of visible damage in the vertebral artery to the likelihood that the exceptionally long period between the Headstand and the hospital admission “may have allowed sufficient time for spontaneous healing.”

The delay in uncovering the woman’s stroke and its likely cause bore lessons for the medical community, Fong and his colleagues argued. The main one was the importance of learning the inconspicuous details of case history, which if taken seriously could speed diagnosis and treatment. Their warning echoed Russell’s observation about overlooking the origin of brain damage.

The gravity of the
Hong Kong case, the team concluded, showed that yoga could pose extraordinary risks to human health. The doctors cautioned that postures in which the neck came under great strain could be “potentially dangerous or even lethal.” The latter word is one that physicians, steeped in a culture of cautious optimism and dry understatement, tend to avoid if possible.

The spike in clinical reports made yoga strokes a common feature of medical concern. The danger was judged to be at least partly due to underlying weaknesses in the vertebral arteries of some individuals. But it was difficult if not impossible to know who was at risk. So the warnings spread. They appeared not only in medical journals but in textbooks as health specialists gained new appreciation of the threat.

Science of Flexibility
, whose first edition appeared in 1996, featured a section called X-Rated Exercises. It linked strokes to poses that stretched the neck far backward, including the Wheel and the Cobra. In summarizing the medical findings, the book’s author called the value of the postures too small “to justify the potential, although rare, risk of vertebral artery occlusion.” He suggested avoidance.

Injuries due to yoga turned out to range far beyond nerve damage and strokes. Waves of practitioners were showing up in emergency rooms. The Consumer Product Safety Commission, in monitoring the hazards of modern life, runs a little-known detective service known as the National Electronic Injury Surveillance System. It samples hospital records in the United States and its territories. By 2002, its surveys showed that the number of admissions related to yoga, after years of slow increases, had begun to soar. The number of admissions went from thirteen in 2000 to twenty in 2001. Then, in 2002, they more than doubled to forty-six. By definition, all these episodes involved men and women (and in some cases children) who had hurt themselves badly enough to seek out emergency assistance.

The spike represented the tip of a very large iceberg, since the system of federal monitoring produced only a statistical sketch. Most emergency rooms lay beyond its reach. Moreover, only a fraction of the injured visited hospital emergency rooms in the first place. Many—perhaps most—went to family doctors, chiropractors, neighborhood clinics, drugstores, and various kinds
of therapists. Some probably decided to avoid treatment altogether and deal with the injury on their own. Thus, many hundreds or even thousands of yoga injuries in the United States went unreported.

The 2002 survey, like that of any year, gave a brief description of each person and each injury. An analysis of the information on the forty-six patients showed that they ranged in age from fifteen to seventy-five years, with the average age being thirty-six. The vast majority—83 percent—were women. The main type of injury centered on the complicated amalgams of bone, tendon, and cartilage known as joints, including the wrist (mentioned six times), the ankle and foot (five times), the knee (five times), the shoulder (four times), and the neck (four times). The injury write-ups contained an area for brief comments, which tended to describe everyday pains, strains, and sprains. But the comments also disclosed a number of serious traumas. Six of the injuries involved dislocations and fractures.

The survey listed no strokes—their diagnosis would typically require detailed examinations that went beyond the simple capabilities of most emergency rooms—but in several cases listed symptoms that might have coincided with the precipitating damage. “Acute neck pain,” read one write-up. “Collapsed to floor while performing yoga,” read another.

The brief comments tended toward the kind of pithy diagnoses and observations heard in emergency rooms: “dislocated right knee,” “hurt shoulder,” “low back pains.” The reports usually cited yoga in general as the cause of the accident but on occasion named specific poses. “Sharp pain in abdomen since doing Cobra,” read one report. Another said a male patient fainted while doing yoga in a warm room, falling and hitting his head hard enough to produce a bruise.

The wave—whatever its true dimensions—represented a clear rebuke to the “mother’s milk” argument. Facts can be stubborn things, and they now suggested that yoga had long involved not only celebrated benefits but a number of hidden dangers.

For most of the twentieth century, yoga in the West enjoyed news coverage that can be described conservatively as excellent. The discipline was portrayed as nearly miraculous in terms of promoting health. An analysis of American reporting in the
Columbia Journalism Review
found much of it fawning.
For gurus and publishers, the favorable coverage was, as the
Columbia
analysis put it, “the stuff of dreams.”

The year 2002 marked a radical shift in the tenor of the reporting as the surge in documented injuries stirred public discussion on the issue of yoga safety. The seeming oxymoron of yoga damage had reached a critical mass in terms of size and social resonance that now made the issue impossible to ignore.

Stories appeared on radio and television as well as in magazines and newspapers, including
The New York Times
and
The Washington Post.
The rising public debate and the accompanying journalism meant that the injured were no longer portrayed exclusively as the anonymous stick figures of medical reports and federal surveys but began to take on the colorations of real life.

Holly Millea, for instance, was a freelance writer living in New York City who prided herself on staying in shape. The petite runner of forty-one practically never got sick.
Body & Soul
magazine recounted what happened when, in 2001, she took up Ashtanga yoga. By August of 2002, Millea began to feel numbness and tingling down her left arm and into her first three fingers. The pain grew and hampered her ability to sleep on her left side. The magazine said that, at one point, she thought the problem might be her heart or even multiple sclerosis—which ran in her family. Finally, after one emergency room visit and two rounds of medical imaging, Millea got the diagnosis: One of her vertebral disks had begun to bulge, squeezing a critical nerve. The magazine reported that her doctor wanted to surgically remove the disk and fuse two vertebrae together if the numbness failed to go away on its own.

“I am sure this is yoga-related,” Millea said in the article, which appeared in 2003 amid her trouble. “It’s at the base of my neck, and I was doing Shoulder Stand a lot. I was doing it wrong, and I was pushing myself too hard.” She blamed herself and her competitive edge rather than yoga and its physical demands. “I am a super-athlete, and thought I could do anything,” she added. “But I took it too quickly. I still needed to take baby steps.”

A number of stories came down hard on Choudhury and his hot yoga. An article in
The New York Times
said health professionals found that the penetrating heat could raise the risk of overstretching, muscle damage, and torn cartilage. One specialist noted that ligaments—the tough bands of fiber that connect
bones or cartilage at a joint—failed to regain their shape once stretched and that loose joints could promote injury. Another said the mirrored walls of Bikram studios encouraged students to neglect the traditional inner focus of yoga for outer distractions and the pressures of a room full of competitive individuals, also courting injury.

Not long thereafter, Choudhury came out with his book
Bikram Yoga.
It said nothing about dislocations or nerve damage, despite the medical warnings and bad press. It also managed to ignore the accusations of his critics. The few references that Choudhury made to the topic of physical damage centered on how hot yoga worked quite beautifully to promote a safe experience. The heat, he declared, lets students “twist and stretch with less chance of injury.”

The period around 2002 also marked a turning point in that some elements of the yoga community started to move beyond denial and evasion to address the issue of damage. To a degree, the bad publicity left few alternatives. Now, for the first time, a number of experienced yogis and yoga publications engaged in serious debate on how to handle the quiet epidemic and come up with safety guidelines. It marked a period of public introspection—with notable exceptions.

The famous gurus, for the most part, remained silent. Publicly, at least, it seemed like their objective was to avoid involvement in any particulars that could prove distracting, embarrassing, and possibly litigious. The candor tended to come from the community’s lower ranks.

A leading forum was
Yoga Journal.
It ran a number of articles, including one in 2003 in which a teacher revealed her own struggles. Carol Krucoff—a yoga instructor, author, and therapist at Duke University in North Carolina—told of being filmed one day for national television. Under bright lights, urged to do more, she lifted one foot, grabbed her big toe, and stretched her leg into Utthita Padangusthasana, the Extended Hand to Big
Toe pose. As her leg straightened, she felt a sickening
pop
in her hamstring.

The next day, she could barely walk. Krucoff found that she needed rest, physical therapy, and a year of recuperation before she could fully extend her leg again. “I am grateful to have recovered completely,” she wrote in
Yoga Journal
, adding that she considered the experience “a small price to pay for the invaluable lessons learned.” These included the importance of warming up and never showing off.