Injuries from Yoga and Contraindications

Compiled by: Trisha Lamb

Last Revised: April 27, 2006

International Association of Yoga Therapists P.O. Box 2513 • Prescott • AZ 86302 • Phone: 928-541-0004 E-mail: [email protected] • URL: www.iayt.org

The contents of this bibliography do not provide medical advice and should not be so interpreted. Before beginning any exercise program, see your physician for clearance.

“It is impossible to injure oneself practicing Yoga. It is very easy to do so performing a posture. If one has injured oneself in practice then no Yoga was happening and one ought consider modifying if not completely changing the âsana or practice that caused the injury.”

—Jason Brown [email protected]

“Remember, the harder you are on anything, the faster you wear it down, not build it up. Exercise these days seems to be about making your body conform to certain standards of strength, flexibility, size and appearance. It seems health is determined wrongly by appearance. What I’ve noticed is a lot of people are beating themselves up and even making themselves sick trying to look good. It seems that mentality has been brought into yoga. Just remember the purpose of this practice is not to become loose, strong, young, pretty or skinny. The purpose is wellness, and its doorway is gentleness. Note, injuries occur when our practice is anything but gentle. It will be extremely difficult to hurt yourself or others when gentleness is the priority!! Also, nothing should ever be excruciating! That’s the body sending a clear message to back off. This is the other barometer of whether you are practicing correctly.”

—Bryan Kest http://www.myguruguide.com/yoga_articles/Quality-Practice-Quality-Results.asp

“Lack of awareness, emphasis on exterior appearance, forcing, and a glamorization of pain cause many people to tragically betray their bodies. And of course, yoga itself is not immune from misuse and poor application either; students and teachers aspire to ‘perfection’ and ‘superiority’ often at the expense of their own bodies’ integrity. Aspiring to an ‘ideal’ is not yoga. Yoga is union of the person with himself, with life. Yoga ceases to be yoga when it is used as a spiritual whip. Yoga is compassion for the body, your body. Compassion for the body is compassion for the spirit.”

—Kevin Kortan http://www.evolutionaryyoga.com/articles/teaching.htm

Adamo, Richard. What is safe yoga? Spectrum: The Journal of the British Wheel of Yoga, Winter 2003, pp. 12-13.

Aldous, Susi Hately. Anatomy and Asana: Preventing Yoga Injuries. URL: www.anatomyandasana.com

From the website: Section 1 introduces the basics of anatomy as they relate to asana, including skin, bone, muscle, nerve, connective tissue, fascia, blood and lymph vessels. Section 2 further explores the language of anatomy and movement. Section 3 explores the 8 essential principles of movement as they relate to Yoga. These principles can be applied to any style of yoga: Ashtanga, Bikram, Iyengar, Viniyoga, Vinyasa Flow, Kripalu, Svaroopa, Anusara, etc. Section 4 applies the 8 essential principles to the specific groups of yoga asanas: standing poses, back bends, forward bends, twists, and inversions. In each group, it is examined where there is a tendency for injury and what can be done to instill space in the body and prevent injury from happening.

2 Anderson, Erica. A world of yoga: Class to books, it’s taking over. J201, Spring 2004. Author email: [email protected]. Article available online: http://www.journalism.indiana.edu/gallery/j201spring04/HealthWise/Casey/Index.html.

“Dr. Mark Moseman, an Indiana University health center physician believes the attachment to yoga can be attributed in part to proprioception; or, as some like to call it, the ‘sixth sense.’

“Proprioception explains the phenomenon of how one can ‘feel’ what position one’s arms and legs are in when moving. The exploration of that, he thinks, can be held partly accountable for yoga’s use as a treatment to ailments.

“‘As proprioception starts to communicate with the body, it starts to get more neurons involved. In turn, the body is better at protecting it from damage,’ Moseman said . . .”

Andes, Karen. Beware yoga’s dark side. Spirited Fitness. Article available online: http://www.myprimetime.com/health/fitness/content/andes_yoga/index.shtml.

Cautions against holding postures too long and locking one’s joints, and also gives specific cautions for halasana, back-bending postures, and forward-bending postures. (Note: Some of these cautions are not necessarily applicable to the experienced and well-trained Yoga practitioner who can, for instance, hold postures for extended periods.)

Ashar, Hemal. Is too much yoga killing Khairnar? Mid-day.com, 2 Mar 2005. Article available online: http://ww1.mid-day.com/news/city/2005/march/104687.htm.

“Mumbai’s former demolition man, ex-deputy municipal commissioner G R Khairnar (63), has succumbed to ‘yogamania.’

“An obsession with yoga (averaging nearly 12 hours a day) has landed him at the KEM Hospital’s intensive care unit. He was admitted on Saturday.

“The first danger signs came a fortnight ago when Khairnar felt discomfort in his nose.

“‘I went to an ear nose and throat specialist and had a minor operation. The ‘curtain’ and cartilage in my nose had been affected because of jal neti and rubber neti. I had developed a monstrous obsession with yoga,’ he confessed.

“‘Then, last Friday, after an extensive yoga session, he asked to be taken to a doctor. He feared he was about to die. I rushed him to Cooper Hospital; he was shifted to KEM the following day,’ recalled his wife Ashalata.

“She continued, ‘His sodium level has dropped to a “dangerously low” level. He is under observation for two days.’ Doctors at the KEM refused to comment on the matter, citing patient confidentiality.

“Khairnar began practicing yoga while on a rehabilitation drive in Kutch, around July 2004. He started with free hand exercises and light yoga daily. On realising its benefits, he became a man with a new mission.

“‘I was bitten by the yoga bug,’ he said, from his hospital bed. ‘The pain in my knee, little finger and waist had disappeared, thanks to yoga. I have been allergic to a host of vegetables and dry

3 fruits for 25 years. Yoga cured that too.’

“After that, there was no stopping. Recounted Ashala ta, ‘He practised jal neti (taking in water from one nostril and passing from the other), rubber neti (inserting a rubber tube through the nose and removing from the mouth) and pet neti (consuming water in abundance and flushing it out) for several hours a day.

“‘He used to practice yoga for 12 hours.

“‘He would push back meal times to 11 pm and sleep for only three hours a day, not wanting to miss his routine. He would sometimes lock himself up in the bathroom for six hours at a stretch, busy with yoga inside.”

“‘I became greedy. If I were asked to consume a litre of water for cleansing, I would take 30. At times, I would repeat an exercise 800 times, thinking that nothing succeeds like excess,’ said Khairnar.

“‘I did not speak to my wife for three months as I used to do yoga the whole day. Where was the time to talk to her?’

“‘Henceforth, I shall practise yoga with expert supervision and stick to a time limit,’ he concluded.”

Bailey, James. Damage control: These herbs help heal and prevent common yoga injuries. Yoga Journal, Jul/Aug 2001, p. 32.

Banslaben, John. Posted message on Yoga as a possible trigger for causing arterial dissection to ESutra mailing list 8/13/02. To join ESutra, email the moderator, Leslie Kaminoff, [email protected].

John Banslaben posted a letter to ESutra that he had sent to Yoga Journal and which Yoga Journal declined to publish. He states that there is no solid evidence, contrary to an article that appeared in Yoga Journal and The New York Times, that Yoga can trigger arterial dissection. The conjecture in the articles is based solely on anecdotal reports.

Barrett, Jennifer. The trouble with touch. Yoga Journal, Mar/Apr 2003. Article available online: http://www.yogajournal.com/views/899_1.cfm.

“Adjustments can help you to gain a deeper understanding of poses, but they can also be misdirected and misunderstood. To get to the heart of this controversial topic, YJ talks to both teachers and students about the trouble with touch.”

Bell, Baxter, M.D. Yoga 911: How should you handle an in-class medical crisis? Yoga Journal, Nov/Dec 2000, pp. 135-137.

Topics covered: Dizziness, fainting, epilepsy, asthma, and heart attack

Benitez, Denise. Drop and give me 10! To do Chaturanga Dandasana, a.k.a. the dreaded yoga push-up, you need more than brute strength. Yoga Journal, Jan/Feb 2001. Article available online: http://www.yogajournal.com/practice/208_1.cfm.

4 Includes a discussion of injuries from performing this pose incorrectly.

Bhaktipoorananda Saraswati, Swami. Can Yoga help in injury? Yoga (Australia edition), May 1999.

Bhaskarananda, Swami. [Hazards of meditation.] In Swami Bhaskarananda, Meditation, Mind & Patanjali’s Yoga: A Practical Guide to Spiritual Growth for Everyone. Viveka Press, 2001.

Bogart, Greg. How to learn from an injury: A pulled muscle or torn cartilage can teach us a lot about our yoga practice—or our life. Yoga Journal, May/Jun 1992, pp. 28-29.

Boyd, Lindsay. Kids are finding a place on the yoga mat. The San Diego Union-Tribune, 17 Jan 2004. “The American Academy of Pediatrics does not have an official stance on the issue, but some doctors say the stretching and relaxation involved in yoga can be beneficial for children. ‘As kids get older and their bones grow, they lose flexibility,’ says Dr. Hank Chambers, director of Sports Medicine at Children’s Hospita l and Health Center in San Diego. ‘This is one of the biggest causes of growing pains.’ Chambers, a pediatric orthopedic surgeon, says he often recommends yoga-like stretches to his patients. While yoga that is very physically demanding might not be good for kids, stretching and relaxation, he says, is fine: ‘I’ve never seen one injury from yoga in 20 years.’”

Brown, Jason. Notes from a concerned practitioner/teacher. Article available online: http://www.yogagoa.com/notes_concerned.htm. Author email: [email protected].

Brundage, Sandy. Bad Vibes: Warning: Meditating may be hazardous to your health. SF Weekly , 28 Aug. 2002.

Discusses work of psychologists dealing with meditation-induced problems.

Campbell, Denis. Bend it like the stars and risk wrecking your health. The Observer, 8 Sep 2002. Author email: [email protected].

“. . . An increasing number of yoga’s army of converts are finding that contorting themselves into complicated positions can hurt their backs and knees, damage their groins, make them faint, bring on splitting headaches and tear muscles and ligaments. One even ruptured his cruciate (knee) ligament from attempting one of yoga’s simpler poses.

“Devotees will be horrified to learn that many of yoga’s most popular positions, such as the cobra, the plough and even touching your toes, are among those likeliest to cause injury. Headstands, which students often try after only a few hours of tuition, are especially dangerous because of the risk of neck damage.

“Doctors and physiotherapists report seeing a sudden upsurge in patients suffering pain who thought yoga would make them strong and flexible like the celebrities whose endorsement of yoga has sent its popularity soaring . . . ”

Carrico, Marie. Contraindications of Yoga. IDEA Health & Fitness Source, Nov-Dec 1998, pp. 34-43.

5 Carrington, Patricia. Some problems arise; The misuse of meditation. In Patricia Carrington, Freedom in Meditation. New York: Anchor Press/Doubleday, 1977, pp. 241-260; 261-270. Topics addressed: Refusal to learn meditation; Those who learn then quit; Resistance of self- image to change; Depression and meditation; Fear of pleasure; Problems from overmeditation

Carter, Darla. Yoga safety: Pushing too hard, too fast can cause injuries—here’s how to avoid them. The Courier-Journal (Louisville, Kentucky), 5 May 2005.

“Vulnerable areas of the body include the knee, particularly the cartilage of the inner knee; the lower back; the hamstring muscles, especially near the buttocks; and the sacroiliac joints, where the spine joins the pelvis, [Yoga teacher Roger] Cole said. Other injury-prone areas include the neck and shoulders.”

Chandra, F. J. [On fainting and Yoga postures.] A discussion in the article “Yoga and the cardiovascular system.” The Journal of The International Association of Yoga Therapists, 1991, 2(1):7.

Chan-Ob, T., and V. Boonyanaruthee. Meditation in association with psychosis. Journal of the Medical Association of Thailand, Sep 1999, 82(9):925-930. MEDLINE® PMID: 0010561951. Abstract: This study analyzed the correlation between contemplation and psychosis from three cases of patients presenting psychotic symptoms subsequent to practicing meditation. Sleep loss following a wrong doing in meditation was found to be the main cause in the first two cases, and drug withdrawal was found to be the principal factor in causing a psychotic eruption in the third case. In this last case, sleep deprivation subsequent to meditation was only a minor influence. Discussion regarding the correlation between meditation and psychosis is presented in this study.

Chisholm, Bob. Injury—in yoga? Yoga & Health , Feb 1999, pp. 20-21,

Chusid, J. Yoga foot drop. Journal of the American Medical Association, 9 Aug 1971, 217(6):827-828.

Cleaves. Kundalini: (The Sublime Power). 15 Jan 2005. Article available online: http://cleaves.zapto.org/clv/newswire.php?story_id=69&search_text=yoga.

“As a result of the widespread commercialisation of ‘Yoga’ in the US and the overnight manifestation of numerous ‘expert’ teachers, an alarming amount of misinformation and misinterpretation of Yoga philosophy has occurred. Unlike other fanciful fads, which pose no health hazard to participants, Yoga improperly taught could result in serious physical and psychological injury to the student. This is particularly the case if advanced levels of Yoga are pursued without proper preparation or expert guidance . . .”

Cohen, Michael H. Ethics, adjustments, and carthartic release. My Yoga Mentor, May 2005, No. 18. Article available online: http://www.yogajournal.com/teacher/1565_2.cfm.

“The owner of successful yoga studio in a major metropolitan city recently welcomed his new yoga teacher with this advice: ‘Our Power Practice is extremely rigorous and precise; therefore, to ensure that all students are appropriately following the correct sequence of poses, be sure to give each the same adjustment.’

6 “Across the same city, the owner of a rival successful studio instructed his teachers as follows: ‘Adjustments should be correct, precise, standard. Teach every student the correct pose.’ He demonstrated. ‘Tailbone tucked in, shoulders back, like so.’ He added, ‘Now you do exactly like me.’

“In a third studio somewhere between the two, a student began crying during shivasana. ‘Process emotions through the breath,’ the teacher responded, and the student immediately stifled her tears. In a fourth studio nearby, the teacher encouraged another student’s crying. ‘These are all of our griefs’" he said. In response, many pent-up voices wailed at once.”

“Which of these practices are ethically and legally risky? And which could be justified as essential components of yoga teaching? Would it make a difference if, in any of these studios, one of the students claimed an injury (physical or emotional) from the recommended advice? If your answer to each of these questions is ‘it depends,’ you are well into the gray zone of ethics. Like questions of liability, most ethical issues require analysis, call for a delicate balancing of values, and cannot easily be answered with certainty. While at times academic, ethics discussions are meant to be applied in practical situations, and the values that guide the discussion are quite established, at least in the care-giving professions.”

Colino, Stacey. The wounded warrior: As yoga classes attract a wider audience, some find they come with a painful twist. The Washington Post, 16 Apr 2002, p. HE01. Article available online: http://www.washingtonpost.com/wp-dyn/articles/A54763-2002Apr15.html. See also the follow- up letter to the editor by Maureen Clyne, 23 Apr 2002, p. HE02, who, unlike the author of the article, places most of the responsibility for the increase in injuries on the proliferation of unqualified/underqualified Yoga teachers.

Corrigan, G. E. Fatal air embolism after Yoga breathing exercises. Journal of the American Medical Association, 8 Dec 1969, 210(10):1923.

Dandy, Bill. Letter to the editor on the negative aspects of breath-holding from a conventional point of view. Yoga Today, Feb 1981, 5(10):31. See the follow-up letters to the editor by Philip Jones, Peter Longcroft, and Jo Hodby Holman bringing the yogic point of view in the Apr 1981 issue.

Dembner, Alice. Stretching has its limits: Injuries are on the rise as newcomers take up yoga. The Boston Globe, 8 Jan 2003. Article available for purchase for $2.95 from The Boston Globe archives: http://www.boston.com (use the “Advanced search” option, then the “Click here to search specific date range” option; enter “stretching has its limits” in the search terms field and set your date range to 1/1/2003 – 1/31/2003).

Doctor: ‘Hot’ yoga may be harmful. The Washington Times, 30 Mar 2004. Article available online: http://washingtontimes.com/upi-breaking/20040330-120151-9363r.htm.

“U.S. doctors are beginning to question the potential for injury among those who practice Bikram yoga, the New York Times reported Tuesday.

“Participants typically spend 90 minutes doing 26 yoga postures—positions that some physicians worry are harmful—in a very hot room.

7 “‘Heat increases one’s metabolic rate, and by warming you up, it allows you to stretch more,’ said Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical Center in Manhattan.

“‘But once you stretch a muscle beyond 20 or 25 percent of its resting length, you begin to damage a muscle.’

“Each week, he sees as many as five yoga-related injuries to the knees or the lower back. Postures that require extreme bending of the knees—squats and sitting backward on folded legs, for example —are the most like ly to cause tears in knee cartilage.

“In Bikram yoga, students practice the ‘toe stand pose,’ a single -legged squat and the ‘fixed firm pose,’ sitting backward with bent knees.”

Does meditation have detrimental effects? A thread in the Meditation in Psychotherapy online forum. URL: http://www.behavior.net/forums/meditation/1998/msg3.html.

Dominguez, Richard. A surgeon’s warning: Don’t do these stretches. Executive Fitness, 29 May 1982, 13(11):2-3. See the entry below for Dr. Swami Gitananda Giri, who replies to this article, and also the detailed reply by Dr. Steven Katz in the 2003 issue of International Journal of Yoga Therapy.

The stretches include halasana, uttanasana, virasana, paschimottanasana, stiff leg raise, hurdler’s stretch, and duck walking in a deep knee bend.

Don’t let ‘er rip when stretching. The Arizona Republic, 16 Apr 2004. Article available online: http://www.azcentral.com/health/fitness/articles/0416stretching-ON.html# .

“Esmonde-White’s integrated approach is time-consuming but effective and a workout in its own right. She targets the entire body by combining dance, yoga, pilates and tai chi. She also utilizes a system called proprioceptive neuromuscular facilitation, or PNF.

“Essentially, PNF combines passive stretching with isometric stretching and involves contracting a muscle, relaxing and releasing it. ‘You can’t just stretch one part of your body,’ she said. ‘The whole thing is linked.’

“I didn’t figure that out until I tried yoga, a comprehensive system of stretching and strengthening using physical poses and the breath. Once I finally learned how to stretch my hips and other hard- to-reach areas, sitting at a desk all day became a breeze.

“But yoga can be deceptively dangerous for the inexperienced and overzealous. Convinced that a strained hamstring just needed to ‘let go,’ I stretched my injured leg as much as possible. A year later, not surprisingly, I was still hurt.

“But yoga, done wisely, works well. So does NIA, or neuromuscular integrative action. The 20- year-old method, which is popping up in health clubs, is a little more upbeat than yoga. The choreographed routine, set to music, mixes jazz dance, aerobics, martial arts, yoga and other movements.”

8 Do you have any injuries that hamper your yoga practice? Yoga Journal, Nov 2002, p. 28. (Three practitioners respond.) Dreyfuss, Ira. Yoga may bend some the wrong way. The Associated Press, 6 Dec 1998.

______. Power yoga can cause powerful aches, pains. Los Angeles Times, 13 Dec 1998, Bulldog Edition, Section: Part A, p. A-10.

Duval, E. L., R. Van Coster, and K. Verstraeten. Acute traumatic stroke: A case of bow hunter’s stroke in a child. European Journal of Emergency Medicine, Jun 1998, 5(2):259-263. Department of Paediatrics, University of Ghent, Belgium.

“Acute traumatic stroke of the cerebellum is rarely seen in children. In adults, chiropractical manipulation, yoga exercises, bow hunting and cervical trauma have all been associated with vertebrobasillar damage and subsequent stroke due to cerebellar infarction.”

Dworkis, Sam. Chronic injury and yoga rehabilitation. Article available online: http://www.yogafamily.com/library/articles/dworkis_injury.shtm.

______. No pain, no gain. Spectrum: The Journal of the British Wheel of Yoga, Summer 2002, p. 30.

On chronic injury and the fascia.

Dynek, Linda. One size does not fit all (letter to the editor). Yoga Journal, Jul/Aug 2003, p. 14.

On forced adjustments and the acceptance of pain as good by some Yoga teachers.

Edell, Dean. Was this yoga class unsafe? 18 Jan 2000. Available online at HealthCentral.com: http://www.healthcentral.com/drdean/deanfulltexttopics.cfm?id=25760.

Editors of Yoga Journal. [On avoiding injury in Yoga by warming up muscles.] Yoga Journal, Nov/Dec 2000, p. 52.

______. [On retinal detachment, glaucoma, and inversions]. Yoga Journal, Nov/Dec 2000, p. 52.

______. Dizzy over backbends. Yoga Journal, Jul/Aug 2001, p. 34. (On dizziness and nausea while doing backbends.)

______. The downside of inversions. Yoga Journal, Jul/Aug 2001, p. 34. (On why inversions should not be practiced during menstruation and asanas to substitute.)

Epstein, M. D., and J. D. Lieff. Psychiatric complications of meditation practice. Journal of Transpersonal Psychology, 1981, 13(2):137-147.

ESutra. Yoga injuries thread, Aug 1999. For information on joining the ESutra mailing list, write to the moderator, Leslie Kaminoff, [email protected].

Fields, Jonathan. Taking the shock out of chaturanga dandasana. Yoga International, Jun/Jul 2005, pp. 94-96.

“With the rapid proliferation of power/vinyasa yoga, chaturanga dandasana (four-limbed stick pose) has become almost as popular as decaf latte. While much has been written about this powerful posture, little has been said about the increasingly dynamic nature of the vinyasa sequence that takes the practitioner from uttanasana (standing forward bend) through chaturanga to urdhva mukha shvanasana (upward-facing dog). Performing this dynamic sequence incorrectly, or while guided by ego, can lead to injury and frustration. With a few simple modifications, practitioners at all levels can experience the power of this sequence with safety and confidence.”

Fincke, Alanna. Bent out of shape. Body & Soul Magazine, 2002. Article available online: http://www.bodyandsoulmag.com/show_document.asp?iDocumentID=142&iBDC=1704&iPage Number=1.

“Holly Millea, a 41-year-old freelance writer living in New York City, was in enviable shape. The petite, 108-pound runner had the body fat of a triathlete and had practically never been sick. Two years ago, she started a vigorous Ashtanga yoga practice. Then, last August, she began to feel numbness and tingling down her left arm and into her first three fingers. The pain intensified, interfering with her ability to lie or sleep on her left side. At one point, she thought it was her heart, or even multiple sclerosis, which has affected several family members.

“Now, one emergency room visit and two MRIs later, Millea has a diagnosis: a bulging disk in her cervical spine, which is causing an impingement to the root of a nerve in her neck. If the numbness doesn’t go away in a couple of months, her doctor wants to surgically remove the disk and fuse two vertebrae together. ‘I am sure this is yoga-related,’ says Millea. ‘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 . . .’”

Fong, K. Y., R. T. Cheung, Y. L. Yu, C. W. Lai, and C. M. Chang. Basilar artery occlusion following yoga exercise: A case report. Clin Exp Neurol (Australia), 1993, 30:104-109.

French, A. P., A. C. Schmid, and E. Ingalls. Transcendental Meditation, altered reality testing, and behavioral change: A case report. Journal Nerv Ment Dis, 1975, 161:55-58.

Funk, Leslie. “Hot” Yoga: Physiological concerns while exercising in the heat. Yoga World, Apr-Jun 2001. Article available online: http://www.iayt.org/hotyoga.html.

Gilmore, Ruth. Answers the question: “When I stretch my head back in postures like ustrasana (camel), I feel dizzy, and once I nearly passed out. Why is this?” Yoga & Health, Nov 1997, p. 11.

Gitananda Giri, Dr. Swami. Real yoga is as safe as mother’s milk. Yoga Life, Dec 1997, 28(12):3-12. Swami Gitananda replies to Dr. Richard Dominguez’s ultracritical article on the dangers of asana practice that appeared in the 29 May 1982 issue of Executive Fitness Newsletter. He gives instructions on how to safely do halasana, paschimottanasana, paryankhasana, eka pada uttana pada asana, and hurdler’s stretch. Dr. Steven Katz, an orthopedic chiropractor who specializes in treating Yoga injuries, will also reply to the Dominguez article in detail in the 2003 issue of International Journal of Yoga Therapy.

10 Giubilaro, Gabriella. How to reinitiate yoga after an injury or after a period of inactivity. Article formerly available online. Hagen, Patricia. Take steps to avoid yoga injuries. The Indianapolis Star, 6 Apr 2004. Article available for purchase from The Indianapolis Star archives: http://www.indystar.com. Hanus, S. H., T. D. Homer and D. H. Harter. Vertebral artery occlusion complicating yoga exercises. Archives of Neurology, 1977, 34(9):574-575.

Abstract: Vertebral artery occlusion developed in a young adult shortly after he had performed neck manipulations during yoga movements. Yoga exercises are a rare cause of acute medullary or cerebellar infarction.

Heide, F.J., and T. D. Borkovec. Relaxation induced anxiety: Mechanisms and theoretical implications. Behav. Res. Ther., 1984, 22:1-12.

Heredia, Christopher. “No pain, no gain” mantra won’t work with yoga: Injuries on the rise as practice goes mainstream. San Francisco Chronicle , 3 Aug 2003. Article available online: http://sfgate.com/cgi- bin/article.cgi?file=/chronicle/archive/2003/08/03/LV82589.DTL.

Hillsman, D., and V. Sharma. Yoga and pneumothorax. Chest, May 2005, 127(5):1863. Author email: [email protected]. This is a response to Johnson, Tierney, and Sadighi, which is cited in this bibliography.

Honebrink, Andrea. Meditation: Hazardous to your health? Don’t overlook the side effects of this powerful transformative technique. Utne Reader, Mar/Apr 1994, p. 26.

Hutchinson, Ronald. How not to cripple yourself doing Yoga. In Ronald Hutchinson, Yoga: A Way of Life. London: Hamlyn, 1974, pp. 39-41.

“Stop competing against the clock. Stop competing against yourself. You get no halos for a rushed virtuoso performance. A few asanas slowly learned and performed gracefully and gently every day will lead you into the Yoga way of life. Trying to be a virtuoso is just an ego-trip . . . Ego trips take you nowhere. How can they if everything is centred round you personally? . . . Whether you gain benefit or whether you damage yourself by doing Yoga postures depends largely on the state of mind in which you approach them. This is why before anything else chelas [students] are taught an understanding of what is meant by the yamas [moral disciplines] and niyamas [self-restraints] . . .”

Ikemi, Y., H. Ishikawa, J. R. Goyeche, and Y. Sasaki. “Positive” and “negative” aspects of the “altered states of consciousness” induced by autogenic training, Zen and yoga. Psychother Psychosom (Switzerland), 1978, 30(3-4):170-178.

Immune system and Yoga. Because of Yoga’s immune-enhancing effects, it may be inappropriate for someone taking immune-suppressant drugs, such as an organ-transplant patient, to do Hatha-Yoga. The advice of the patient’s physician and a qualified Yoga therapist should be sought.

It’s own-up time: I’m a hardcore yoga fan. Health.Telegraph, 6 May 2005. (On Bikram Yoga.)

“. . . one doctor from the Beth Israel Medical Centre in New York . . ., earlier this year, told a British journalist that he saw up to five Bikram-related injuries a week, a result, apparently, of stretching muscles too far beyond their resting lengths.”

Iyengar, Geeta. Practice of inversions during & after menstruation. Yoga Rahasya, 1997, 4(1):30-31. Jameson, Marnell. In over their heads: Americans’ competitive nature and a dearth of seasoned instructors mean more injuries on the yoga mat. Los Angeles Times, 13 Aug 2001. Article available online: http://www.latimes.com/features/health/la -081301yoga.story. Also available under the title: In a bad position: Yoga may be soaring in popularity, but the lack of seasoned instructors puts students at risk, Detroit News, 5 Sep 2001. URL: http://www.detnews.com/2001/health/0109/05/h06-285621.htm. Johnson, Andrew, and Marged Richards. Celebrity power yoga: the new craze from over there causing bad karma over here. The Independent (U.K.), 30 Jan 2005.

On the opening of a Jivamukti Yoga studio in London and concerns about potential injuries.

“It’s hard, it’s fast and it tones tired bodies. But, Andrew Johnson and Marged Richards ask, was yoga ever supposed to be a competitive sport?”

“. . . Gary Carter, who runs the Natural Bodies yoga centre in Brighton, recently named one of the 10 best centres in the country by The Independent, said: ‘We tend to see people coming in with a number of injuries from these newer forms of yoga, which we have to unravel. Injuries are to the neck, shoulder, toes, knees, hips and lower back. They are pulling their bodies into positions they are not ready for.

“‘For some, aerobics has been replaced by the hardcore branch of yoga and the attitude is the same as going into a gym,’ he said.

“John Stirk, one of Brita in’s leading yoga teachers, who is also an osteopath, said: ‘I’ve seen many people who have injured themselves by pushing themselves too hard and too far. A lot of bodies don’t need things done to them, they need things undone. They should follow the body, not work against it.

“‘Yoga generally has an enormous amount to offer. It’s a shame that people who take this on often don’t take the maximum benefit. They do incur injuries. Everyone should do yoga, but at their own pace.’

“Jackie Barker, a yoga teacher from Oxford with more than 30 years’ experience said: ‘This is a young person’s yoga. There are a lot of males—it’s a bit egotistical. What is dangerous is that people aren’t aware of what they are doing. You can quite easily end up getting injured . . .’”

Johnson, Derek B., Mathew J. Tierney, and Parvis J. Sadighi. Kapalabhati pranayama: Breath of fire or cause of pneumothorax? Chest, May 2004, 125(5):1951-1952. Author email: [email protected]. Author email: [email protected]. See also response by Hillsman and Sharma cited in this bibliography.

Abstract: Spontaneous pneumothorax is the most common cause of pneumothorax. We report a case of a 29-year-old healthy woman who presented to the emergency department with a

12 spontaneous pneumothorax caused by a yoga breathing technique called Kapalabhati pranayama, or breath of fire. Yoga breathing exercises are commonly practiced, and a limited number of studies have shown various physiologic benefits of yoga breathing. This is the only known report of spontaneous pneumothorax caused by pranayama, but some other rare causes are noted. This case should illustrate that adverse side effects can occur when one pushes the body to physiologic extremes.

Jollymore, Amy Eden. Emotional ambush: Surprisingly, the most tranquil of therapies— acupuncture, meditation, and massage—can incite extreme emotions. Natural Health , Nov/Dec 1999, pp. 87-89.

Jordan, Thea. You can’t be Bruce Lee in a day. As more people take up martial arts [and Ashtanga Yoga], the number of related injuries is rising. Thea Jourdan reports on the importance of proper training. The Daily Telegraph, 21 Sep 2000.

Kaminoff, Leslie, with Coeli Carr. Mr. Fix It for injured yoga enthusiasts. The New York Times, 11 Aug 2002.

On injured Yoga students, Yoga teachers, and others that Yoga teacher Leslie Kaminoff has helped.

Katz, Steven. Rebuttal to a surgeon’s warnings. International Journal of Yoga Therapy, 2003, no. 13, pp. 43-44.

Kennedy, R. B., Jr. Self-induced depersonalization syndrome. American Journal of Psychiatry, 1976, 133(11):1326-1328. (On possible negative consequences for the novice meditator.)

Kohli, Anu. Interview with Dr. Suhas Kate, orthopaedic surgeon: Clarification on an article on Yoga. Yoga and Total Health , Dec 2000, pp. 7-8. (Indicates that there should be no negative consequences from performing classical asanas, such as padmasana, if done properly.)

Kreahling, Lorraine. When does flexible start to mean harmful? ‘Hot’ yoga draws fire. The New York Times, 30 Mar 2004. Article available online: http://www.nytimes.com/2004/03/30/health/30YOGA.html.

“As more and more people take up Bikram to lose pounds and gain strength, however, medical professionals are expressing concerns about the demands of yoga contortions performed in extreme heat.

“‘Heat increases one’s metabolic rate, and by warming you up, it allows you to stretch more,’ said Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical Center in Manhattan. ‘But once you stretch a muscle beyond 20 or 25 percent of its resting length, you begin to damage a muscle.’

“Each week, Dr. Gotlin said, he sees as many as five yoga-related injuries to the knees or the lower back. Postures that require extreme bending of the knees—squats and sitting backward on folded legs, for example —are the most likely to cause tears in knee cartilage. In Bikram yoga, students practice the ‘toe stand pose,’ a single -legged squat and the ‘fixed firm pose,’ sitting backward with bent knees.

13 “‘Basically, the knee is a piece of bone with two strings of muscle on the top and bottom, and you can only tighten those strings so much,’ Dr. Gotlin said. ‘The more you flex the knee under load, the more pressure is exerted on the kneecap.’

“Bikram advocates maintain that the immediate warmth and simple movements at the start of each class are safer than traditional yoga.

“‘The heat helps people work slowly and safely into the postures and makes injuries infrequent,’ said Jennifer Lobo, an owner of Bikram Yoga NYC. But David Bauer, a physical therapist in New York who also teaches yoga, said the enthusiasm and competition among participants could contribute to injuries.

“‘When you are in a hot studio filled with hard-core Type A personalities, and everyone’s adrenaline and endorphins are pumping, you’re not feeling any pain,’ he said, ‘and it may mask how far you can go.’

“The mirrored walls in Bikram studios may encourage students to concentrate on outward form, Mr. Bauer said. In contrast, more traditional yoga emphasizes an inward focus on breathing and individual limitations, possibly helping to curb injuries.

“‘Learning where your body is and what your body can do is what yoga is about, not reaching for an ideal or modeling yourself after a picture in a book,’ Mr. Bauer said. ‘If you are just flexible and not strong, at the end of your range you are going to tear a muscle.’

“Indeed, part of the Bikram yoga philosophy is the push to go a little farther every time a posture is performed. Each pose is done two times per class. Participants arch backward and bend to the side in ‘the half-moon pose,’ for example, and then do the movement again, trying to bend the spine even more.

“Practitioners maintain that the spinal flexibility and strength cultivated in Bikram yoga can be vital in warding off the effect of aging on posture. Some physical therapists, however, question the value of excessive joint flexibility, saying it can lead to inflammation and pain.

“‘The extreme range of motion yoga develops does not necessarily have an advantage, and it may be counterproductive,’ said Dr. Shirley Sahrmann, a professor of physical therapy at the Washington University School of Medicine in St. Louis.

“Like dancers, practitioners of yoga cultivate overly flexible spines, which often cause problems in resting posture.

“‘In my business,’ Dr. Sahrmann said, ‘I have more problems with people who have excessive mobility than limited mobility.’ “The thigh socket, or ball-and-socket joint, at the top of the leg is another overworked joint in yoga. Bikram’s ‘tree pose’ requires standing on one leg and drawing the opposite foot to the top of the thigh. The point is to rotate the joint of the drawn-up leg outward as far as possible; but what looks good may not be what is best for the body.

“‘More is not always better when it comes to joints,’ said Lee Staebler, a licensed physical therapist on the North Fork of Long Island, who is studying movement impairment syndromes at the State University of New York at Stony Brook.

14 “‘Warmer tissues will yield more easily, but stretching beyond optimal limits can compromise joint tissue,’ Mr. Staebler said.

“Ligaments, tough bands of fibrous tissue that connect bones or cartilage at a joint, do not regain their shape once they are stretched out, Mr. Staebler said. A loose joint can be like a loose door hinge that prevents the door from closing tightly . . .

“Still, warnings about torn cartilage or painful wobbly joints are unlikely to keep Bikram devotees out of the saunalike studio they claim to find as pleasant as the beach.

“‘People either cringe when you describe the heat, or they come and get addicted to it,’ said Christina Ha, a New York television reporter who first took up Bikram three years ago. On her doctor’s advice, Ms. Ha has now stopped doing Birkam because she is pregnant.

“Physicians caution that exercising in heat 2 to 7 degrees above the body’s core temperature of 98.6 can be dangerous.

“Dr. Nieca Goldberg, chief of women’s cardiac care at Lenox Hill Hospital in New York, said that because of the stress that extreme heat places on the heart through the demand for increased circulation, people with medical disorders should not do Bikram yoga.

“‘If you smoke, are overweight or have high blood pressure, this is not the exercise for you,’ she said.

“Some practitioners of Bikram report dizziness, nausea, muscle weakness and cramping. Dehydration is the most probable cause, said Dr. Catherine Compito, an orthopedic surgeon specializing in sports medicine at New York-Presbyterian Hospital.

“In extreme cases, losing electrolytes through perspiration can cause cardiac arrhythmia.

“‘Your body can only tolerate so much fluid loss,’ Dr. Compito said. She added that in high heat, the normal mechanisms for restoring the body’s optimal core temperature cannot function. Evaporation cannot cool the skin. Cool air currents cannot move the hot air away from the body.

“Over time, Dr. Compito said, adherents of hot yoga may be able to condition their bodies to work out safely in the heat, but she questioned whether the practice offered any advantages over other types of exercise. For stalwart Bikram devotees, however, she recommended drinking more water than the single bottle most take to class.

“‘Drinking before, during and after is really the way to go here,’ Dr. Compito said.”

Krucoff, Carol. Insight from injury: If the practice of hatha yoga was meant to heal, why are there so many yogis getting hurt? Yoga Journal, May/Jun 2003, pp. 120-124, 203. Article available online: http://www.yogajournal.com/views/908_1.cfm.

______. Yoga does every body good. Yoga Journal, Jul/Aug 2005, pp. 64-71, 110-111.

“Injury, illness, or age can alter your asana practice dramatically, but you can still reap benefits.”

Kugler, J. Neurologische Storungen nach Yogaubungen. [Neurologic disorders following yoga exercises]. Med Klin. (West Germany), 15 Sep 1972, 67(37):1195. [In German.]

Lasater, Judith. Yogi beware: Hidden dangers can lurk within even the most familiar pose. Yoga Journal, Jan/Feb 2005, pp. 110-119.

Covers the safe practice of padmasana, paschimottanasana, marichyasana III, and chaturanga dandasana.

Lazarus, Arnold A. Psychiatric problems precipitated by Transcendental Meditation. Psychological Reports, 1976, 39:601-602.

Little, Tias. Answers the question: “I’m naturally very flexible. But a teacher once told me that flexible people are more likely to become injured than people with stiff muscles. Why is this true? If I’m naturally flexible and the asanas require flexibility, then how do I prevent injury?” Yoga Journal. Article available online: http://www.yogajournal.com/practice/753_1.cfm.

Lukoff, D., F. Lu, and R. Turner. From spiritual emergency to spiritual problem: The transpersonal roots of the new DMS-IV category. The Journal of Humanistic Psychology, 1998, 38(2):21-51.

Machander, A. R. Comments on the increase of intrathoracic pressure in the practice of pranayama. Jógová Cvicení, 1982, pp. 65-70. [In Czechoslovakian.]

Summary: “Both intrathoracic and intraabdominal pressure can be increased during yogic practice. Abhyantara kumbhaka . . . during pranayama can increase intrathoracic pressure in different degree[s], according to the technique used. The increase of thoracic pressure elevates venous pressure with consequent venous blockade and the increase of pressure both in cerebrovascular fluid and intracranially. If the breath-holding with increased intrathoracic pressure lasts 45 seconds, it causes stagnant hypoxy of the brain with metabolic changes . . . Thanks to limited venous return, minute heart volume is decreased to one-half with consequent disturbance of cardiac rhythm. Therefore the breath-holding with increased thoracic pressure is not without danger (cerebral stroke, collapse, paroxysm of epilepsy, coronary infarction).

“Pronounced increase of thoracic pressure can be caused by [the] following conditions: 1) if tension of expiratory thoracic muscles is increased after glottis is closed, 2) if uddiyana bandha is practiced incorrectly, causing abdominal press[ure], 3) if there is relaxation of diaphragm during breath-holding and increased abdominal pressure expands over it to thoracic cavity. Increased intraabdominal pressure can have negative effect also during asanas, if they are practice with longer breath-holding and with activation of expiratory muscles (e.g., mayurasana, backward bending).

“As a consequence we can state that incorrect practicing of certain yogic exercises can endanger especially disposed persons and regular incorrect practice could negatively influence even healthy people.”

Mahabir, Deolal. Yoga: Hints and cautions. Available online: http://www.mindexplorer.com/Hints%20and%20Cautions.htm.

Includes cautions regarding 1) postures that increase abdominal pressures, 2) inverted postures, 3) hypertension, and 4) low back problems.

16 Mangla, Divay. Meditation is not free from side-effects. Article available from Dr. Ananda Balayogi Bhavanani, ICYER, [email protected].

Some of the negative effects of meditation that have been noted in different scientific studie s:

Boredom, impaired reality testing Less motivation in life Relaxation-induced mild-to severe anxiety Paradoxical increases in mental tension Confusion and disorientation Feeling of being “spaced out” Depression, increased negativity, being more judgmenta l Feeling addicted to meditation Psychosis-like symptoms Appearance of hidden memories from the past, such as incest, rejection and abandonment Other adverse effects are uncomfortable bodily sensations, feelings of guilt, grandiosity, elation, destructive behavior and suicidal feelings

Manheim, Allison. Ouch! Learning from pain in my asana practice. Yoga International, Apr/May 2003, pp. 36-40.

Margo, C. E., J. Rowda, and J. Barletta. Bilateral conjunctival varix thromboses associated with habitual headstanding. American Journal of Ophthalmology, Jun 1992, pp. 726-727.

Mattio, T. G., T. Nishida, and M. M. Minieka. Lotus neuropathy: Report of a case. Neurology, 1992, 42:1636.

McCall, Timothy. Doctor’s call: Should you discuss your yoga routine with your physician? Yoga Journal, Jan/Feb 2004, p. 30.

Discusses a lot of contraindications for Yoga and the possible restriction of movement that may be necessary following injury.

McClanahan, Amrita, M.D. Yoga 911 workshop. 5th Annual Integral Yoga Teachers Conference, 30 Aug - 3 Sep, 2001, Satchidananda Ashram - Yogaville, Buckingham, Virginia. Email: [email protected].

Workshop description: As the popularity of Yoga grows, and more students are being referred to Yoga classes by their health practitioners, the possibility of an emergency health situation in your Yoga class increases. As a Yoga teacher, you can take steps to prepare for future unexpected events. This workshop will focus on some of the possible scenarios that may [arise], such as dizziness, fainting, seizure, asthma, and heart attack.

McGonigal, Kelly. Nursing an injury or illness. Article available online: http://www.openmindbody.com/nursing_an_injury.htm.

“It’s the reality of living in a physical body in a complex world: sometimes we hurt, and sometimes we are ill. Maybe your yoga practice has reduced the frequency of everyday aches or illnesses, but even the most dedicated yogis get injured or sick sometimes. Sometimes, the practice of yoga produces an injury. A yoga injury can seem like a betrayal: How could something so good have hurt us? Whether you have a mild injury caused by carelessness or

17 ambition in your yoga practice, or are recovering from an illness that makes your regular strenuous yoga practice seem like torture, write yourself an individualized yoga prescription . . .”

McKinney-Vialpando, Kaylan. Yoga injuries: The real problem. Yoga Studies, May-Aug 2003.

Meditation can damage your health. SF Weekly (San Francisco), 28 Aug 2002. Article available online: http://www.psychiatrymatters.md/index.asp?sec=mag_article&mag_id=1001&article_id=1041.

“Usually described as a technique for self-improvement and even healing, meditation is generally presented as suitable for everyone. Just as some people are allergic to penicillin, however, some people react badly to meditation. These harmful effects are not limited to one form of meditation, or to long retreats rather than short sessions, and have been known for 30 years. Adverse health effects include psychologic and physical problems ranging from muscle spasms to hallucinations, facial tics, insomnia, spacing out, anxiety, and even psychotic breakdowns. These effects have now been shown to have a physiologic basis, as blood flow to the brain is redistributed and brain neurotransmitter release alters . . .”

Miller, Tim. Answers the question: “I practice Ashtanga Yoga and have developed a very painful ache around my sit bone area. I’ve tried to bend my knees in forward bends, but this makes the pain worse. Now even walking can set off the ache. Can you suggest anything?” Yoga Journal. Article available online: http://www.yogajournal.com/practice/764_1.cfm.

Moulinjeune, [first name unknown]. Les véritables dangers du Yoga. Paper given at a conference in France, probably in the late 1960s. No further information available. [In French.]

Mulcahy, Lisa. Heal smart. Yoga Journal, Jul/Aug 2005, p. 26.

“Suffering from a pull, pain, or strain but still want to practice? It’s possible, but only if you do it right . . .” A chart is provided that outlines poses that can help or hurt when recovering from a sore hamstring attachment or a rotator cuff strain or tear.

Murphy, Michael, and Steven Donovan. Negative experiences. In Michael Murphy and Steven Donovan, The Physiological and Psychological Effects of Meditation: A Review of Contemporary Research with a Comprehensive Bibliography 1931-1996. 2d ed. Sausalito, Calif.: The Institute of Noetic Sciences, 1997, pp. 143-145.

Negative experiences reported include: For Transcendental Meditation: anxiety, confusion, depression, emotional instability, frustration, physical and mental tension, procrastination, restlessness, suspiciousness, intolerance of others, withdrawal; For meditation in general: can encourage some individuals to become more obsessive-compulsive and dwell on trivia or nonessentials; can cause anxiety, tension, anger; can precipitate a psychotic episode/schizophrenic breakdown; dissociative semi-trance states can upset some individuals; can cause body pain, insomnia, severe depression, suicide attempts, and withdrawal and concentration on the internal to the neglect of the external.

In addition to research citations, other texts that warn of the difficulties of meditation/spiritual practice and how to deal with them are cited. The latter include the Katha-Upanishad, The Collected Works of St. John of the Cross, Sri Aurobindo’s Collected Works, Aldous Huxley’s The Perennial Philosophy, and William James’s The Varieties of Religious Experience.

18 Murphy, T., and M. A. Persinger. Complex partia l epileptic -like experiences in university students and practitioners of Dharmakaya in Thailand: Comparison with Canadian university students. Psychological Reports, Aug 2001, 89(1):199-206. PMID: 11729543.

Abstract: We tested the hypothesis that individuals who frequently practice meditation within another culture whose assumptions explicitly endorse this practice should exhibit more frequent and varied experience associated with complex partial epilepsy (without the seizures) as inferred by the Personal Philosophy Inventory and Roberts’ Questionnaire for the Epileptic Spectrum Disorder. 80 practitioners of Dharma Meditation and 24 university students in Thailand were compared with 76 students from first-year courses in psychology in a Canadian university. Although there were large significant differences for some items and clusters of items expected as a result of cultural differences, there were no statistically significant differences between the two populations for the proportions of complex partial epileptic -like experiences or their frequency of occurrence. There were no strong or consistent correlations between the history of meditation within the sample who practiced Dharma meditation and these experiences. These results suggest complex partial epileptic -like experiences may be a normal feature of the human species.

Nagarkatti, Shantanu. Does meditation have detrimental effects? Article available online: http://www.behavior.net/cgi-bin/nph- display.cgi?MessageID=173&Top=172&config=meditation&uid=nC1M8.user&new=0&adm=0.

Nespor, Karel. Yoga and health. Article available online: http://www.geocities.com/health_yoga_poetry/phys.html. Dr. Nespor’s email address: [email protected].

Discusses contraindications in general and also includes an extensive section on contraindications listed alphabetically by disorder.

Oakes, Stephanie. Answers the question: “I injured my knee in a yoga class (it might be the tendons or ligaments around my knee—I can’t really tell). Since then, I’ve continued with my yoga class and golfing but have stopped running. I’m trying to be careful about putting pressure on the knee. It sometimes pops when I walk, like it’s out of joint or something. There’s no swelling and no visible change in the muscle. What should I do to heal this injury?” USA Weekend, 15-17 Nov, 2002, p. 14.

Otis, L. Adverse effects of meditation. In D. H. Shapiro, and R. N. Walsh, eds., Meditation: Classic and Contemporary Perspectives. New York: Aldine Publishing, 1984, pp. 201-208.

Palkhivala, Aadil. How to teach peace. My Yoga Mentor, Nov 2004, no. 12. Article available online: http://www.yogajournal.com/teacher/1409_1.cfm.

“. . . as teachers, we must be very careful with certain pranayama practices. Bhastrika pranayama (often known as ‘Breath of Fire’) can damage or eve n destroy the nervous system. I’ll never forget a woman who came to me for legal advice when I was practicing law. She was extremely agitated, constantly distracted, and couldn’t finish a thought or a sentence. I learned that her nervous system was burnt out from years of practicing pranayama improperly, specifically bhastrika and kapalabhati (Skull-shining breath). When an excess of pranic energy floods the nervous system, it is like a balloon that’s filled with more air than it has the strength to contain. The nervous system is shattered and severe mental trauma can result. The body must be properly prepared with years of asana (especially backbends) to safely receive and contain the power of prana.

“And there are other ways to harm our students with the practice. For instance, the nervous system is agitated by jerky movements. This includes trembling during a pose by working too hard. Remind your students that there is no virtue in holding poses too long, for the benefits quickly unravel and turn into detriments. I have heard some teachers say to their students, ‘Shake it out!’ and encourage their students to shake themselves after intense poses to release tension. This misses the point. It is far better to be still and melt the tension with awareness.”

Parr, Sandra. Yoga in a rehabilitative environment. Reaching Out with Yoga, no. 6, p. 8.

“The Millar Rehabilitation Centre in Edmonton, where I work as a contract yoga teacher, provides rehabilitation programs for a wide variety of seriously injured people and has just begun a program for fibromyalgia . . .”

Persinger, M. A. Transcendental meditation and general meditation are associated with enhanced complex partial epileptic -like signs: Evidence for cognitive kindling? Perceptual Motor Skills, 1993, 76:80-82.

Peterson, Anthony. Video yoga a health hazard. The Daily Telegraph (Australia), 28 Jun 2004, Edition 1, Page 004.

Yoga exponents are being caught out by the activity’s relaxing and low impact image with more than one in four injured during sessions.

A failure to warm up and prepare adequately for the exercise has been identified as causing the surprising injury rate.

The risks of yoga are contained in a sports injuries report to be released today.

The research, commissioned by Medibank Private, found sports injuries cost the Australian community more than $1.8 billion in the past year. The medical bill was $300 million more than the previous year.

Footballers were the most likely to be hurt and those aged between 18 and 24 were at greatest risk of breaking down.

Sports physician Dr Peter Larkins said yoga was not inherently dangerous but the injury rate showed many participants were not doing it correctly.

“You have to get the correct program and advice. There are a lot of stretching manoeuvres and maybe some are trying it at 38 thinking there are 18,” he said.

“Yoga has become the new aerobics and some people are getting it out of a book or video. Participants need to ensure that they don't overdo it, particularly when starting a new health and fitness regime”' Yesterday at Body Mind Life yoga studio in Surry Hills owner Nicole Walsh said she had not experienced the injury rate found in the survey.

She said students of Bikram yoga complete warm up breathing and stretching exercises before progressing. The increased room temperature also made injuries less frequent.

20 “I would have thought one in 10 [injured],” she said.

“It depends on the kind of injuries. Some people have old injuries and do yoga and the old injuries flare up.” The report found 5.2 million injuries were incurred on Australian sporting fields and courts in the past 12 months requiring almost 25,000 hospital admissions and 250,000 emergency department presentations.

An alarming 3.6m injuries were untreated.

Ankle, foot and achilles injuries are the most common accounting for 20 per cent of all sporting injuries.

Knee (13 per cent), back and spine (9 per cent), shoulder (8 per cent) and wrist or forearm (5 per cent) followed.

The warning from fitness experts to warm up and cool down had failed to reach the masses with only 38 per cent of survey respondents saying they regularly completed pre and post sport regimes.

Regimbeau, Charles, and Josette Regimbeau. Manuel Pratique de Gymnastique Posturale: 160 Postures dont 80 Asanas avec Leurs Indications et Leurs Contre-Indications: Le Livre Clef Du Hatha-Yoga. Paris: Maloine, 1976. [In French.]

Robin, Mel. Injuries incurred by improper yogasana practice. In Mel Robin, A Physiological Handbook for Teachers of Yogasana. Tucson, Ariz.: Fenestra Books, 2002, pp. 511-518.

Contents: Practicing yogasanas from a book, without a teacher; Being too tried can lead to injury; Being too ambitious can lead to injury; Congenital weaknesses; Specific case histories: Neurological damage, Vascular damage, Muscular damage

Rose, Tracy. The injury is the practice. Article available online: http://www.practiceashtanga.com (click on “Archived Articles”).

On the extensive number of injuries experienced by Ashtanga Yoga practitioners.

Rosen, Ellen. Trying a new sport? Sign a waiver, then hope for the best. The New York Times, 13 Aug 2005.

“Waivers of varying form and complexity are popping up everywhere, from parents like Ms. Salazar to companies offering extreme sports like heli-skiing to those running petting zoos. Even yoga centers, which promise a place of calm, often require them.

“A sample release, found at the Web site for the Yoga Alliance, states that the individual practicing yoga understands certain poses may in fact pose some risks. The waiver offers this instruction: ‘If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly . . .’”

Russell, W. R. Yoga and the vertebral arteries. British Medical Journal, 1972, 1:685.

Safe yoga. 26 Sep 2000. Article available online: http://www.zenyoga.co.uk/yoga/health.htm.

Saraydarian, H. The dangers of meditation. In H. Saraydarian, The Science of Meditation. Agoura, Calif.: The Aquarian Educational Group, 1971, pp. 198-239. (On the wrong use of meditation.)

Satyananda Saraswati, Paramahansa. People who should not do inverted poses; Inverted poses should not be done under the following circumstances. In Paramahansa Satyananda Saraswati, Health Benefits of Inverted Asanas. 2d ed. Munger, Bihar, India: Bihar School of Yoga, 1992, pp. 32-33.

______. Who should not do forward bending poses? In Swami Satyananda Saraswati, Health Benefits of Inverted Asanas. 2d ed. Munger, Bihar, India: Bihar School of Yoga, 1992, pp. 19-20.

Schenk, Stephanie. Avoiding injury (letter to the editor). The New York Times, 14 Jan 2001. Article available online: http://query.nytimes.com/search/article - page.html?res=9D04EFDB143DF937A25752C0A9679C8B63.

Schneide r, Carrie. Ouch! If yoga is such a gentle practice, why are so many people getting hurt? Yoga Journal, Jul/Aug 1999, pp. 36-43, 121. Article available online: http://www.yogajournal.com/views/287.cfm. See also follow-up letters to the editor in the Sep/Oct 1999 issue of Yoga Journal, pp. 8-9.

Schorr, Melissa. Preventing yoga injuries. Lifetime Television for Women. Article available online:

”Yoga has a reputation for being super-gentle—but that’s not always the case. Here’s how to stay injury-free.”

Schultz, Larry. Coming back from injury [or surgery] through Ashtanga. Article available online: http://www.itsyoga.net/us/articles_read.asp?id=7.

Schumacher, John. [Contraindications for] Astavakrasana. Yoga Journal, Jul/Aug 2000, p. 124.

______. [Contraindications for] Eka Pada Sirsasana. Yoga Journal, Sep/Oct 2000, p. 120.

______. [Contraindications for] Eka pada rajakapotasana. Yoga Journal, Nov/Dec 2000, p. 112.

Sethi, Sujata, Subhash C. Bhargava. Relationship of meditation and psychosis: Case studies. Australian and New Zealand Journal of Psychiatry, Jun 2003, 37(3):382ff.

Shapiro, Deane H., Jr. Adverse effects and contraindications. In the article by Deane H. Shapiro, Jr., “Overview: Clinical and physiological comparison of meditation with other self- control strategies,” American Journal of Psychiatry, Mar 1982, 139(3):270-271.

______. Adverse effects of meditation: A preliminary investigation of long-term meditators. International Journal of Psychosomatics, 1992, 39:1-4, SI:62-67.

22 Sims, Amy C. Treading into fitness trends with care. 22 Oct 2002. New York: Fox News. Article available online: http://www.foxnews.com/printer_friendly_story/0,3566,66012,00.html.

“Exercise fads infiltrate gyms faster than you can say ‘cardio strip,’ but these new routines can be dangerous for people hopping on the fitness bandwagon.

“‘Jumping on something too fast can be a mistake,’ said David Kirsch, owner of the New York gym Madison Square Club. ‘Tae Bo was once the latest and greatest craze, but where is it now?’

“Yoga is one trend that seems far from extinction. Approximately 15 million people practiced yoga in the United States, a figure that has almost doubled in the past five years, according to Yoga Journal.

“But the rush in popularity has led to some cases of novice instructors teaching the masses, according to Leslie Kaminoff, a yoga therapist who has treated many injured yoga enthusiasts.

“And as people push themselves to keep up with advanced classes, they get hurt. ‘I’ve had clients who’ve been injured by domino effect,’ he said, which happens when students fall into each other while doing inverted positions like headstands.

“He compares the yoga trend to the aerobics craze in the 1980s. ‘If you look at Jane Fonda’s first tape, it’s like, “How to injure yourself to music,”’ he said.

“But chronic injuries are more pervasive than acute ones, he said. One such chronic injury is what Kaminoff calls ‘yoga butt.’

“‘It’s a pain that starts in the butt and goes down back of the leg,’ he said. ‘It develops over time because the sequencing used in some classes involves long extended periods of time sitting on the butt . . . then twisting and bending into positions.’

“But chronic pain can come in many forms. Meyung Kim, 31, who began practicing yoga four months ago has already gotten hurt. ‘I pulled the muscle underneath my shoulder blade, performing a shoulder stand during a class,’ she said. ‘It started feeling better and I went back and now it hurts again.’

“Kim said she works out regularly, but started taking yoga at the gym to try something new. These days, people looking for the latest fad will likely come across kettlebells, a trend just hitting the U.S. . . .”

Smith, Susan J. Pregnancy Today’s advisory panel answers: What yoga positions should I avoid during pregnancy? Available online at: http://www.pregnancytoday.com/experts/posavoid.htm.

Spira, Jim. What about depersonalization/derealization [during meditation]? 11 Jun 1999. Article available online: http://www.behavior.net/forums/meditation/1998/msg114.html.

Stott, Sharon. Glaucoma, detached retina. In Sharon Stott, “Sarvangasana (shoulderstand) or candle pose,” Yoga & Health, Dec 1997, p. 21. (On contraindications for sarvangasana.)

Stovsky, Jill. Yoga during pregnancy. Available online: http:// www.babycenter.com/expert/5699.html.

23 Stretched to the limit. Dr. Andrew Weil’s Self Healing, Jun 2003, p. 1.

On the increasing number of injuries in Yoga classes.

Teutsch, Danielle. Yoga positions that pregnant women should not consider. The Sydney Morning Herald, 19 Jun 2005. Article available online: http://www.smh.com.au/news/National/Yoga-positions-that-pregnant-women-should-not- consider/2005/06/18/1119034104294.html.

“Pregnant women are hurting themselves and risking their unborn children by practising some common yoga poses, experts say.

“An informal committee including midwives and obstetricians has been set up to develop guidelines for safe practice of the popular activity.

“Royal Prince Alfred Hospital childbirth educator Enid Guthrie, who is spearheading the committee, said she had seen women with ruptured membranes, and there was a risk of miscarriage for women who did inappropriate poses.

“Mrs Guthrie said she did not let her pregnant yoga students do inversions - including the downward facing dog and shoulder stand - partly because the hormone relaxin causes the ligaments that hold the uterus to soften during pregnancy. Other "no-no" positions were intense twists, sit-ups and strong stretches.

“Mrs Guthrie said that, while she had no scientific evidence that yoga could cause miscarriage, her concern was based on her experience as a midwife, theatre nurse and prenatal yoga teacher of 13 years.

“She said many women signed up for yoga classes when they fell pregnant, thinking it was a gentle activity.

“‘It’s the women who have never done yoga before they get pregnant who I am most concerned about,’ she said.

“She warned pregnant women should not rely on yoga DVDs, unless they already knew the yoga practitioner and had been to their classes.

“Generally, they should not be doing yoga in the first trimester because of the danger of miscarriage. Women's health physiotherapist Julia Schwarz, who is also on the committee, said prenatal yoga teachers needed to have some obstetrics training to understand the particular changes in a pregnant woman's body.

“‘With pregnant women you need to be careful. You are not dealing with a normal body,’ she said.

“Ms Schwarz said women with pubic symphysitis, which causes groin pain and can occur after 20 weeks of pregnancy, should not be allowed to squat, sit cross-legged or do one-legged poses.

“She also said pregnant women with sacroiliac joint dysfunction needed to avoid lying on their backs.

24 “Prenatal yoga teacher Sally Molineaux said if women were very fit and experienced in yoga, she allowed them to do inverted poses—but only at their own risk: ‘I tell them they can only do certain poses if they take responsibility for it themselves,’ she said.

“‘I do not think women should be doing inversions and strong twists during pregnancy.’

“Sports Medicine Australia director Anita Green said anyone teaching an exercise class or yoga to pregnant women required additional expertise.

“‘Yoga is good, but it needs to be modified accordingly for each stage of pregnancy,’ Dr Green said.

“AMA’s obstetrics spokesman Andrew Pesce said there was no evidence that yoga was anything other than beneficial and safe in pregnancy. However he said women should listen to their bodies.

Specific contraindicated poses demonstrated in this article: boat pose (“can cause a miscarriage”), downward facing dog pose, shoulder stand, a seated closed strong twist, camel pose (and “other strong abdominal stretches”).

The various implications arising from the practice of Transcendental Meditation: An empirical analysis of pathogenic structures as an aid in counseling. Bensheim, Germany: (Institut fur Jugend und Gesellscaft, Ernst-Ludwig-Strasse 45, 6140): The Institute for Youth and Society, 1980.

Vogel, C. M., R. Albin, and J. W. Alberts. Lotus footdrop: Sciatic neuropathy in the thigh. Neurology, Apr 1991, 41(4):605-606.

Walker, Melanie, Gregg Meekins, and Shu-Ching Hu. Yoga neuropathy: A snoozer. The Neurologist, May 2005, 11(3):176-178. Author email: [email protected].

Abstract: Sciatic nerve compression very rarely occurs bilaterally. The authors present a woman [on psychoactive medication] with profound lower extremity weakness and sensory abnormality after falling asleep in the head-to-knees yoga position (also called “Paschimottanasana”). Clinical and electrodiagnostic findings are discussed in detail and a brief review of the literature is presented.

From the article: Exercise-induced injuries are not uncommon, but some may have dramatic consequences. Patients in high-risk categories or those who are dependent on psychoactive medications should be counseled on the dangers that might be associated with their activities . . .

The practice of yoga by a person with an altered mental status is dangerous, more so than many other exercise regimens, because sustained postures may result in nerve compression and impairment. Physicians prescribing sedative or hypnotic medications should advise patients of the risks that are associated with otherwise benign activities like yoga. This report serves to illustrate the risk of overdosing routine medications, and the dangers that heavy sedation may present. Adjustments in medication dosage or timing, such as avoidance of sedating medications immediately prior to exercise, might prevent precarious situations and lead to less exercise- induced injury. Discussing side effects of medications and establishing regular follow-up for patients taking neuroactive medications cannot be overemphasized.

25 Walsh, R., and L. Roche. The precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry, Aug 1979, 136:1085-1086.

Watt, Laura. As temps rise, so do yoga injuries, medical experts say. Seattle Post-Intelligencer, 6 May 2004.

Weiler, Linda-Christy. Yoga and contraindications. In Linda-Christy Weiler, Yoga Solutions: for Poor Posture and an Aching Back! Linda-Christy Weiler, 2001, pp. 65-72.

Topics addressed: extension/hyperextension of the neck, inversions, unsupported forward flexion, and weight-bearing poses

Westring, Jonas, and Magagie Hopson. The Biomechanics of Yoga: Understanding & Preventing Yoga Injuries workshop. Offered at Kripalu Center for Yoga and Health, www.kripalu.org. For more information about Jonas Westring, see www.ThaiYogaHealing.com.

When your practice is a pain, part 1: Yes, you can hurt yourself during yoga—here’s how to avoid injury. Article available online: http://allspiritfitness.com/library/features/aa020701a.shtml.

When your practice is a pain, part 1: Pain without gain. Article available online: http://allspiritfitness.com/library/features/aa020701b.shtml.

Williams, Cheryl. Alignment—little things mean a lot. Australian Yoga Life, 2004, no. 8, pp. 42- 44.

“The body, like the mind, can unconsciously fall into bad habits. If these habits are repeated on the yoga mat, we run the risk of aggravating injuries, or even creating new ones. But a fresh approach to our practice is often all we need to get the body and the mind into correct alignment.”

Wray, Elizabeth. Yoga matters: Esprit de core: Being flexible isn’t everything. A floppy body that lacks core strength can be easily injured. Body & Soul, Jul/Aug 20032, pp. 38-43. Article available online: http://www.bodyandsoulmag.com/show_document.asp?iDocumentID=160&iBDC=1920&iPage Number=1.

Yoga Abuse Forum. Established 30 May 2005. URL: http://p097.ezboard.com/byogaabuse.

A forum for discussing self-inflicted and teacher-inflicted injuries, injuries pertaining to specific styles of Yoga, etc. The admininstrators of this forum do not identify themselves.

Yoga and pregnancy. Available online: http://www.zenyoga.co.uk/yoga/pregnancy.htm.

Yoga injuries increasing. BBC News World Edition, 9 Sep 2002. Article available online: http://news.bbc.co.uk/2/hi/health/2245807.stm.

“. . . doctors and physiotherapists are reporting an upsurge in the number of inexperienced studients getting injuries after straining to get into difficult positions. “The British Wheel of Yoga, the governing body in the UK, has blamed a lack of properly trained instructors.

“It believes that only half the estimated 10,000 people who now teach yoga in the UK are properly qualified.

“The BWY recommends that instructors should complete a four-year training course before they start to school others in the ancient discipline.

“However, it says that some sports centres are employing trainers who have completed just a month-long course.

“The most common yoga injuries are caused by repetitive strain or overstretching and occur at the wrists, shoulders, neck, along the spine, and at the sacroiliac joint (which links the spinal column and pelvis), hamstrings, and knees . . .

“Keith Waldon, vice chair of the Society of Sports Therapists, told BBC News Online that yoga should be tightly regulated . . .”

Yoga injuries on the rise. Health24.com, 2005. Cape Town, South Africa. URL: www.health24.com.

“As the popularity of yoga rises to new heights, so are the injuries attrib uted to the ages-old practice—especially among newbies.

“Along with the surge of people practising yoga, doctors, physical therapists and chiropractors are also seeing a rise in muscle and ligament sprains, neck and back problems, and cartilage tears.

“And the trend has strengthened with the recent advent of ‘power yoga,’ a more athletic style in which participants move rapidly from one pose to another.

“Some experts say a growing number of untrained teachers may be to blame.

“An American teacher-organised group called the Yoga Alliance recommends at least 200 hours of expert training, but since there is no licensing or official certification required, untold numbers of teachers may have done little more than complete a week-end training or correspondence course.”

Yoga should heal, not hurt, says ACSM expert. Medical News Today, 8 Aug 2005.

“Yoga should heal, not hurt, according to Roger Cole, Ph.D. In his presentation at the ninth- annual American College of Sports Medicine (ACSM) Health & Fitness Summit & Exposition, Cole reviewed the injuries most often suffered by yoga practitioners and recommended ways to avoid them.

“‘Many injuries-such as those to the knees, back, neck, shoulders, wrists and ankles-occur when practitioners try to force themselves into difficult postures,’ Cole said. ‘The first rule of safety is to avoid forcing your body. Instead, practice with awareness, common sense and self-respect. Yoga is supposed to teach us not to compete or show off, but to use focused attention, conscious effort and rela xation to achieve results.’

“Cole also emphasized the importance of learning proper technique to keep safe in yoga. ‘Specific poses carry the risk of injury if you do them incorrectly. It’s easy to avoid problems if

27 you know what you are doing. For example, forcing the lotus position can damage cartilage in the knees, but you can prevent this by learning ways to redirect the force away from the knees to the hips, where it is needed.’

“In addition to the knees, bodily sites most prone to yoga injuries include the lower back, hamstring and sacroiliac, according to Cole. While the latter two are more commonly injured, problems with the knees and lower back tend to be more serious.

“‘Many common yoga injuries occur during straight-leg forward bends from a standing or seated position,’ said Cole. He recommends stretching moderately in such poses; bending from the hip joints and elongating the spine, and taking days off from these postures.”

Yoga System. Yoga practice contraindications: by yoga technique and by disease. Falls Church,Va.: Yoga System, www.yogasystem.com, 866-880-4008, 703-578-4008.

Yoshikawa, Yoko. When not to invert. Yoga Journal, Sep/Oct 2000, pp. 98, 174-177. (See also pp. 94-97 on a Yoga practitioner who suffered possible injury from long-term practice of inversions.)

Zarthoshtimanesh, Zubin. The 10 don’ts of yoga. Mid-day.com, 3 Mar 2005. Article available online: http://web.mid-day.com/news/city/2005/march/104768.htm.

Of Related Interest

Clark, Walter Houston. Fear & terror in religious experience: A theoretical commentary. Journal of Religion and Psychical Research, Apr 1980, 3:134ff.

Cohen, J. A., D. H. Char, and D. Norman. Bilateral orbital varices associated with habitual bending. Arch Ophthalmol, Nov 1995, 113(11):1360-1362.

Edell, Dean. Answers the question: “Didn’t I hear you say that bending the head back can cause a stroke?” Available online at HealthCentral.com.

Exercise, Stop, Danger: 30 Exercises to Avoid Plus 100 Safer and More Effective Alternatives. A British-Australian Fitness Leader Network Publication, 1994.

In the Autumn 1994 issue of Yoga Biomed News, Robin Monro writes: “[This book] does give sensible and valid information on the right and wrong way to exercise . . . but even though the book is addressed to aerobic or dynamic -type exercises . . . it contains exercises that bear a relationship to yoga postures [standing straight-leg toe touch, seated toe-touch, banana bends, cobra, and plow] . . . We say ‘bear a resemblance to yoga postures’ because although they may look similar, in essence they are not . . . Central to yoga practice is body and breath awareness. The mind is fully involved in every movement, and this attitude of constant, gentle vigilance provides both effectiveness and safety. The same postures practised in a mindless way in the context of aerobic and fitness groups can indeed be dangerous . . . At a time when the medical profession is at last becoming more open to alternative treatments for chronic health problems, publications of this sort which insidiously link yoga to other forms of exercise can do little to help further its cause.”

28 Green, Lauriann. Injury prevention for massage practitioners. Article available online: http://www.positivehealth.com/permit/Articles/Massage/green58.htm.

______. Save Your Hands! Injury Prevention for Massage Therapists. Fort Collins, Colo.: Gilded Age Press.

“The first comprehensive injury prevention manual written for massage therapists.”

Nagler, W. Vertebral artery obstruction by hyperextension of the neck. Arch Phys Med Rehabil, 1973, 54:237-240.

Pryse-Phillips, W. Infarction of the medulla and cervical cord after fitness exercises. Stroke, 1989, 24(6):355-359.

Smith, Timothy. Is it time to hang up your spikes? Joint and muscle strain [and the boomer generation]. Business 2.0, Jan 2002.

Xu, S. H. Psychophysiological reactions associated with qigong therapy. Chinese Medical Journal (English), Mar 1994, 107(3):230-233. PMID: 8088187.

Abstract: Qigong as a part of the traditional Chinese medicine is similar to western “meditation,” Indian “Yoga” or Japanese “Zen,” which can all be included in the category of traditional psychotherapy. A series of physiological and psychological effects occur in the course of Qigong training, but inappropriate training can lead to physical and mental disturbances. Physiological effects include changes in EEG, EMG, respiratory movement, heart rate, skin potential, skin temperature and finger tip volume, sympathetic nerve function, function in stomach and intestine, metabolism, endocrine and immunity systems. Psychological effects are motor phenomena and perceptual changes: patients experienced warmness, chilliness, itching sensation in the skin, numbness, soreness, bloatedness, relaxation, tenseness, floating, dropping, enlargement or constriction of the body image, a sensation of rising to the sky, falling off, standing upside down, playing on the swing following respiration, circulation of the intrinsic Qi, electric shock, formication, during Qigong exercise. Some patients experienced dreamland illusions, unreality and pseudohallucination. These phenomena were transient and vanished as the exercise terminated. Qigong deviation syndrome has become a diagnostic term and is now used widely in China.

Zetaruk, M. N., M. A. Violán, D. Zurakowski, and L. J. Micheli. Injuries in martial arts: A comparison of five styles. British Journal of Sports Medicine, Jan 2005, 39(1):29-33. Author email: [email protected].

Abstract: Objective: To compare five martial arts with respect to injury outcomes. Methods: A one year retrospective cohort was studied using an injury survey. Data on 263 martial arts participants (Shotokan karate, n = 114; aikido, n = 47; tae kwon do, n = 49; kung fu, n = 39; tai chi, n = 14) were analysed. Predictor variables included age, sex, training frequency (3 h/week v >3 h/week), experience (<3 years v 3 years), and martial art style. Outcome measures were injuries requiring time off from training, major injuries (7 days off), multiple injuries (3), body region, and type of injury. Logistic regression was used to determine odds ratios (OR) and confidence intervals (CI). Fisher’s exact test was used for comparisons between styles, with a Bonferroni correction for multiple comparisons. Results: The rate of injuries, expressed as percentage of participants sustaining an injury that required time off training a year, varied according to style: 59% tae kwon do, 51% aikido, 38% kung fu, 30% karate, and 14% tai chi.

29 There was a threefold increased risk of injury and multiple injury in tae kwon do than karate (p<0.001). Subjects 18 years of age were at greater risk of injury than younger ones (p<0.05; OR 3.95; CI 1.48 to 9.52). Martial artists with at least three years experience were twice as likely to sustain injury than less experienced students (p<0.005; OR 2.46; CI 1.51 to 4.02). Training >3 h/week was also a significant predictor of injury (p<0.05; OR 1.85; CI 1.13 to 3.05). Compared with karate, the risks of head/neck injury, upper extremity injury, and soft tissue injury were all higher in aikido (p<0.005), and the risks of head/neck, groin, and upper and lower extremity injuries were higher in tae kwon do (p<0.001). No sex differences were found for any of the outcomes studied. Conclusions: There is a higher rate of injury in tae kwon do than Shotokan karate. Different martial arts have significantly different types and distribution of injuries. Martial arts appear to be safe for young athletes, particularly those at beginner or intermediate levels.