Yoga-Related Injuries in the US 2001-2014

Yoga-Related Injuries in the United States From 2001 to 2014 – Orthopaedic Journal of Sports Medicine, November 2016 – free full-text NIH article

This long article details the injuries yoga participants are prone to and warns that people aged 65 and older suffer 5 times as many injuries as those aged less than 45.

The CDC’s recommendation of this practice as a “treatment” for chronic pain does not take into consideration the injury rate and further recommends that painful injuries not be treated with effective medication (opioids).

This should make all older pain patients wary.  

Background: Yoga has become more popular among people in the United States and has been touted by both yoga participants as well as some physicians and researchers for its health benefits.

While the health benefits have been studied, the frequency of injury among yoga participants has not been well documented.

Results: There were 29,590 yoga-related injuries seen in hospital emergency departments from 2001 to 2014.

The trunk (46.6%) was the most frequent region injured, and sprain/strain (45.0%) accounted for the majority of diagnoses.

The injury rate increased overall from 2001 to 2014, and it was

  • greatest for those aged 65 years and older (57.9/100,000)
  • compared with those aged 18 to 44 years (11.9/100,000) and
  • 45 to 64 years (17.7/100,000)

in 2014.

Conclusion: Participants aged 65 years and older have a greater rate of injury from practicing yoga when compared with other age groups. Most injuries sustained were to the trunk and involved a sprain/strain.

While there are many health benefits to practicing yoga, participants and those wishing to become participants should confer with a physician prior to engaging in physical activity and practice only under the guidance of certified instructors.

The practice of yoga has become increasingly commonplace in American society, with the number of participants nearly doubling from 5.1% to 9.5% of adults in the United States from 2007 to 2012

Yoga is an encompassing activity and can refer to an array of physical and mental activities, including stretching, physical postures, breath control, and meditation.12 Yoga is touted for its overall health benefits and mental well-being; participants indicate indirect health benefits through improved physical fitness and reduced stress as well as direct health benefits such as reduced back and neck pain, arthritis, and anxiety.

Recently, there have been a number of studies that sought to compare outcome measures and burdens of various diseases while incorporating yoga as complementary therapy. For example

a review article of 13 nonrandomized and 12 randomized controlled trials of patients with type 2 diabetes found that the practice of yoga promoted significant improvements in glycemic control, lipid levels, and body composition

Yoga has been shown to improve depression, anxiety, and sleep disturbance among pregnant women as well as improving fatigue and depression among breast cancer patient

Yoga has improved arrhythmia burden, heart rate, and blood pressure among patients with atrial fibrillation

Additionally, yoga has been shown to improve outcomes for stroke patients as well as those with chronic neck and back pain

For older individuals, a lack of balance and falling can indicate a physical decline; however, yoga has been shown to improve balance and self-perception of falling

According to the National Institutes of Health, yoga is safe for healthy individuals when practiced with a well-educated instructor; however, caution is given that adverse effects can occur, including nerve damage and even stroke

In an Australian national survey, 78.7% of respondents reported never having been injured while practicing yoga, and among those who did report injuries, many were strains or related to injuries that occurred more than 12 months prior

A survey of more than 1300 yoga teachers worldwide indicated that the most frequent injuries occurred to the neck, lower back, knee, shoulder, and wrist, and the most common causes were poor technique, poor instruction, previous injury, and excess effort

When examining the risks and benefits of yoga as an alternative therapy for osteoporosis and spinal movement in aging adults, it was found that moderate flexion and extension was beneficial; however, caution is given that therapy should be individualized, as bone density can differ and some yoga positions can be damaging

A case series of yoga-related injuries from 1991 to 2010 at a single hospital emergency department in Canada found that 73% of cases were seen after 2005, showing that the number of injuries is increasing.

While the practice of yoga is beneficial for many regardless of health status, the possibility of injury due to the practice still exists. Additionally, the incidence of yoga injuries in the United States is not well characterized. The purpose of this study was to determine the number of yoga-related injuries in the United States from 2001 to 2014 seen by emergency departments and describe injury characteristics so the risk of injury involved in participating in yoga is established.

Discussion

The incidence of yoga-related injuries increased from 2001 to 2014. Of note, the analysis indicates that injury rates increased 8-fold for those aged 65 years or older; the injury rate among those 18 to 44 years only increased fractionally and doubled among those 45 to 64 years during this period

While lack of technique and experience could explain some of the increase in injury incidence

The results suggest that regardless of technique and experience, people older than 44 years, and especially those older than 65 years, are at greater risk of injury associated with practicing yoga.

The high rate of injury among those 65 years or older could be explained by biological changes induced through aging.

Since there was an increase in incidence of injury among all age groups from 2001 to 2014, factors besides aging must also be present. One potential cause for the increase is lack of qualified instructors

With an increase in the number of yoga participants, there has been increased need for instructors; according to a 2015 article, there are more registered yoga instructors than ever before, even more than needed by the industry.1 With the increase in both the number of certified instructors and injuries it would seem that there is a potential lack of appropriate education even for certified instructors.

Although one should participate in yoga at a well-known studio with qualified instructors, more important, an individual should not engage in poses that they feel are beyond their physical limitations

This study is limited in that the cases were estimates of individuals who sought treatment only at emergency departments

Due to this, estimates are likely lower than the total number of yoga-related injuries occurring in the United States since treatment could have been sought elsewhere

Additionally, since older individuals are more likely to have severe injuries associated with yoga and therefore need emergency help, their rate of injury when compared with younger age groups is likely elevated

Yoga is a safe form of exercise with positive impacts on various aspects of a person’s health; however, those wishing to practice yoga should be cautious and recognize personal limitations, particularly individuals 65 years and older. National standards for yoga instructor certification should be created and should more aggressively teach information about safety and injury prevention.

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