FROM THE NEW YORK TIMES ARCHIVES

YOGA: RISKS AND BENEFITS

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Yoga After 50By KELLY COUTURIER

May 1, 2013

While many yoga classes across the country seem to cater to the youthful enthusiast who

wants to sweat his or her way through an hour-and-a-half workout, a growing number of

longtime yoga devotees are raising questions about the best way to safely continue a yoga

practice into midlife and beyond.

“I suspect that yoga was at times an old person’s sport, and that it has prolonged the

life and liveliness of people over the millennia,” said Dr. Loren Fishman, a back-pain

specialist in Manhattan who uses yoga in his rehabilitation practice and has written

extensively about yoga as an adjunct to medical treatment.

“Designed appropriately and taken in proper dose,” he said, “it is certainly safe.”

Carrie Owerko, a New York-based teacher of Iyengar yoga who has been a yoga

student for decades, agreed. “Yoga can be practiced fully and deeply at any age,” she

said, with an added caution that “the practice has to change as the body changes.”

Dr. Fishman noted that aging brings impairments of range, motion, strength and

balance that can require modifications, even among veteran yogis, like using the support

of a chair or the wall for many poses. In addition, students may begin to feel the effects of

arthritis, injuries and other ailments that may require students skip certain poses

altogether.

Someone with osteoporosis, for example, may want to avoid headstands and poses

requiring extreme spinal flexion or extension, while someone with glaucoma may want to

avoid taking the head below the heart in poses like headstand, handstand, shoulder stand

and standing forward bends. When in doubt about the safety of practicing with any

specific medical condition, Dr. Fishman recommended working with a doctor.

Generally speaking, a warm-up sequence is important for the veteran yogi, Ms.

Owerko said. “Our bodies may need more time to warm up properly, especially if we are

experiencing stiffness or arthritic changes in the joints or in areas that may be more

vulnerable to previous injuries,” she said.

It is also important to include various one-legged standing poses — Tree Pose or

Eagle Pose are examples — that challenge one’s ability to balance, even if you need the

support of the wall, Ms. Owerko said. Weight-bearing poses, like Plank Pose and

Forearm Plank, and standing poses like Warrior pose variations, are also important to

help counteract the decline in muscle mass and strength as we age, she said.

To help maintain flexibility, poses like standing or seated forward bends and hip

openers, like Bound Angle Pose or Pigeon Pose, are also important, said Roger Cole, a

longtime Iyengar yoga teacher and psychologist in San Francisco.

Mr. Cole emphasized that a regular yoga practice can help the body maintain a high

level of flexibility into midlife and beyond. If a student continues the same practice as

much as possible without interruption through the 50s and beyond, he or she will see a

gradual decline in certain abilities, but not necessarily a decline in flexibility, he said.

“I think the average person probably does get stiffer as they age,” he said, “but I

believe that it’s mainly because they stop doing the things that keep them flexible.”

The passage of more and more baby boomer yogis, teachers as well as students into

and past middle age has sparked interest in creating a new kind of peer yoga community

as well.

Desirée Rumbaugh, a longtime yoga teacher who passed the 50-year mark a few

years ago, started a class in Del Mar, Calif., aimed at yoga veterans 50 and over. Called

Wisdom Warriors, it was intended to offer veteran yogis the chance to keep learning in an

environment that is comfortable and encouraging.

“People want to be pushed, but not in the same way they did in their 30s,” she said.

“They want a little slower pace.”

Slower pace or not, Ms. Rumbaugh includes a full range of poses in her classes,

including backbends and inversions. A recent Wisdom Warriors workshop, presented by

Ms. Rumbaugh and Cyndi Lee at the Yoga Journal Conference in New York in April,

would have been a vigorous day of yoga for students of any age.

Debra Hodgen, 61, of Vista, Calif., is a student in Ms. Rumbaugh’s class. A former

dancer, she said that she began a consistent yoga practice when she was 48. She said she

has become “stronger and more fearless” as a result of the class, despite having

osteoarthritis, no cartilage in her right knee and joint pain throughout her body.

“I may have trouble just sitting in simple cross-legged pose, but I did full Monkey

Pose recently,” she said.

The most important way a seasoned student will be able to continue to practice

safely, many teachers say, is to listen to signals their body sends them in class, and know

when to back off.

“In my experience, older students often bring a mature wisdom to the practice,” said

Ms. Owerko, who turned 51 this week and has for many years attended an advanced yoga

retreated for women over 40. “They have lived long enough to have a sense of humor

about themselves. And they are often more compassionate toward themselves and other

students.”

Opinion: Wounded Warrior PoseBy WILLIAM J. BROAD

December 22, 2012

Men are famous for ignoring aches and pains. It’s macho. Men get physical exams less

often than women. They tend to remain silent if worried about their health. When hurt,

their impulse is to shun doctors and rely on home remedies, like avoiding heavy lifting to

ease backaches. Male athletes play through injuries. It’s all about virility and manliness.

The stereotype has exceptions, of course. But denial of injury and ill health — from

the relatively inconsequential to the grave — is common enough that physicians seek

ways to encourage men to be more forthcoming.

So it pays to listen carefully when guys start talking about intolerable pain and

upended lives. Doing so led me to an unexpected finding that I have confirmed in a trove

of federal data. It suggests that yoga can be remarkably dangerous — for men.

Guys who bend, stretch and contort their bodies are relatively few in number,

perhaps one in five out of an estimated 20 million practitioners in the United States and

250 million around the globe. But proportionally, they are reporting damage more

frequently than women, and their doctors are diagnosing more serious injuries — strokes

and fractures, dead nerves and shattered backs. In comparison, women tell mainly of

minor upsets.

Men who are breaking the code of silence are doing so with physicians in hospital

emergency rooms, who in turn report their findings to the federal government.

Their outspokenness reveals much about modern yoga and suggests ways it can be

made safer. As a practitioner since 1970, I know some of the guy hazards personally and

have learned through painful experience how to live with my inflexible body.

The male disclosures help explain one of the central mysteries of modern yoga —

why it is largely a feminine pursuit. As Yoga Journal, the field’s top magazine, put the

question: “Where Are All the Men?”

Science has long viewed the female body as relatively elastic. Now the new

disclosures suggest that women who tie themselves in knots also enjoy a lower risk of

damage. It seems like common sense.

Surprisingly, evidence of the male danger has, to my knowledge, never before been

made public. Nor has its flip side — that women seem less vulnerable. The subject of

male risk merits discussion if only because the booming yoga industry has long targeted

men as a smart way to expand its franchise.

Informal observations hint at possible explanations. Yoga experts say women tend

to see classes as refuges while men see challenges — their goal at times to impress the

opposite sex.

Women say men push themselves too far, too fast. Men admit to liking the intensity

but say the problem is pushy teachers who force them into advanced poses while urging

them to ignore pain.

I stumbled on the issue after my book, published in February, laid out a century and

a half of science and, in its chapter on injuries, contradicted the usual image of yoga as

completely safe. The yoga establishment makes billions of dollars by selling itself as a

path to healthy perfection. Predictably, it responded with sharp denials.

I also received a surprising number of moving replies from injured yogis — male

and female — including stroke victims.

A letter initiated my inquiry. In April, a man told how an agonizing back injury had

turned his life into “a living hell.” Too many instructors, he wrote, are “pushing us too

hard and having us do dangerous poses.”

The “us” resonated.

Suddenly, I realized his cry sounded familiar.

I raced through a correspondence file and saw that many of the letters about serious

damage had come from men.

Tara Stiles, a yoga teacher who runs a popular studio in Manhattan, told me that

guys have more muscle (one reason for their relative inflexibility) and can thus force

themselves into challenging poses they might otherwise find impossible. It seemed a

plausible explanation for blinding pain.

Other teachers echoed her analysis and cited supporting anecdotes.

Yoga poses are unisex. But in my research, I found a world of poorly known

information on gender disparity.

“Science of Flexibility,” by Michael J. Alter, explained how the pelvic regions of

women are shaped in a way that permits an unusually large range of motion and joint

play. In yoga, the pelvis is the central pivot for extreme bending of the legs, spine and

torso.

In June, I turned to the Consumer Product Safety Commission and its National

Electronic Injury Surveillance System, which monitors hospital emergency rooms. In

July, officials sent me 18 years of annual survey data that summarized the admission

records for yoga practitioners hurt between 1994 and 2011, the maximum available span.

First, I needed a baseline that would let me compare the guy admissions to males

doing yoga in the United States. Figures in the yoga literature described men as making

up some 10 percent of practitioners at the beginning of the period and 23 percent at the

end. So the middle ground seemed to be roughly 16 percent.

Then I dug into the medical data. The analysis took weeks, but the results spoke

volumes.

If men were getting hurt in proportion to their numbers, the rate of injury would

have been about 16 percent — my estimate for the fraction of practitioners who were

male. But the rate was higher. Over all, I found that men accounted for slightly more than

24 percent of the admissions to hospital emergency rooms.

To deepen my analysis, I focused on specific injuries, especially ones inside the

body. Guys, it turned out, accounted for 20 percent of the torn muscles and damaged

ligaments, which result in swollen joints. Dislocations of the knee, shoulder and other

joints came in at 24 percent.

The figure for broken bones and fractures was 30 percent. The injury sites ranged

from the toe to the tibia, the bigger of the two bones in the lower leg.

For nerve damage, which can result in pain and lost muscle control, the male figure

jumped to more than 70 percent. The cases included sciatica, where compression of a

spinal nerve in the lower back can result in pains that race down the back, hip and leg.

I found the trend in women’s admissions to be just the opposite. The major injuries

were few proportionately, and the minor traumas quite abundant. Women, for instance,

accounted for a vast majority of the fainting episodes.

None of this means that women go unharmed, as my letter files and the admission

records show. But men seem to get it worse.

In August, I shared my analysis with Loren M. Fishman, a doctor in Manhattan who

uses yoga in his rehabilitation practice and whom I profile in my book. “It’s men’s

strength turning against them,” he remarked.

Some yoga practitioners will surely see my analysis as unconvincing. That’s O.K.

It’s the kind of topic that can only benefit from thorough discussion — as well as rigorous

new studies that can rule out the possibility of false clues.

Skeptics may argue that the injured guys are simply wimps who are inflating the

male-injury figures.

That seems unlikely. A new book, “Hell-Bent,” by Benjamin Lorr, evokes the

contrary ethos in its subtitle: “Obsession, Pain, and the Search for Something Like

Transcendence in Competitive Yoga.”

Happily, the field is evolving in ways that may enhance safety.

All-male classes, by definition, avoid the flexibility gap between women and men

and instead play to masculine strengths. The classes tend to emphasize muscle building

and fitness moves like squats, as well as poses. Their developers tend to avoid talk of

injuries, a marketing no-no.

The styles include YoGuy (“be comfortable”) and Broga (as in bro yoga, “where it’s

O.K. if you can’t touch your toes”). A number of studios offer what they call yoga for

dudes.

I’m a yoga enthusiast, not a basher. I do my routine every day and want the practice

to thrive — but to do so honestly, with public candor about its real strengths and

weaknesses.

From reader mail, I know that many yogis are working hard to make the practice

safer. The male risk factor seems an important consideration in the redesign of poses and

routines. And I’m sure instructors of mixed classes will find many ways of reducing any

danger. A first step would be frank discussions with students.

In time, it seems likely that the myth of perfection will give way to the reality of

better yoga — for everyone, including guys.

(William J. Broad is a science reporter for The New York Times and the author of “The

Science of Yoga: The Risks and the Rewards.”)

It’s Not Too Late to Become a YogaBelieverBy JANE E. BRODY

February 20, 2012

One morning, a well-meaning swimming buddy called out for all in the Y locker room to

hear: “I can’t believe Jane Brody doesn’t do yoga!”

She was right: I didn’t do yoga and, not knowing what it might offer me, I was loath

to try it. I also feared that the meteoric growth of yoga had outpaced the training of

quality teachers able to protect my aging body parts.

Now, it seems, my thinking and schedule may be due for a change. After reading

my colleague William J. Broad’s new book, “The Science of Yoga,” and observing a

class at my local Y, I see there may be a lot more to this centuries-old activity, more to its

benefits and its risks, than I had ever imagined.

And if the science recounted in this book is correct (knowing Mr. Broad, I have

every reason to think it is), my creaky joints and muscles may reap some important

rewards from an individualized yoga prescription. I’m especially concerned about my

back, which is riddled with narrowed vertebral spaces and prone to spasms and sciatica.

Mr. Broad said decades of yoga have helped protect his back from excruciating pain

initially caused by a ruptured disc. Yet in 2007, even he succumbed to a yoga-induced

back injury as he was coming out of a pose called the Extended Side Angle.

“Recovery took weeks,” he wrote. “But the humbling experience gave me a deeper

appreciation for yoga safety.”

Not all yoga poses are beneficial or safe for everyone, and enthusiasts are hard put

to know whether the teacher and class they select are more likely to help than to hurt

them.

What I need is yoga therapy, and I can only hope to benefit from it if the teacher is

well-qualified. And therein lies the rub.

As I learned from Mr. Broad’s book, “the United States has no regulatory body for

yoga therapy. The field is, on the whole, completely unlicensed and unregulated. There is

no such thing as a Registered Yoga Therapist. Applicants for registration usually face no

requirements to establish their education credentials, to pass national exams or to show

other evidence of expert proficiency. Registration, in short, bears no comparison to the

rigorous world of health-care certification.”

Anyone who chooses to can hang out a shingle and call himself a yoga therapist.

Licensing requirements exist for beauticians and hairdressers, but not for yoga therapists.

The Yoga Alliance, a national organization for yoga in the United States, fills in this

gap with specific training standards that, if met, earn the title registered yoga teacher. The

standards involve either 200 or 500 hours of instruction and supervised practice, with

specialized training for children’s and prenatal yoga.

To be sure, the yoga world is rife with true believers, many of whom bombarded

Mr. Broad with complaints about an article he wrote in The New York Times Magazine

last month chronicling a raft of devastating yoga-induced injuries. But he was also

deluged with dozens of personal injury stories that included strokes and ruptured discs.

Among them was that of a 39-year-old man who said in an e-mail that he’d “always

been very active,” having “skied, boxed, climbed, surfed, etc.” The man began practicing

yoga in 2000 and said he reveled in the meditative aspects of it, in contrast to his more

“brutal sports.”

Then, in 2010, he enrolled in a new class and developed “severe spinal stenosis”

with debilitating back spasms when the teacher “literally forced me into maintaining an

extremely painful Downward Dog.” This is a classic pose in which hands and feet are flat

on the floor, knees are straight (though not locked) and the body is bent at the waist at a

right angle.

In a more serious injury resulting from the Downward Dog, a woman in

Washington, D.C., suffered a spinal cord infarction, a blockage that caused sudden leg

paralysis. She has since regained only partial use of her legs.

Mr. Broad concluded, based on his research, that the benefits of yoga

“unquestionably outweigh the risks. Still, yoga makes sense only if done intelligently so

as to limit the degree of personal danger.”

Thus, it is critical to choose your class and teacher carefully. Grace Grochowski, a

registered yoga teacher at my local Y who has been teaching for 20 years, recommends

that prospective students ask about an instructor’s formal training, tell him or her what

they hope to get from the discipline and report any injury, ache or health condition that

might affect their participation.

The teacher should be willing to suggest changes in the moves you attempt or even

say that the class may not be right for you.

“A good teacher listens and makes appropriate suggestions,” Ms. Grochowski said.

Though her popular class is large, she regularly walks among the participants, correcting

and modifying their poses and suggesting alternatives.

Most important, Randi Baker, one of her students, told me, is to “never go for the

burn. If something hurts, don’t do it.”

Many of the oft-touted virtues of yoga have yet to be established in well-designed

clinical trials, Mr. Broad wrote, and some popular claims have been shown to be bogus,

like the belief that yoga breathing suffuses the body with extra oxygen or that it revs up

metabolism and can foster weight loss. (Yoga actually slows metabolism, though its

relaxing effect may reduce stress-related eating.)

Good scientific studies, including many supported by the National Center for

Complementary and Alternative Medicine, an arm of the National Institutes of Health,

have demonstrated that regular yoga practice can improve cardiovascular risk factors like

elevated blood pressure, blood sugar, blood cholesterol and clot-inducing fibrinogen, and

it can raise blood levels of protective antioxidants.

Yoga was shown to improve balance in elderly women and thus may reduce their

risk of falls, a leading cause of injury-related death in older people. And, I was pleased to

learn, perhaps by enhancing blood flow and the production of growth factors, yoga can

counteract the deterioration of spinal discs, a plague of millions of Americans, young and

old.

Possibly through its stimulation of the vagus nerve, yoga appears to counter

inflammation throughout the body, and may reduce the effects of diseases like lupus and

rheumatoid arthritis. And by relieving physical and mental stress, which can erode the

tips of DNA, which are called telomeres and program cell death, yoga may slow

biological aging and prolong life.

A more immediate benefit, to which Mr. Broad devotes an entire chapter, is yoga’s

apparent ability to revitalize a person’s sex life by producing surges in sex hormones and

the brain waves associated with sexual arousal. Just don’t try to act on this stimulation in

class.

Yoga’s Stress Relief: An Aid forInfertility?

Tracy Toon Spencer teaches yoga to Jessica Tabibnia, left, and Kimberly Soranno, at the N.Y.U. Fertility

Center. (Michelle V. Agins/The New York Times)

By CATHERINE SAINT LOUIS

February 4, 2011

Kimberly Soranno, a 39-year-old Brooklynite undergoing an in vitro fertilization cycle as

part of her quest to become pregnant, had gone to her share of yoga classes, but never one

like that held on a recent Tuesday night in a reception area of the New York University

Fertility Center. There were no deep twists or headstands; just easy “restorative” poses as

the teacher, Tracy Toon Spencer, guided the participants — most of them women

struggling to conceive — to let go of their worries.

“Verbally, she brings you to a relaxation place in your mind,” Mrs. Soranno said,

adding, “It’s great to do the poses, get energy out and feel strong. But the most important

part for me was the connection to the other women.”

Besides taxing the mind, body and wallet, infertility can be lonely. Support groups

have long existed for infertile couples, but in recent years, “yoga for fertility” classes

have become increasingly popular. They are the latest in a succession of holistic

approaches to fertility treatment that have included acupuncture and mind-body programs

(whose effectiveness for infertility patients is backed by research); massage (which

doesn’t have specific data to support it); and Chinese herbs (which some say may be

detrimental).

No study has proved that yoga has increased pregnancy rates in infertility patients.

But students of yoga-for-fertility classes say that the coping skills they learn help reduce

stress on and off the mat. For many, it’s a support group in motion (or lotus).

“As important as the yoga postures was the idea that women could come out of the

closet with their infertility and be supported in a group,” said Tami Quinn, the founder,

with Beth Heller, of Pulling Down the Moon, a company with holistic fertility centers in

Chicago and the Washington area. “If you say come to my support group, women going

through infertility are like, ‘I don’t need some hokey support group’ or ‘I’m not that bad.’

But with yoga they are getting support and they don’t even realize it.”

Holly Dougherty, 42, didn’t want to talk about her drug-infused slog through

fertility treatment that began seven years ago. “I didn’t tell anyone,” said Ms. Dougherty,

with the exception of her parents.

This changed after she started going to yoga-for-fertility classes taught by Ms.

Spencer at World Yoga Center in Manhattan in 2005. The gentle poses helped take her

mind off her setbacks, and each week, she found the community that she hadn’t realized

she needed.

“Being able to open up in a safe environment with support and encouragement of

others on the journey, everyone became each other’s cheerleader,” said Ms. Dougherty,

now a mother of two who still socializes with students from Ms. Spencer’s class. “I

learned to become so open about it.”

Smoking, alcohol, caffeine and some medications can hurt fertility, as can being

overweight or underweight, said Dr. William Schoolcraft, a medical director of the

Colorado Center for Reproductive Medicine, whose main branch is in Lone Tree. As for

improving one’s chances with massage, diet or yoga? “That’s where the data gets

murkier,” he said.

“We will never promise that you will get pregnant by doing yoga,” Ms. Quinn said.

“We can tell you many women who have done yoga have gotten pregnant. But there’s no

clinical data supporting the fact that yoga increases conception rates. The last thing we

would want to do is give false hope.”

Stress, however, has been shown to reduce the probability of conception. Alice

Domar, who has a Ph.D. in health psychology and is the director of mind-body services at

the Harvard-affiliated center Boston IVF, said of yoga: “It’s a very effective relaxation

technique, and a great way to get women in the door to get support. It’s a way to get them

to like their bodies again.”

A handful of prominent medical centers have partnered with yoga teachers to offer

classes. Pulling Down the Moon now holds its $210 six-week Yoga for Fertility programs

at Fertility Centers of Illinois in Chicago (since 2002), and Shady Grove Fertility in the

Washington area (since 2008.)

Recently, Dr. Domar, a psychologist whose research has shown that participation in

a mind-body program can positively affect fertility, joined with Ms. Quinn and Ms.

Heller to take wellness programs, including yoga and acupuncture, to infertility clinics

nationwide. They have formed a new company, Integrative Care for Fertility: A Domar

Center, and plan to open seven branches this year.

In 2009, the New York University Fertility Center in Manhattan brought in two

yoga instructors to help patients. “We really do push it,” Dr. Frederick Licciardi, a

founding partner of the center, said of its wellness programs that include mind-body work

and acupuncture along with yoga. “We put it up front. We know they are doing it

anyway. We want to show we are supportive that they are doing it.”

Some infertility clinics advise patients not to do vigorous exercise like running for

fear of twisting their drug-stimulated enlarged ovaries. (This excruciating condition,

called torsion, is rare, but surgery is often required if it happens with the possibility of

losing the ovary, said Dr. Brian Kaplan, a partner at the Fertility Centers of Illinois, who

advises his patients to limit exercise while taking stimulating drugs.)

But Dr. Domar, the executive director of a namesake center for mind-body health in

Waltham, Mass., has found that some women are loath to give up their daily anxiety-

relieving run during infertility treatments, or are “freaked out about gaining weight on

fertility drugs.” In some cases, yoga is her bargaining chip. She tells those patients, “you

can do hatha yoga and stay fit and toned, and give up your run.”

Ms. Spencer explained in an e-mail that for many patients, “There is a feeling of

walking on eggshells and also that one false move may throw off the chances of success.”

A class like hers lets them move and blow off steam, students said. “It’s like a can of

worms,” she said in an interview. “You can’t stop women from talking to one another.”

But the relief can be quiet as well. Elaine Keating-Brown, 38, an elementary-school

teacher in Manhattan who is in her last trimester after in vitro fertilization, found the yoga

classes she took with Laura O’Brien, then at N.Y.U., helped her silence a tireless negative

voice in her head. Her fertility-related worries felt endless, from “What happens if it

doesn’t work?” to “financially, it’s not exactly cheap,” Mrs. Keating-Brown said.

But “once you’re in the yoga room, you haven’t got all that anymore,” she said,

“you’re concentrating on you, and put those thoughts aside, put your body in a good

place, and come out of class feeling a real feeling of relaxation and it’s going to be O.K.

If it isn’t, it isn’t.”

Lori, a 32-year-old management consultant who asked that only her first name be

used for privacy, lived with “the chatter in the back of her mind” so constantly after

losing twins and suffering two miscarriages that she named that voice Constance in a

yoga class she took at Pulling Down the Moon. After learning meditation techniques in

class, Lori, the mother of a newborn, said she could observe, but not succumb to her

negative thoughts. “I’m aware I feel that way,” she can tell herself when an anxious

thought surfaces, “but I’m not going to let it overwhelm me right now.”

Medical acceptance of yoga as a stress reliever for infertility patients is slowly

growing. In 1990, when Dr. Domar first published research advocating a role for stress

reduction in infertility treatment, “I wasn’t just laughed at by physicians,” she said. “I was

laughed at by Resolve, the national infertility organization. They all said I was

perpetuating a myth of ‘Just relax, and you’ll get pregnant.’” At the last meeting for the

American Society for Reproductive Medicine, Dr. Domar, now on the national board of

Resolve, gave multiple talks, including one about how to help the mind and body work

together in infertile couples.

Yoga and Stretching Equally Effectivefor Back PainBy ANAHAD O’CONNOR

October 24, 2011

Weekly yoga classes relieve symptoms of low back pain about as well as intense, regular

stretching sessions, a new study shows.

The research found that yoga and stretching were equally effective in easing chronic

back pain and improving function, but participants had to practice each regularly to see

benefits. The subjects in both groups took weekly 75-minute classes and practiced yoga

or deep stretching at home for about 20 minutes at a time at least three days a week.

The study is the largest and most thorough to date to look at whether yoga has an

effect on chronic low back pain, a problem that affects millions and has no surefire long-

term remedy. A number of earlier studies suggested that regular yoga classes might

benefit back pain sufferers, though most were limited by small sample sizes, short study

periods and other flaws.

The latest study, published in The Archives of Internal Medicine, involved more

than 200 people who were followed for up to 26 weeks.

“This is good news for yoga,” said Karen J. Sherman, lead author of the study and

senior scientific investigator at Group Health Research Institute in Seattle. “The smaller

studies which hinted that yoga might be helpful all had problems one way or another.

This is a much larger study, and the findings are robust.”

About four out of five people experience low back pain at some point in their lives,

prompting Americans to spend $50 billion a year on medications, physical therapy and

related costs. Exercise, and in particular strength-training routines that develop muscles of

the trunk and core, can help reduce pain and improve function, though many people avoid

them for fear of doing further harm.

To find out whether the movements and static poses associated with yoga could

make a difference, as earlier research had suggested, Dr. Sherman and her colleagues

recruited 228 people with chronic low back pain in the Seattle area. Their mean age was

in the late 40s to 50, and they were randomly assigned to one of three groups. One group

took weekly yoga classes over 12 weeks, which typically included breathing exercises, 5

to 11 postures and guided deep relaxation. Another group went to weekly stretching

classes built around aerobic exercises, deep stretches and strengthening exercises focused

on the trunk and leg muscles. Both groups were given handouts and instructional CDs

and DVDs and asked to practice 20 minutes at home on days when there was no class.

Those in the third group served as “self-care” controls and received a book containing

advice on back exercises and ways to reduce pain.

After 12 weeks, those in the yoga group were, over all, significantly less bothered

by symptoms than the control group, and they reported better function and less difficulty

in mundane daily activities like walking up stairs and bending down to put on socks. The

improvements remained when the researchers checked with them 26 weeks after the start

of the study. Those in the stretching group saw just as much benefit as the people taking

yoga. More than half of the subjects in each group improved on measurements of

function by at least 50 percent, compared with less than a quarter of the controls.

“Compared with self-care, yoga and stretching class participants were significantly

more likely to rate their back pain as better, much better or completely gone at all follow-

up times,” the study noted. “More participants in the yoga and stretching groups were

very satisfied with their overall care for back pain.”

Dr. Sherman said that like many other therapies for low back pain, yoga probably

would not work for everyone. For those who want to try, a weekly class and a few 20-

minute sessions at home might be a good starting point, she said.

“Does everybody need to practice at least 20 minutes a day three times a week? It

probably depends on your back pain,” she said. “At a certain point in time you learn what

your back needs.”

As an alternative to yoga, stretching may be a viable option. Dr. Sherman

recommended taking an intensive stretching class, then establishing a routine at home.

But she cautioned that her study looked specifically at deep stretching that is far more

involved than the brief, light stretches most people do before or after a workout.

“It’s not like stretching each leg for 30 seconds,” she said. “It’s much more

intensive. You might spend two minutes stretching each leg before moving on and

stretching other parts of the body, so you’re really getting in there.”

Ancient Moves for Orthopedic ProblemsBy JANE E. BRODY

August 1, 2011

With the costs of medical care spiraling out of control and an ever-growing shortage of

doctors to treat an aging population, it pays to know about methods of prevention and

treatment for orthopedic problems that are low-cost and rely almost entirely on self-care.

As certain methods of alternative medicine are shown to have real value, some

mainstream doctors who “think outside the box” have begun to incorporate them into

their practices.

One of them is Loren Fishman, a physiatrist — a specialist in physical and

rehabilitative medicine affiliated with NewYork-Presbyterian/Columbia hospital. Some in

the medical profession would consider Dr. Fishman a renegade, but to many of his

patients he’s a miracle worker who treats their various orthopedic disorders without the

drugs, surgery or endless months of physical therapy most doctors recommend.

Many years ago, I wrote about Dr. Fishman’s nonsurgical treatment of piriformis

syndrome, crippling pain in the lower back or leg caused by a muscle spasm in the

buttocks that entraps the sciatic nerve. The condition is often misdiagnosed as a back

problem, and patients frequently undergo surgery or lengthy physical therapy without

relief.

Dr. Fishman developed a simple diagnostic technique for piriformis syndrome and

showed that an injection into the muscle to break up the spasm, sometimes followed by

yoga exercises or brief physical therapy, relieves the pain in an overwhelming majority of

cases.

Nowadays yoga exercises form a centerpiece of his practice. Dr. Fishman, a lifelong

devotee of yoga who studied it for three years in India before going to medical school,

uses various yoga positions to help prevent, treat, and he says, halt and often reverse

conditions like shoulder injuries, osteoporosis, osteoarthritis and scoliosis. I rarely devote

this column to one doctor’s approach to treatment, and I’m not presenting his approach as

a cure-all. But I do think it has value. And he has written several well-illustrated books

that can be helpful if used in combination with proper medical diagnosis and guidance.

For many years, yoga teachers and enthusiasts have touted the benefits to the body

of this ancient practice, but it is the rare physician who both endorses it and documents its

value in clinical tests. Dr. Fishman has done both.

This year, Dr. Fishman received a prize at the International Conference on Yoga for

Health and Social Transformation for a paper he presented on a surprising yoga remedy

for rotator cuff syndrome, a common shoulder injury that causes extreme pain when

trying to raise one’s arm to shoulder height and higher. He described a modified form of a

yoga headstand that does not require standing on the head and takes only 30 seconds to

perform, and presented evidence that it could relieve shoulder pain in most patients, and

that adding brief physical therapy could keep the problem from recurring.

Rotator cuff injuries are extremely common, especially among athletes, gym and

sports enthusiasts, older people, accident victims and people whose jobs involve repeated

overhead motions.

For patients facing surgery to repair a tear in the rotator cuff and many months of

rehabilitation, the yoga maneuver can seem almost a miracle. It is especially useful for

the elderly, who are often poor candidates for surgery.

Dr. Fishman said he successfully treated a former basketball player, who responded

immediately, and a 40-year-old magazine photographer who had torn his rotator cuff

while on assignment. The photographer, he said, had been unable to lift his arm high

enough to shake someone’s hand.

Instead of an operation that can cost as much as $12,000, followed by four months

of physical therapy, with no guarantee of success, Dr. Fishman’s treatment is an

adaptation of a yoga headstand called the triangular forearm support. His version can be

done against a wall or using a chair as well as on one’s head. The maneuver, in effect,

trains a muscle below the shoulder blade, the subscapularis, to take over the job of the

injured muscle, the supraspinatus, that normally raises the arm from below chest height to

above the shoulder.

The doctor discovered the benefit of this technique quite accidentally. He had

suffered a bad tear in his left shoulder when he swerved to avoid a taxi that had pulled in

front of his car. Frustrated by an inability to practice yoga during the month he waited to

see a surgeon, one day he attempted a yoga headstand. After righting himself, he

discovered he could raise his left arm over his head without pain, even though an M.R.I.

showed that the supraspinatus muscle was still torn.

Dr. Fishman, who has since treated more than 700 patients with this technique, said

it has helped about 90 percent of them. “It doesn’t work on everyone — not on string

musicians, for example, whose shoulder muscles are overtrained,” he said in an interview.

In a report published this spring in Topics in Geriatric Rehabilitation (an issue of the

journal devoted to therapeutic yoga), he described results in 50 patients with partial or

complete tears of the supraspinatus muscle. The initial yoga maneuver was repeated in

physical therapy for an average of five sessions and the patients were followed for an

average of two and a half years.

The doctor and his co-authors reported that the benefits matched, and in some cases

exceeded, those following physical therapy alone or surgery and rehabilitation. All the

yoga-treated patients maintained their initial relief for as long as they were studied, up to

eight years, and none experienced new tears.

Perhaps more important from a public health standpoint is the research Dr. Fishman

is doing on yoga’s benefits to bones. Bone loss is epidemic in our society, and the

methods to prevent and treat it are far from ideal. Weight-bearing exercise helps, but not

everyone can jog, dance or walk briskly, and repeated pounding on knees and hips can

eventually cause joint deterioration.

Strength training, in which muscles pull on bones, is perhaps even more beneficial,

and Dr. Fishman has observed that osteoporosis and resulting fractures are rare among

regular yoga practitioners.

In a pilot study that began with 187 people with osteoporosis and 30 with its

precursor, osteopenia, he found that compliance with the yoga exercises was poor. But

the 11 patients who did 10 minutes of yoga daily for two years increased bone density in

their hips and spines while seven patients who served as controls continued to lose bone.

He noted that yoga’s benefits also decrease the risk of falls, which can result in

osteoporotic fractures.

Medical guidance here is important, especially for older people who may have

orthopedic issues that require adaptations of the yoga moves.

Downward-Facing Dog’s LifeBy JOHN HANC

May 5, 2010

When the world of the business traveler turns upside down — whether because of a

missed connecting flight, lost luggage or an uncooperative volcano — Steve Boerema

knows just what to do.

He finds a convenient corner in the airport and stands on his head.

Mr. Boerema, who is 45 and lives in St. Augustine Beach, Fla., travels an average of

150 days a year, most of them overseas, as a consultant to the yachting industry. He has

also been practicing yoga daily for four years. That practice has now become as essential

a part of his business travel as his frequent-flier mileage.

“Initially, it helped me dealing with homesickness and melancholy,” said Mr.

Boerema, who is married with two teenage children. “All of us on the road suffer some

sort of guilt, being away from our families. Yoga really calmed my head, helped keep me

from thinking about things I had no control of.”

Several million Americans practice yoga at least once a week, according to surveys

by the sporting goods industry. Many are college-educated professionals in their 30s and

40s, demographics that match those of business travelers, so it is logical that they would

adapt their practice to their life in transit.

“I knew I had to find something to keep me centered,” says Sarah Howell, a 29-

year-old sales trainer for a software company based in Austin, Tex. She started traveling

for work three years ago and is now on the road two to three days a week, most months of

the year.

Ms. Howell, who writes a business travel blog called the Road Warriorette

(roadwarriorette.com), describes herself as “a better person and certainly a better

employee” when she practices yoga while on her business trips. “I’m better able to focus

on the task at hand,” she said.

“Research has shown that those who practice yoga and Pilates have improved sleep

quality,” said Michele Olson, an exercise physiologist at Auburn University-Montgomery

in Alabama. “That’s a big plus for travelers.”

“If you’re sitting for hours on a plane, your hip flexors and hamstrings and other

muscles shorten, and we know that can lead to back problems,” Dr. Olson says. “Yoga,

because it involves a lot of moves and positions that lengthen those muscles, can be very

beneficial in combating joint stiffness at the hip joint and preventing back problems.”

Christopher Berger, an exercise physiologist at the University of Pittsburgh, is

leading a task force for the American College of Sports Medicine called “Exercise Is

Medicine on the Fly,” designed to promote physical activity among travelers and airport

employees.

“Since 9/11, we have very long lines, unpredictable searches and more demands on

people,” he said. “There’s certainly psychological stress associated with that. One of our

goals for this task force is to get people to use airports as places to blow off that steam.”

Some major American airports do seem to be trying to offer passengers more

opportunities to get blood flowing instead of boiling. Detroit Metropolitan Airport, for

example, has a marked one-mile walking trail on the airport grounds, and so-called

Reflection Rooms in each of its two main terminals — one 720 square feet, the other 357

square feet — where yoga and meditation can be comfortably practiced.

Beryl Bender Birch, a yoga teacher and author of “Beyond Power Yoga” and

“Boomer Yoga,” suggested this sequence of three stretches for business travelers.

SEATED FORWARD BEND (relieves stress in the neck, lessons tensions in the

hips and lower back caused by lengthy sitting)

Inhale, stretch your arms out in front of you. Fold your hands and interlace your

fingers, then exhale and stretch your arms up overhead. Keeping your fingers interlaced,

reverse your hands, so your palms are facing up. Arch your back, press your ribcage out

and your buttocks forward, tighten your belly, straighten out your legs and point your

toes. Feel the shins stretch as the toes point. Look up and back. Take three deep breaths

with your mouth closed. Then inhale and release the whole stretch on an exhale. Repeat.

SEATED BACK STRETCH (stretches the back of your body)

Grab your knees with your hands. On an exhalation, pull against your knees with

your hands, curl forward, rounding your spine and pushing your back into the back of

your seat (make sure the seat-back tray in front of you is up). Drop your head forward and

press your chin into your chest. Pull your shoulders up around your ears and round them

forward, tighten the belly, pull your heels back toward the bottom of your seat and lift

your toes. Feel the stretch all the way from your shoulders to your feet. Repeat.

SEATED SPINAL TWIST (stretches and strengthens sides of body)

Put your right ankle on your left knee in a cross-legged position. Inhale deeply and

grab your right knee with your left hand. Lean forward slightly and take hold of the arm

rest to your right with your right hand, then exhale deeply and twist as far as you can to

the right. Inhale again and as you exhale, pull with your left hand and reach your right

arm up in the air. Push your right shoulder back, and look back over your right shoulder.

Pull your belly in and take three big conscious breaths with your mouth closed. Repeat.

When Yoga HurtsBy LIZETTE ALVAREZ

July 24, 2010

As Cathy Lilly folded into downward dog at a workshop in January, a novice instructor,

eager to help, lifted Ms. Lilly’s thumbs and angled them forward. Her thumbs are still

recovering from the strain.

Ms. Lilly, 53, a yoga teacher with more than two decades on the mat, also once

injured her rotator cuff jumping distractedly into plank pose. And after another instructor

forced her to kiss her knee while in heron pose, her hamstring suffered the consequences.

Isn’t yoga supposed to be good for you? After all, doctors prescribe it to injured

athletes and cancer patients. And while tennis players can expect ripped-up elbows and

runners know they may blow out their knees, yogis don’t usually anticipate having to

hobble off their mats.

It is this “do no harm” mind-set that can lead to strained backs, pulled knees, aching

wrists and slipped discs. Ms. Lilly is part of a growing roster of yoga practitioners on

injured reserve.

“Yoga is a good thing, so you tend to push further than you would in a sport where

you are actually more attuned to injury and afraid of injuries,” said Dr. Michelle Carlson,

an orthopedic surgeon at the Hospital for Special Surgery in Manhattan who specializes

in arms and hands. She said she recently “saw four women in a row in my office with

hand injuries from yoga.”

Nobody seems to keep careful track of the numbers. The most recent estimate comes

from the United States Product Safety Commission, which tracks sports injuries: it listed

4,450 reported yoga injuries in 2006, up from 3,760 in 2004. But Dr. Carlson and several

others said they had seen large increases lately, as yoga became more popular. “I have

been doing this for 20 years, and I didn’t see yoga injuries 20 years ago,” Dr. Carlson

said. “I can see a couple of injuries a week.”

Training for yoga teachers can vary, and classes are so large in some studios that

instructors do not pay enough attention to everybody. In New York, many people

approach yoga with a no-pain, no-gain mind-set, with predictable results.

Then there is the age factor: you see a fair share of middle-aged people twisting and

bending and lunging, and I know from experience that a 40-something body is

temperamental.

Back injuries are quite common. Positions like upward dog and cobra, requiring

backbends, can aggravate the spine. Others that call for elongating the back, like seated

forward bend, can wreak havoc on discs. Rotator cuffs and wrists can get battered during

plank poses and chaturangas, which are like push-ups, while knees are susceptible to the

lotus position, hero’s pose and the warrior positions.

The headstand — a more advanced move — is an equal opportunity offender. If

done improperly, it can roil your back, neck, shoulders and wrists.

Then there are the freak injuries. A woman in crow pose fell over and broke her

nose. Ouch.

“The most common form of injury is the overzealous student,” said Dr. Loren

Fishman, a spine specialist, yoga teacher and medical director of Manhattan Physical

Medicine and Rehabilitation. “The second most common reason for injury is poor

alignment, and that is usually crummy teaching.”

The best way to avoid injury, particularly if your body is creaky, is to take it slow

and make sure to nail the fundamentals, experts said. Injuries can happen with all forms

of yoga, but one of the safer approaches is Iyengar, which moves at a slower pace,

focuses meticulously on proper alignment and uses props. Iyengar teachers also undergo

rigorous training.

At one recent class at the Iyengar Yoga Institute in Chelsea, we spent about 20

minutes on extended side angle pose; I learned quite a few things in those 20 minutes.

(Anusara, based on Iyengar, is similar in its attention to alignment.) I love vinyasa — the

breathing, the pace — but it can flow too quickly, and its many chaturangas have

sometimes strained my wrists. Since classes are large, adjustments from instructors can

be few and far between. Also, I find the lack of mirrors in most yoga studios cuts both

ways: You’re not obsessed with your own image, but you can’t see your body in a pose.

The other day I took a class in Union Square with Ellen Saltonstall, an acclaimed

Anusara teacher who recently wrote a book with Dr. Fishman on yoga for osteoporosis.

Her class is slow enough that you can settle into the right alignment. Afterward, she

critiqued my push-up pose. My elbows were not at right angles, and she cautioned me

about dropping too far down. She also gave me stretches for my wrists.

“Precision,” she said, “is important.”

Yoga’s Newest Fans

A yoga class at the RAIN Inwood Senior Center in New York, led by a substitute teacher, Jennifer Block.

(Richard Perry/The New York Times)

By DALE RUSSAKOFF

August 5, 2010

The 18 men and women slowly climbing the steps to their yoga class at RAIN Inwood

Senior Center in New York the other day hardly resembled the young, lithe exemplars of

America’s yoga boom. You won’t find the likes of Sylvia Guzman, 81, on the covers of

yoga magazines or Francisco Batista, 88, on the proliferating Web sites hawking trendy

yoga clothing.

But Mrs. Guzman, Mr. Batista and the other 70-and 80-somethings who faithfully

attend Ricardo Sisco’s chair yoga class every Friday are a vanguard in one of yoga’s

fastest-growing fan bases: the very old. More and more retirement communities offer

gentle yoga classes, with heavy emphasis on breathing and awareness and less on

movement. In chair yoga classes like Mr. Sisco’s, almost all poses are modified so that

they can be done in a chair, accommodating people with balance problems or weak legs.

Mr. Sisco’s students say yoga has changed their lives. “It makes me feel good,

happy, full of energy, vibrant,” said Mrs. Guzman, pumping her arms as if running a race.

She has been taking the class and doing yoga nightly for eight years, and she credits it

with reducing arthritis pain in her knees. “I walk better now,” she said. She also said she

sleeps better.

Mr. Batista, who joined the class two months ago when his doctor recommended

yoga to help with leg pain from a fall, said he already feels the effects. “My body feels

lighter,” he said. “I’m not as tense. I sleep better. I eat better.”

Most of the participants easily touched their toes and, while sitting in chairs, lifted

both legs as high as or higher than their waists. They said they are amazed that their 80-

plus-year-old bodies can do these things.

The health effects of yoga on older people is a budding research topic. A study by

researchers at Oregon Health and Science University found that after six months of yoga,

people ages 65 to 85 could stand longer on one leg and gained flexibility as well as

“significant improvement in quality of life measures,” compared with a control group.

And Veterans Administration researchers in Indianapolis found that 12 weeks of yoga

increased lower-body flexibility by 34 percent in older people, but found no impact on

cognitive abilities.

A study led by Dr. Gail Greendale, a professor of medicine at the University of

California, Los Angeles, found that six months of yoga helped reduce excessively

rounded backs in people ages 65 to 90. “They were less rounded and a tad taller at the

end, and that’s very exciting,” she said.

Dr. Greendale said that researchers at U.C.L.A. and the University of Southern

California are now working with elderly people in a biomechanics lab to modify

beginning yoga poses so as not to aggravate common muscle and joint problems.

“We are trying to do this in a standardized way that is transportable, so a yoga

teacher can use it as a recipe for doing yoga for seniors in a way that is not harmful,” Dr.

Greendale said.

When the research team advertised for subjects, she said, “we were just deluged

with seniors. We were filled up in a week. Seniors are very open to yoga.”

Andrew Greenland, who teaches yoga at Memorial Sloan-Kettering Cancer Center,

said he frequently works with elderly people who are too weak even to sit in a chair. “I’m

not trying to get them to do a warrior pose,” he said. “I might do the whole lesson with

them lying in the bed. I work on breath awareness and gentle movement. In a way, their

physical limitation allows them to be closer to the root of the yoga experience, which is

breathing and awareness.”

He said he often teaches bed-bound patients the savasana, or corpse pose, lying on

their backs with legs apart and arms at their sides. He instructs them to inhale, raising

arms over their heads, and exhale, bringing them back to their sides. “It opens their lungs,

creating more space in their torso,” he said. “In almost all cases, these are people who’ve

never done yoga. When they feel the breath expand them, they’re wide-eyed.”

Mr. Sisco’s students were also new to yoga before joining the Inwood class. They

said few adults in their mostly Dominican community practice yoga, although in some

cases their grandchildren and great-grandchildren are learning it in elementary school.

Throughout the class, Mr. Sisco emphasized breathing and relaxation. “Observe the

breath. Remain witness of the breath,” he said.

He led the students through a modified belly dance, in which they planted their feet

on the floor while rotating their hips. “This will ease the stiffness in the hips,” he said.

“This prepares you for the winter. If for some reason you fall on the ice, the fall is not so

bad.”

At the end of the class, he led five minutes of deep relaxation, in which everyone

tensed, then relaxed every inch of the body, from toes to the crown of the head. Then he

turned off the lights and the class sat in complete stillness, hands on thighs, eyes closed,

the only sound the whir of a window air-conditioning unit.

“They say they feel looser, and they think it’s physical, but it’s also mental,” Mr.

Sisco said. “People think to do yoga you have to be flexible. But the flexibility is not in

the body. It’s in the mind. That’s why anyone can do it.”

The Yoga Therapist Will See You NowBy NORA ISAACS

May 10, 2007

For three years after a car crash left her with chronic pain, Deanna Adams searched high

and low for relief. Mrs. Adams, 41, a stay-at-home mother in West Palm Beach, Fla.,

consulted a physical therapist, a chiropractor, two doctors (a pain specialist and a

neurologist) and an acupuncturist — to no avail.

She also went to basic yoga, hoping asanas would ease the debilitating back pain,

neck spasms and migraines that plagued her. After each class at LA Fitness, Mrs. Adams

felt better for a few hours, but her symptoms inevitably returned.

It was only after her first yoga therapy session with Emily Large, who runs Living

Large Therapeutics, that she realized why group yoga left her cold. “When you go to a

yoga class, everybody is doing the same thing,” Mrs. Adams said. “If you have a neck or

back injury, the instructor doesn’t know.”

Yoga therapy — one-on-one visits which take place in medical clinics, physical

therapist offices and yoga studios — takes into account pain and injuries for a customized

experience.

As her client did yoga postures she had handpicked, Mrs. Large, a yoga therapist

with a physical therapy license, lightly touched her to sense where Mrs. Adams was tense

or weak. Then she designed a sequence of poses to target those areas, including a lying

twist with the knees bent and a repetitive variation of triangle pose. As Mrs. Adams grew

stronger and more flexible doing poses at home, her routine was updated, and after three

months, her pain has largely subsided.

People often turn to yoga when they are injured because they want gentle exercise

that’s easy on the joints. But, most yoga teachers don’t have time to address individual

problems, nor do they regularly deal with special needs.

Enter yoga therapy, an emerging field in the United States, although commonplace

in India. Therapists work in small groups or privately, adapting poses for musculoskeletal

problems that have been diagnosed by doctors. Other therapists help people deal with the

anxiety of living with illnesses as varied as cancer and chronic fatigue.

“We recognize that not every pose is for everybody,” said Robin Rothenberg, a yoga

therapist who runs the Yoga Barn studios outside of Seattle. “If you are a 20-something

dancer, that is one thing and if you are a 50-year-old computer programmer, that’s a

different thing.”

Yoga therapy is nowhere near as popular as one-pose-fits-all classes. Still, in the last

three years, membership in the International Association of Yoga Therapists, a trade

group based in Prescott, Ariz., has almost tripled to 2,060, from 760.

But experts inside and outside the industry say yoga therapy should be approached

with caution. In general, a person can practice as a yoga therapist after 200 hours of yoga

teacher training, which might include basic training in anatomy, breathing, meditation

and giving adjustments.

“Anybody can hang their shingle and say they are a yoga therapist,” said Julie

Gudmestad, a physical therapist who also practices yoga therapy in Portland, Ore. “Buyer

beware. I’ve seen some strange things done in the name of yoga therapy.”

Most reputable yoga therapists have additional credentials. Some are physical

therapists or nurses or have completed two years of training in Iyengar yoga, which

emphasizes anatomy and kinesiology.

Others have been certified as therapists by schools like Integrative Yoga Therapy or

American Viniyoga Institute. The institute is run by Gary Kraftsow; applicants must have

completed 500 hours of his teacher training. His course teaches the clinical applications

of yoga for spine, joint and muscle problems.

There is no national credentialing system, and the lack of industry-wide standards

worries doctors. “You need some core set of certification that allows a patient to know

that they are going to someone from whom they can reliably get appropriate treatment,”

said Dr. James Weinstein, chairman of the department of orthopedic surgery at

Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the editor of the medical

journal Spine. “I have certainly seen patients asked to do positions that have made them

worse.”

Just as certain conditions can be helped by extension, flexion, twisting or side

bending, they can also be aggravated, said Robert Forster, a physical therapist in Santa

Monica, Calif.

Some doctors advocate its use, however. “I deeply believe in yoga and know the

therapeutic value of yoga for health care,” said Dr. Michael Sinel, an assistant professor

of physical medicine and rehabilitation at the University of California, Los Angeles, who

has a private practice in Santa Monica. In the next six months, he plans to start YogaMed,

a company that will offer medical care and therapeutic yoga within the Yoga Works chain

of studios.

Yoga therapists are not qualified to diagnose injuries, although some do, said Leslie

Bogart, a yoga therapist in Santa Monica, who has worked as a nurse. “Everybody should

be seen by a medical person first, without question,” Ms. Bogart said. “Yoga should be an

adjunct to” treatment, not “a replacement.”

Longtime yoga therapists say the next step for them is learning to work with

doctors. Larry Payne, who has practiced since 1982 and is the founding president of the

yoga therapist association, said therapists need to learn to read medical reports and to

work in clinical settings. “The doctors aren’t interested in Sanskrit, they just want to be

sure that yoga therapists they work with are properly trained,” he said.

To that end, Dr. Payne created a yoga therapy teacher training course at Loyola

Marymount University in Los Angeles, where students learn yoga therapy for both

systemic and muscular ailments.

Dr. Payne and Dr. Richard P. Usatine also started yoga classes for medical students

at the David Geffen School of Medicine at U.C.L.A. “Once they understand and can feel

the value of yoga personally, they can then suggest and prescribe it for their patients,”

said Dr. Usatine, a professor of family medicine at the University of Texas Health

Science Center at San Antonio.

Chronically Ill Patients Turn to Yoga forReliefBy CAROL E. LEE

December 15, 2005

Jack Waters credits yoga with saving his life four years ago. Riding the subway in Paris,

he began experiencing chest pain. He knew that signaled a heart attack because he’d had

two already, side effects of an H.I.V. medicine that raised his cholesterol. He needed to

get to a hospital, but first he wanted to do a yoga pose.

“I had to get out and sit down and use the bench and do an inversion so that I would

be able to walk somewhere to get help,” he said. He started to take deep, slow breaths to

maximize his oxygen intake and did a shoulder stand to increase his circulation. Then he

found a taxi and went to a hospital.

Mr. Waters, 51, a filmmaker, learned these techniques in a yoga class for people

with H.I.V. and AIDS. The weekly session at the Iyengar Yoga Institute in Manhattan

teaches exercises that can ease side effects like headaches or fatigue and aid bodily

functions like digestion. “It pretty much saved my life,” Mr. Waters said.

People with chronic illnesses from AIDS and cancer to osteoporosis and Crohn’s

disease are increasingly turning to yoga classes that single out their specific ailments.

Often it is something their doctors recommend for the stress-relieving benefits of both

exercise and meditation. But many patients find that the sessions, which make them feel

more comfortable, also lessen some of their symptoms and the side effects of their

medications. And because students exercise alongside others with their same medical

problem, the classes also provide emotional support.

“I had always been exercising, but I had never done anything that focuses on the

mind and the body,” said Cynthia Mencher, a breast cancer survivor. Five years ago Ms.

Mencher, 69, joined a yoga class at the Integrative Medicine Service at Memorial Sloan-

Kettering Cancer Center in Manhattan while recovering from her illness. “That gave me

back a sense of reinhabiting my body.”

Two lumpectomies and radiation therapy had made the left side of her upper body

very stiff, but the shoulder poses and twists she practiced in yoga increased her flexibility.

Ms. Mencher said she never felt self-conscious if she struggled to do a pose because her

class consisted mostly of other cancer patients and survivors. The yoga also relieved

some of her mental anguish, she said.

Teresa Kennedy, a former executive at MTV Networks who has Crohn’s disease,

found that yoga classes relieved her gastrointestinal symptoms to the extent that she was

inspired to open her own studio, Ta Yoga House in Harlem. “I don’t get G.I. symptoms,”

she said. “I hardly get stomach aches.”

Yoga classes for people with specific illnesses are typically smaller than regular

yoga classes — sometimes accommodating no more than 8 to 10 people — and they are

usually slower-paced. Postures, which are on the gentler end of the difficulty spectrum,

are often done with blankets and bolsters so participants can experience the physical

benefits of poses while exerting a minimum of muscular strength and energy.

“We’re trying to restore the body and give it juice,” said James Murphy, the

president of Iyengar Yoga Association of Greater New York, who teaches the free H.I.V.

and AIDS class at the institute. “Even if they’ve been lying in bed for three weeks with

pneumonia,” he said, “they can start with some poses that can open up their chest.”

Medical professionals have embraced meditative practices like yoga in managing

illnesses. Studies have shown that yoga can, among other things, reduce fatigue in people

with multiple sclerosis and lower anxiety in patients with cancer, heart disease or

hypertension. In a recent preliminary study at Brigham and Women’s Hospital in Boston,

people with chronic insomnia who practiced yoga daily said that they were sleeping

significantly better and for longer periods.

Some skeptics say the benefits are no greater than what patients would get from

praying, taking a warm bath or any other stress-relieving practice.

“It gives some people peace of mind or makes them feel better,” said Dr. Robert

Baratz, a dentist and a physician in Braintree, Mass., who is the president of the National

Council Against Health Fraud. “But there’s no medical or plausible mechanism by which

it affects the disease process.”

There is a danger, he said, in giving patients the impression that a practice like yoga

could somehow cure their illness.

Advocates of yoga therapy agree that it does not cure or treat disease. But they say it

helps patients better tolerate their symptoms and lessens the anxiety that an illness

creates. By boosting flexibility, increasing the heart rate and calming the mind, yoga

helps people relax, said Jo Sgammato, an administrative manager of the Integral Yoga

Institute in Manhattan. “Why not take advantage of these practices and healing modalities

that make a difference in the quality of life while you’re going through chemotherapy and

radiation?” Ms. Sgammato said.

The students themselves often say that one of the things they like best about illness-

specific yoga classes is that the instructors understand their physical limitations. “In a

yoga class at a health club they might be doing 25 different postures,” said Jackie

Herbach, a massage therapist and yoga instructor at Memorial Sloan-Kettering’s

Integrative Medicine Service. “In a class here you might be doing 8 or 10.”

Classes also avoid any postures that could be harmful — by overstretching the

joints, for example — and sometimes include uncommon props.

“We begin seated in a chair,” said Cynthia Mathis, who runs Unity Yoga in

Mountainside, N.J., and who offers a weekly class for people with osteoporosis, “then do

movements, raising arms over the head, stretching to the side.” The class also does poses

while standing against a wall. “The premise is that you’re returning the spine to its natural

alignment,” she said.

Teachers like Ms. Herbach take a delicate approach to students with physical

illnesses. “They could have low blood counts, so you have to be cautious as an instructor

to transition slowly,” she said of the students with cancer, “and if you’re assisting them,

you have to be careful because they’re more prone to bruising.”

Some instructors inquire privately about their students’ medical history. For a

person with heart disease, the teacher might want to know if the student has high blood

pressure or has recently had heart surgery.

Inevitably a class of students with a common illness creates a community, especially

if it includes a therapy component similar to the support group meetings held after yoga

classes at Beth Israel Hospital’s Center for Cardiac and Pulmonary Health in Manhattan.

“The bonds that form are remarkable,” said Deborah Matza, a registered nurse and yoga

instructor who runs one of the groups.

The possibility of meeting other people like himself was what drew Peter Griffin,

46, who is H.I.V. positive, to the free yoga class for people with H.I.V. and AIDS at the

Integral Yoga Institute. But the poses have been more beneficial than he expected; he

says they have helped relieve the numbness in his feet, a side effect of the medication.

The class was started 20 years ago, when AIDS patients often did not live very long.

“The feeling of health is there, the optimism and hope are there,” said Lee Pleva, the

instructor. “There’s a real sense of personal connection and caring.”

When Does Flexible Become Harmful?‘Hot’ Yoga Draws FireBy LORRAINE KREAHLING

March 30, 2004

Every day, in New York and Paris, Tokyo and Houston, students clad in little more than

swimwear grab towels, bottled water and rubber mats and enter a very hot room. As the

teacher calls out instructions, they sweat profusely, performing a sequence of 26 yoga

postures, repeated in every 90-minute class.

Bikram or “hot” yoga took root in Los Angeles three decades ago, but the technique

has spread far beyond coastal cool. The Bikram Yoga College of India in Los Angeles,

named for its founder, Bikram (pronounced BEEK-rum) Choudhury, has 314 certified

schools worldwide, with 12 studios in the New York area.

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.

“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.

“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.

Latest Way to Cut Grade School Stress:YogaBy PATRICIA LEIGH BROWN

March 24, 2002

SAN FRANCISCO, March 22 — Fourth graders at the Rosa Parks Elementary School

have various classroom jobs: line leader, attendance taker, door locker, yoga monitor.

“When you’re mad you go do yoga and you feel much better,” said Frederick

Nettles, 10, a monitor who was coaching first graders in the intricacies of the “new

moon,” a forward-bending yoga posture. “It calms your nerves.”

At seven public schools here — with more on the way — the “yoga break” has

taken its place beside typical school rituals like recess and the Pledge of Allegiance.

Yoga Journal, a Berkeley bimonthly, calls it “om schooling.” Besieged by budget

cuts — most of California’s elementary schools no longer have physical education

teachers — schools like Rosa Parks are finding their own center. With free teacher

training by Tony Sanchez, a yoga master, yoga is becoming an integral part of the

physical education classes and the regular classroom as well. Mr. Sanches founded the

United States Yoga Association, a nonprofit organization.

Students in Elaine Gee’s fourth-grade Chinese bilingual class spent 10 minutes the

other day doing yoga before a big grammar test. A favorite is the “cocoon,” which

involves relaxing the head, spine, arms and legs on the floor and breathing to release

tension.

“It helps them concentrate, especially on rainy days when there’s a lot of nervous

energy,” Ms. Gee said. “These students are under a lot of pressure to succeed. Testing is

coming up, reports are going home, so we’re doing more yoga.”

Rosa Parks Elementary is worlds away from the universe inhabited by yoga

devotees like Madonna and Sting. All students qualify for a free or reduced-price lunch.

Mr. Sanchez, with the help of a small stipend for teachers from the San Francisco

Education Fund, has trained 60 classroom teachers citywide in hatha yoga, which

concentrates on athletic postures and breathing techniques.

Yoga is not common in the American classroom yet. But it is increasingly becoming

part of the physical education curriculum nationwide, along with other nontraditional

activities like weight training, biking and in-line skating. It has recently been introduced

to adolescent inmates on Rikers Island, where “we’ve found it teaches concentration, self-

control and discipline,” said Tim Lisante, New York City’s deputy superintendent for

alternative, adult and continuing education.

In Chamberlain, S.D., Ronda Klein, the school nurse, recently began teaching yoga

to students at St. Joseph’s, a Catholic boarding school for American Indian children.

In Seattle, 15 of 97 public schools have yoga as a warm-up in gym class, and it is an

elective for high school students, said Bud Turner, the physical education coordinator.

“Physical education is moving in the direction of lifetime activities like toning,

swimming and yoga,” Mr. Turner said. “We’re getting away from traditional team sports

dominated by three kids in the athletic elite.”

A nonprofit group called Yoga Inside, founded three years ago in Los Angeles,

sponsors classes in 31 states, many in schools in poor urban neighborhoods.

San Francisco’s yoga-in-the-schools program was prompted by the failure of 74

percent of California public school students to meet state fitness requirements, said Gloria

Siech, a physical education content specialist for the San Francisco public schools. “We

felt elementary school kids were more receptive and there was a lot of need,” she said.

To avoid potential controversy, she said, the program focuses solely on the physical

aspects of yoga. There is no Sanskrit or mention of Hindu deities.

The Accelerated School in South Central Los Angeles, an acclaimed public charter

school, introduced yoga classes for all students last year. Kevin Sved, the school’s co-

founder, said a few parents declined to have their children participate for religious

reasons. “The tricky part is that some of the teachers want to connect spiritually,” Mr.

Sved said. “But this is about the physical, mental and emotional aspects of yoga.”

The San Francisco schools have gone further than most by training teachers to

include yoga as a regular part of the day — “in the classroom, when they’re scrambling,”

said Sandy Wong Sanchez, program director for the United States Yoga Association.

At the James Lick Middle School, Adiam Aklilu, 11, had just come out of “the

tree,” an elaborate pose in which she placed the inside of her right foot on her left thigh

and then balanced. “It gets me pumped,” she said. “It makes me feel like I did a lot of

work.”

At Rosa Parks, there are signs that students are bringing their yogic karma home.

Danny Washington, said his daughter Ariel, 9, is “a lot calmer now in different

situations.”

Tea-shall Britton, 9, taught yoga to her mother, Tawanna Granger, a freelance nurse,

and now they do it together in their living room in Chinatown. “We become partners,”

said Ms. Granger, a single mother. “It helps us focus.”

When she received a paycheck in the mail the other day that was less than she

expected, her daughter knew what to do. “Mommy,” Tea-shall commanded. “Do your

cocoon.”

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