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Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management

Published:February 18, 2019DOI:https://doi.org/10.1016/j.mayocp.2018.09.024

      Abstract

      Objective

      To analyze injuries that were directly associated with yoga practice and identify specific poses that should be avoided in patients with osteopenia or osteoporosis.

      Patients and Methods

      We retrospectively reviewed the medical records of patients with injuries that were primarily caused by yoga. Patients were seen from January 1, 2006, through December 31, 2018. Injuries were categorized into 3 groups: (1) soft tissue injury, (2) axial nonbony injury, and (3) bony injury. Patients underwent evaluation and were counseled to modify exercise activity.

      Results

      We identified 89 patients for inclusion in the study. Within the soft tissue group, 66 patients (74.2%) had mechanical myofascial pain due to overuse. Rotator cuff injury was seen in 6 (6.7%), and trochanteric bursopathy was observed in 1 (1.1%). In the axial group, exacerbation of pain in degenerative joint disease (46 patients [51.7%]) and facet arthropathy (n=34 [38.2%]) were observed. Radiculopathy was seen in 5 patients (5.6%). Within the bony injury category, kyphoscoliosis was seen on imaging in 15 patients (16.9%). Spondylolisthesis was present in 15 patients (16.9%). Anterior wedging was seen in 16 (18.0%), and compression fractures were present in 13 (14.6%). The poses that were most commonly identified as causing the injuries involved hyperflexion and hyperextension of the spine. We correlated the kinesiologic effect of such exercises on specific musculoskeletal structures.

      Conclusion

      Yoga potentially has many benefits, but care must be taken when performing positions with extreme spinal flexion and extension. Patients with osteopenia or osteoporosis may have higher risk of compression fractures or deformities and would benefit from avoiding extreme spinal flexion. Physicians should consider this risk when discussing yoga as exercise.
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      Linked Article

      • Yoga: Safe for All?
        Mayo Clinic ProceedingsVol. 94Issue 3
        • Preview
          In this issue of Mayo Clinic Proceedings, Lee et al1 report a retrospective chart review of soft tissue and bony injuries attributed to the practice of yoga. This study identifies various medically documented yoga injuries, with the spine being the most common cited location of injury. Spinal flexion and extension seem to be particularly high-risk positions. Although soft tissue injuries were more common, bony injuries, including osteoporotic compression fractures, were also noted, and these types of injuries pose an increased risk of morbidity.
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