Yoga can be a pain in the neck … and head and spine

Study looks at injuries caused by extreme poses, but you can avoid them and still find your Zen.

A new yoga study published by the Mayo Clinic suggests that some of those extreme poses on the mat could land you in the doctor’s office.

That feeling of “shanti,” a Sanskrit word that means peace, calm or bliss, could be disrupted the next time you try the “king” of all poses – the headstand – and others that can lead to injury, primarily in people with bone-loss conditions including osteoporosis and osteopenia.

A retrospective study of 89 patients with injuries primarily caused by yoga and seen from 2006-2018 revealed a collection of soft tissue injuries, axial non-bony injuries and bony injuries, including compression fractures.

The poses most to blame involved hyperflexion and hyperextension of the spine, the study said.

But as in anything, moderation – and sometimes modification – are key, according to an IU Health physician.

Dr. Shashank Dave, who specializes in neck and spine treatment at the IU Health Neuroscience Center and IU Health North Hospital, treats many patients with yoga injuries, especially in the spine clinic at North.

“A lot of patients I’ll ask, ‘when did you start noticing symptoms,’ and more often lately they’ll say they were doing yoga and went into an extreme pose and had pain almost immediately.”

That, he said, is where yogis should stop.

“Pain is really a signal your body is giving you that it is being pushed too far,” he said. “Poses might be uncomfortable, but they should definitely not be painful.”

The Mayo report outlined a lot of the injuries he sees in his practice – head, neck and spine. Injuries can also occur in the hips and hamstrings.

“Sometimes we ask people, especially if they’ve got arthritis in their hips, knees or shoulder, even if it’s not painful, to avoid prolonged ranges of motion,” he said, “like the hip going into this wicked outward rotation might not be good for the joint itself.”

Dr. Dave is a yoga lover himself. He carves out time three days a week to practice the physical movements, breathing exercises and meditation that help center him.

“The benefits for me are really grounding myself, grounding my body,” he said, in addition to reducing stress.

And as an enthusiastic runner, yoga also helps him maintain flexibility and thus prevent injuries.

But he took it too far once. He recalled taking a yoga class during his residency in which the teacher asked him and others to go into a full headstand. He did it, but “I remember walking away from that with neck pain that I did not have to begin with,” he said.

There’s an element of pride that can overtake caution in a class with motivated students and a demanding teacher, but instructors can suggest modifications or variations to poses that can be done comfortably and safely, he said.

When in doubt, consult your primary care physician, Dr. Dave said, and don’t think you have to give up yoga.

In treating patients with yoga injuries, which might include physical therapy, the goal is to get them back to whatever activity they were doing, albeit modified.

“We want them to be more functional and independent,” he said. “Obviously, they wanted to go to yoga for a reason, so we ask the therapist to walk them through what they should and shouldn’t do during class and to be open with the teacher.”

There may not be a lot of cardiovascular benefits to yoga, but the improvement in overall fitness and quality of life should not be underestimated, Dr. Dave said.

“We want patients to be as active as possible, and the benefits of yoga outweigh some of these risks. If it’s done in the right way, there are so many benefits.”

–- By Maureen Gilmer, IU Health senior journalist