It may seem ironic at first, but the exercise regime often recommended by doctors and therapists (aka yoga) as a rehabilitation tool to overcome a range of sports injuries can itself become a cause of sports injuries if people get "too into it".
Yoga, considered a relatively gentle means of building flexibility, muscle strength and endurance through physical poses and controlled breathing, can lead to a number of repetitive strain injuries and even osteoarthritis, Ontario doctors say.
"Most of the injuries I see are from repetitive strain," says Dr. Raza Awan, a Toronto sports medicine physician who's been practising yoga for about a decade.
The most common yoga-related injuries he sees in patients are rotator cuff tendonitis and tears; spinal disc injuries in the low back and neck; cartilage tears in the knee; hamstring strain and tears; and wrist injuries.
There are a number of reasons why yoga — in which practitioners generally perform a series of poses, called asanas — can cause injury, he says.
One of the causes is "definitely pushing too hard" to attain a specific pose, which can involve stretching the upper body into a forward or backward bend, twisting the torso, or performing an inversion, such as a handstand or headstand, balanced on the hands or forearms.
In other words trying to show off by doing handstands and headstands can get you injured. Gotcha!
"So, for instance, people who are too flexible or people who are too tight, they're at more risk, I find," says Awan. "If you're too tight and you try to force yourself into a pose and your muscles aren't flexible, then you might strain another area to compensate."
"Or let's say that you're very flexible and you get to the end range of a pose and you don't have the muscular support to maintain the pose ... you're holding the pose without muscular endurance, you're basically holding it on your ligaments or your tendons and you strain those structures that way."
Ego also can lead to injury, he says, explaining that in yoga classes, some people push their bodies beyond their limits trying to match or outdo the person on the next mat. Being a showoff is basically an excellent way to get yourself injured doing any exercise.
"You strain yourself because you push yourself."
Sometimes, overdoing it in yoga may exacerbate an underlying problem called femoroacetabular impingement, or FAI, in which the bones of the hip are abnormally shaped and don't move together smoothly. The hip bones grind against each other during movement, causing joint damage over time and osteoarthritis.
Dr. Chris Woollam, a Toronto sports medicine physician, says he started seeing "an inordinate number of hip problems" about two years ago, including among women aged 30 to 50 who were practising yoga.
When range of motion in their hips was tested, not only was movement limited, but "they would jump off the table because of the pain," Woollam says.
MRI scans showed the women had joint damage resulting from FAI, which can be severe enough in some cases to require hip-replacement surgery.
And since yoga is becoming increasingly popular it is now ever more important to warn people about the dangers of trying to over do it.
"So maybe these extreme ranges of motion were causing the joint to get jammed and some to wear," Woollam says of certain yoga poses. "If you start wearing a joint down, then it becomes arthritic. So you're seeing these little patches of arthritis in an otherwise normal hip that seems to be related to these extremes of motion or impingement or both."
However yoga isn't entirely to blame. You just have to listen to your body. When it's saying there's a pain, then you have to recognize that and then take a break from whatever you are doing. Pain is a good signifier that you are overdoing it.
Vancouver chiropractor Robin Armstrong, who's been practising yoga since 1999, says the most common injury she sees among fellow enthusiasts are hamstring strains. Typically, they are overuse injuries and tend to occur more among experienced practitioners rather than beginners.
"I think it's also just repeating core movement patterns, and if you have a teacher who corrects the way you're moving, I think that can help prevent these types of injuries," says Armstrong, who also teaches anatomy and injury prevention to yoga instructors.
"I talk about where you have to use caution in certain poses and when appropriate use certain poses for certain people and when to avoid them altogether."
Some yoga teachers will encourage students to try a more challenging pose, while others may physically "adjust" a student to correct their posture and alignment. And that can take a person to a place their muscles and joints aren't ready to go. So sometimes it is the yoga instructor who is pushing the student too much.
But Armstrong says how far and how fast an individual advances in yoga is a shared responsibility between the student and the instructor.
"Don't get so attached to making the pretty picture with your body, you're still doing yoga even if you're not doing the full expression of the pose," she says. "And that goes back to not comparing yourself to others, because everyone comes with a different body and a different experience."
Yoga has many upsides, including sharpening mental focus, easing stress, and improving range of motion that can help avoid injuries while performing day-to-day activities or participating in sports.
"There's a lot of benefits to doing yoga for certain types of problems, but obviously any physical activity has its risks, too," says Dr. Awan, who is among those who uses yoga as a therapy for some patients and believes most yoga-related injuries are preventable.
"It's a great movement-based activity to do, but you have to try to keep safe, just like in other sports activities. Don't push your body beyond."
