INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008) 59
A Survey of Musculoskeletal Injury among Ashtanga Vinyasa Yoga Practitioners
Jani Mikkonen, Palle Pedersen, DC, MPhil, DPMSA, Peter William McCarthy, PhD Welsh Institute of Chiropractic, University of Glamorgan, Pontypridd, CF37 1DL, Wales, UK
Recent research on Yoga has concentrated on its health benefits and therapeutic effects.1-4 Although there has been an increasing amount of research on the physical and thera- peutic effects of Yoga posture and breathing practices, it ap- pears that the musculoskeletal risks of Yoga practice have not been well studied. There is an increasing awareness of Yoga-related musculoskeletal injuries in the popular press, mainly in the U.S. However, most of these reports have been based on a smaller number of teachers’ personal views and individual cases.5-11
Yoga has become increasingly popular in the Western world in the past ten years,12,13 with Ashtanga Vinyasa Yoga becoming one of the most popular Yoga styles. This style of Yoga emphasizes the importance of standardized physical posture practice with synchronized breathing.14ˉ18 In recent decades, teachers have been certified and/or authorized by the director of the Ashtanga Vinyasa Yoga Research Institute, Sri K Pattabhi Jois. Certified or authorized teachers in Europe can be found in 15 countries, including Finland.19 The Ashtanga Vinyasa Yoga School of Finland is lead by certified and authorized Ashtanga Vinyasa Yoga teachers, and the documented and traditional Ashtanga Vinyasa Yoga method is followed in the Yoga schools that were involved in this study.
The rigid adherence of Ashtanga Vinyasa Yoga practitioners to a standardized and documented posture series makes it a strong candidate for scientific study. However, research into Ashtanga Vinyasa Yoga appears to be limited to two re- cent studies. One study concluded that practitioners benefited from statistically significant improvements in muscular strength in the upper body and core, endurance, flexibility, and health perception, as well as decreased diastolic blood pressure and perceived stress, in a six-week period of regular practice.3 A second study reported that heart rate during Ashtanga Vinyasa practice can be compared to heart rate during moderate exercise, and therefore possibly leading to improved cardiac and respiratory fitness.4
The Present Study
The primary objective of this study was to survey the in- jury rate among current Ashtanga Vinyasa Yoga practitioners in Finland, and, further, to determine the rate of injuries per 1,000 hours of practice. We chose to limit the survey to musculoskeletal injuries with at least a one-month dura- tion, to place more emphasis on longer duration injuries. Short-lived “injuries” from Yoga practice or other activities can change presentation and come and go without an obvious reason. We also wanted to exclude from the study short-term overuse pain such as delayed onset muscle sore- ness (DOMS), which is a regular occurrence in any exercise program.20 The secondary objective of this study was to determine the location, type, and outcome of musculosk- eletal injuries in this population. We conducted a survey of participants’ history of musculoskeletal injuries during the previous three years, irrespective of cause. The survey speci- fied that all injuries listed should be musculoskeletal injuries of more than one month duration and have occurred during the participant’s period of Ashtanga Vinyasa Yoga practice. The survey questionnaire adhered to the guidelines stated in the Epidemiology of Sport Injuries categorization sys- tem.21 The study was ethically reviewed and approved by the research project module team at the Welsh Institute of Chiropractic (WIOC), University of Glamorgan.
Retrospective reports of injuries were collected from students at the Yoga schools of Helsinki and Tampere dur- ing the period of January 6, 2006 to May 20, 2006. We also posted advertisements about the survey in the areas around the Helsinki and Tampere Yoga schools. The poster included contact details, stipulated the voluntary and confidential nature of study, and stated the aim (prevalence of musculoskeletal injuries incurred by Ashtanga Vinyasa Yoga practice) and target participants of the survey. The posters and information section attached to the questionnaire explicitly requested that all practitioners complete the survey “whether you have or have not suffered any injuries.” The questionnaires were anonymous, and the Yoga teachers at the centers were not aware of who had completed a ques- tionnaire and who had not. There was no time limit or pres- sure placed on participants, as the completed questionnaires could be placed into a collection box in the communal areas at any time during the collection period (16 weeks).
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“The results from this survey appear to support the conclusion that Ashtanga Vinyasa Yoga practice under appropriate supervision does not dramatically increase the risk of injury to its practitioners. The most commonly reported injuries (hamstring strains and sprains) may be related to the posture sequence of the primary series, and appropriate instruction and practice may reduce this risk. As Ashtanga Vinyasa Yoga includes standardized series of postures, a greater emphasis on individual needs and the importance of relaxed non- goal-oriented practice could prevent some injuries. In the Ashtanga Vinyasa Yoga schools in Finland, the trend has been towards emphasising the importance of the internal experience and mind-body cooperation during practice.”