Hyperextension of the Knees and Yoga

by Nina

Hyperextending!

Typically it’s not me who writes about anatomical aspects of the asana practice. After all, we’ve got both Baxter, an MD who teaches anatomy to yoga teachers and Shari, a physical therapist who teaches anatomy to yoga teachers, on our staff. But after reading Baxter’s post about the standing leg and knee in Warrior 3 pose (Vrbradrasana 3), I decided to write about hyperextension in the knee joints in general because, you see, I have it myself. And I have been working with it in one way or another for about fifteen years (after it was pointed out to me by a couple of my teachers). I decided that since I had a lot of knowledge about it, it would be good to get it down in writing. 

As Baxter said in his post, hyperextension of the knee joint means that your knee joint has a slightly greater range of motion in extension than the average person’s does. In other words, in people with hyperextension of the knees, when the knee is straight, instead of the femur bone on top and the shinbones on bottom forming one straight line, your knee joint bows slightly backwards. I’d like to add to what Baxter said by observing that when your knees are hyperextended, your kneecaps don’t face straightforward; instead, they turn in slightly, with the inner edges pressing back more than the outer edges (making you look a bit knock kneed). Also, with hyperextended knees, you tend to bear more weight on your heels than on the balls of your feet and your thighs press back so they are not aligned directly over your shins. All this unevenness in your legs, knees and feet is the reason there is concern about hyperextension, with concern that it could lead to uneven wear and tear on the cushioning cartilage of your knee joint, which could result in dysfunction and pain down the road. 

Rather than simply avoiding poses where you tend to hyperextend your knees, I believe that by observing the unevenness in your legs, knees and feet, and making adjustments, you can bring your legs, knees and feet into a healthier alignment. And in this post, I’m going to share with you how I do that myself.

First I’ll recommend that you test yourself to see if you have hyperextension rather than knock knees, and then I’ll describe a few techniques for correcting your alignment, both as you move into and out of poses and while you are practicing them.

Testing Yourself

1. Start by standing in front of a mirror in Mountain pose (Tadasana), with your feet together (yes, together). Now look at your knees. Are they turning slightly in toward each other and coming closer together than the rest of your legs? This could be either a result of hyperextension or knock knees.

2. Next, bend both knees by moving your shins forward and shift some of your weight from your heels to the balls of your feet. Then straighten your knees by lifting from your thighs, while keeping some of your weight in the balls of your feet.

3. Look at your knees again. Are they now facing straightforward with more space between them? If so, you have corrected your hyperextended knees. If there is no change, you may have knock knees. But try the adjustment once more just in case.

Moving into Straight Leg Poses

The technique you just used to correct your hyperextended knees in Mountain pose test is one that you can use as you move into any straight-legged standing pose. For example, if you are moving into Warrior 3 (Vrbradrasana 3) or Half Moon Pose (Arda Chandrasana), where you bend your knee first and then straighten it, you will bend your knee by moving your shin forward and shifting some weight onto the ball of your foot. Then, as you straighten your leg to come in the pose, you would lift from your thigh to straighten your knee as you keep some weight in the ball of your foot. (As you come out of the pose, use the same techniques to bend and then straighten your knee.)

Warrior 3

For poses such as Triangle pose (Trikonasana) and Pyramid pose (Parsvottanasana) where you normally move into the pose with a straight leg, you can try changing the way you move into the pose, as it is the front knee in these poses that you tend to hyperextend. Using Triangle as an example, you would take the foot position for the pose and raise your arms out the sides. Then, bend your knee by moving your shin and shift some weight onto the ball of your foot. Next, as you come into Triangle pose, lift from your thigh to straighten your knee as you keep some weight in the ball of your foot. Does it feel different to you?

Triangle Pose

Working in Straight Leg Poses

When you’re already in a pose, you can make adjustments to bring your legs into healthier alignment. 

First, in any pose with a straight leg, even balancing poses such as Tree pose (Vrksasana), you can slightly bend your knee and then straighten it again using the technique I described above. One week I tested this technique with every single standing pose in Light on Yoga, and found benefits in almost every single pose. In many poses, such as Dancer’s pose (Natarjasana), this adjustment brought me deeper into the pose!

Second, without bending your knee, you can try softening your front thigh muscles (quadriceps) and allow your thighbone (femur) to move slightly forward so it aligned more directly over your shinbone and more weight moves onto the ball of your foot. This will bring your leg into a straighter alignment. I just learn this one recently, and it works well in Half Moon pose (Arda Chandrasana).

Working in Seated Poses

In seated poses with one or more straight legs, including forward bends and twists, people with hyperextension of the knees tend to press the knee of their straight leg down toward the floor when their foot is fully flexed (vertical), hyperextending the knee. So, instead of flexing your foot in these poses, try pushing the ball of your foot a bit past your heel (without pointing your toes). I call this the “Barbie foot,” as it looks like the doll’s feet without her high heels on, and I’ve noticed Iyengar uses this foot position. The result is that your knee no longer hyperextends and—additional bonus!—your hamstrings soften a bit because pressing your front foot forward loosens the tug on the calf muscle, which then loosens the tug on the hamstrings, allowing you to come more deeply into forward bends. 

Moving into Bent Leg Poses

Remember that people who hyperextend tend to have knees that turn in slightly. So in weight-bearing poses with bent knees such as Warrior 1 and 2 (Vrbradrasana 1 and 2) or Extended Side Angle pose (Utthita Parsvakonasana), it’s a good idea to try to ensure that you’re bearing the weight evenly on your bent knee. Use the same technique of entering the pose by bending from your shin and moving some weight onto the ball of your foot. And, as you bend, pay attention to your inner back knee, deepening it as much as your outer back knee. This will help align your kneecap directly over your second and third toes and distribute your weight more evenly.

Extend Side Angle Pose

As you come out of the pose, use the same technique to straighten your leg as I described above, lifting from your thigh while keeping some weight on the ball of your foot. 

Thanks, Donald!

Whew! That’s it for now. I’d like to end by saying that I learned almost all of this from my teacher Donald Moyer, both while I was training with him to become a yoga teacher and in his ongoing classes. I'm very grateful for all that and more....

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Ashtanga Yoga: Following the Eight-Fold Path

by Ram

Eucalyptus by Melina Meza

Misconception 1: Yoga means The Mat & Asanas.

Reality: This is a common misconception. In reality, yoga is one of the six schools of Hindu philosophy that describes: 1) our true nature, 2) our goal/purpose in life, and 3) the means to achieve the goal. Thanks to Swami Vivekananda, yoga came to the West in 1893 and found a very receptive audience. Yoga philosophy has its origin in the Vedic texts that address health and health practices. If ayurveda is the healing aspect, yoga is the spiritual/practical side of the Vedic teachings.  Together they emphasize a complete approach to the well being of the body, the mind, and the spirit. In fact their close relationship has even led to some scholars arguing that Patanjali, considered by many to be the father of yoga, and Charaka, often considered as the father of ayurveda, may have in fact been one and the same person known in Vedic India by different names during his travels to spread the teachings of these ancient sciences.

The underlying principle of the yoga philosophy is the fostering of the wellbeing of an individual at the level of body and mind, and helping an individual re-connect to his/her true nature through direct and personal experience (pratyeksha in sanskrit). Thus, yoga prepares the body and mind of the individual for eventual liberation and enlightenment.  

Misconception 2: Yoga Philosophy deals with different asanas or postures to achieve union of the mind and body. 

Reality: In today’s world, yoga is often thought of as “asanas only,” something like a stretching tool to keep the body limber and agile. People are drawn to yoga as a way to keep fit even though the idea behind the physical practice of yoga is to help the mind to become clear or pure and develop deeper mind-body awareness. A clear mind is not affected by stress and produces a healthy body, thus creating a greater connection with one's own pure, essential nature. Yoga philosophy describes achieving mind-body awareness through the four-fold path, namely: 

1. Karma Yoga: The yoga of selfless-action. Any individual can achieve mind-body awareness and ultimately attain enlightenment by practicing self-less service (seva), without expectations for service provided. As a result, the practitioner’s heart and mind become pure, the ego is subdued and the light of divinity shines through them.
2. Bhakti Yoga:  The yoga of devotion. Any individual can achieve mind-body awareness and ultimately attain enlightenment by chanting devotional hymns and engaging in devotional ceremonies.
3. Jnana Yoga: The yoga of knowledge. Through study, inquiry, reflection, and awareness, a practitioner’s consciousness is able to pierce through the illusory world, achieve mind-body awareness and ultimately attain enlightenment. 
4. Raja Yoga: The Royal Path of Yoga or the Yoga of Practice, a philosophy of mind-body awareness that was outlined by Patanjali. One reaches enlightenment by practicing the eight-fold path of self-realization.

Misconception 3: Ashtanga Yoga is a style of yoga founded by Pattabhi Jois.

Reality: While the above is true, the actual term “Ashtanga Yoga” (ashta=eight, anga= limbs) refers to the eight-fold path/eight rungs/limbs/steps of yoga as described in the Raja Yoga section of the yoga philosophy.  Its practice helps us to discriminate between ignorance and awareness and truth from illusion, which is the means for liberation or enlightenment. In the Sadhana Pada of the Yoga Sutras by Patanjali we are introduced to the concept of Ashtanga Yoga. Verse 2.28-2-29 declares:

yoga anga anusthanad ashuddhi kshaye jnana diptih a viveka khyateh
yama niyama asana pranayama pratyahara dharana dhyana samadhi ashtau angani

Through the practice of the different limbs, or steps to Yoga, whereby impurities are eliminated, there arises an illumination that culminates in discriminative wisdom, or enlightenment. The eight rungs, limbs, or steps of Yoga are the codes of self-regulation or restraint (yamas), observances or practices of self-training (niyamas), postures (asana), expansion of breath and prana (pranayama), withdrawal of the senses (pratyahara), concentration (dharana), meditation (dhyana), and perfected concentration (samadhi).

In future posts, I'll discuss each of these eight limbs individually. Until then, you can use the search function on our blog to find posts from our archives on some of these topics, including the yamas, pranayama, meditation and so on.

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Athlete profile and tips: Hans Cheeneebash.

Athlete profile

HANS CHEENEEBASH

Profile

NAME : HANS CHEENEEBASH

AGE : 19

CURRENT WEIGHT : 61.4 KG

HEIGHT: 1.70 M

GYM : PREETAM BARBELL GYM 

TRAINING DURATION :  8 Months

GOALS : Having a nice and sexy body... aim to participate in MR Vacoas Phoenix in under 60 kg category next year   

FAVOURITE BODYBUILDERS : Local - PREETAM RAMTOHUL 

                                               International - LAZAR ANGELOV/JEFF SEID 

TYPICAL DAILY DIET  - I call it 'Breakfast Overload' , eat as much as you can during breakfast... Daily diet : Oats(minimum 2 times a day),Pasta(i use it as carb atleast 3 times a week),Peanut Butter( i eat about 3 spoons of peanut butter in bread every morning during breakfast). 

FAVOURITE SUPPLEMENTS : Centrum Multivatimin tabs, Nature firm Creatine Capsules , Musclepharm Combat Powder 

Hardcore Training Programme 

Monday  :   Chest and arms 

CHEST

·       Heating up 5-10 mins (for every training day)

·       DECLINE BENCH PRESS : 12-10-8-6 ( Be sure to be increasing weights every rep)

·       INCLINE BENCH PRESS : 12-10-8-6

·       DUMBELL FLIES : 12-10-8-6 (Start only after 1 month training)

·       DUMBELL PULLOVER : 12-10-8-6 

·       CABLE CROSS : 3X12 (12-12-12)

ARMS  

·         STANDING BARBELL CURL : 12-10-8-6

·         SEATED CONCENTRATION CURL : 3 X 12

·         SCOTT CURL : 12-10-8-6

·         SKULL CRUSHERS : 3 X 12

·         OVERHEAD DUMBELL PRESS : 3 X 12

·         TRICEP PUSHDOWNS : 12-10-8-6       

·         WRIST CURLS : 3 X TILL FAILURE       

*Training duration : Approximately 2 hours       

WEDNESDAY  :   SHOULDER,BACK,LEGS   

·         SHOULDERS SHRUGS ( WITH BAR) : 12-10-8-6

·         UPRIGHT ROWING( WITH BAR) : 12-10-8-6

·         SIDE LATERAL(DUMBELL) : 12-10-8-6

·         FRONT DUMBELL RAISE : 12-10-8-6 

·         BENT OVER LATERAL : 12-10-8-6

·         LATS PULLDOWN : 12-10-8-6

·         PRESS BEHIND NECK : 12-10-8-6

·         T BAR ROW : 12-10-8-6

·         ONE ARM ROWING(DUMBELL) – 3 X 12

·         LEG EXTENSTION : 12-10-8-6

·         LEG PRESS : 12-10-8-8-6

·         STANDING CALF RAISE : 3 x 21 
*FRIDAY REPEAT MONDAY TRAINING 

HERE’S SOME PICS OF WHAT I BECAME IN 6 MONTHS FOLLOWING THIS TRAINING PROGRAMME 

TIPS FOR BEGINNERS

I would advise the following based on my personal experience if any beginner would like to become like me though i am myself a beginner . 

TRAINING : 1. Atleast 3 times a week  

2. Rest is equally important, leave each bodypart to rest for 24-48 hours. e.g Monday you do chest and arms  andWednesday you do legs and shoulders , Friday back to arms and chest.   

NUTRITION : 1. Oats is my key nutrition,i always eat oats 1 hr before training and within 2 hours after training 

2. High protein foods and carbs are also major in my nutrition(pasta 3/4 times a week and tuna also)   

SUPPLEMENTATION : The only supplement i used till now is multivitamins. The best i've been using is probably the 'Centrum Multivitamin tabs', it is sold at affordable prices and is a complete multivatimin  

MOTIVATION : That is surely the most important part . I follow 2 BIG rules : ' NO PAIN , NO GAIN'  and  ' IF YOU WANT TO BE A LION, TRAIN WITH LIONS'... Just keep in mind that bodybuilding takes time and you always bear the fruit of your hardwork.What i do is fix myself an objective, a model to follow and what my idol is undoubtedly LAZAR ANGELOV. Most importantly find a pleasure in going at the gym, make it a pleasant moment, like it ,love it , if you don't like it you will barely progress don't make it an obligation but something you are eager to go with.  

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The Standing Leg and Knee in Warrior 3 Pose

by Baxter

A funny thing happened a few weeks back as I watched my teacher trainees teaching one another: I saw things happening in their bodies that I miss when I am  the one teaching. That is the benefit of sometimes just watching what’s happening around you! And the most interesting thing I noticed was what happened to the standing leg and knee when one of them was teaching Warrior 3 to the others. I am fond of Warrior 3, and often also frustrated by it, too. It requires balance, strength and flexibility in different parts of your body. Your standing leg hamstring has to be flexible enough to straighten at the knee while your pelvis, top leg and torso all tip over it. Your back body muscles have to be strong enough to keep your top leg, torso and sometimes arms all in one long line parallel with the floor resisting the pull of gravity. Your shoulders have to be flexible enough to take the arms overhead for the full expression of the pose. And those are just the most obvious things going on!

What I saw that day relates to the alignment of the standing leg knee joint and is most relevant to you practitioners out there who know you are prone to hyperextension of the knee joint. Hyperextension of the knee joint means that your knee joint has a slightly greater range of motion in extension than the average person does. In other words, in people with hyperextension of the knees, when the knee is straight, instead of the femur bone on top and the shinbones on bottom forming one straight line, your knee joint bows slightly backwards.

Nina Hyperextending Her Knees

There is some controversy as to whether this is a problem in the long run. On the one hand, it likely allows those of you out there with this kind of knee joint the ability to do many of the more challenging yoga poses where the legs are straight. God knows I could use a bit of that openness in Standing Forward Bend (Uttanasana)! But there is some concern that it could lead to uneven strain on the supporting structures of the knee and could also lead to uneven wear and tear on the cushioning cartilage of your knee joint, both of which could result in dysfunction and pain down the road. So, it may be worthwhile to minimize hyperextension in the knees when possible!

What I noticed that fortunate day was the following: When the students did the Warrior 3 variation in which the legs and torso are parallel with the floor and the arms are out to the sides of the body at a 45 degree angle, the standing leg was very vertical and I did not observe much hyperextension in the 8 or 9 students who normally exhibit this tendency in some of their standing poses.

But the moment they shifted to the “full” pose, where the arms are brought forward along side the ears, am amazing thing happened: everyone’s center of gravity shifted a bit forward in the body, and the body appeared to slide back a few inches in space.

And in that moment, all my hyperextenders hyperextended in that bottom knee in unison!!! It was silent, but visually exploded into my awareness! I was stunned, but it was confirmed when they did the pose on the second side. What’s a newly enlightened (at least in this case of Warrior 3) teacher to do? Share the news with you all, of course. I have been teaching the pose in the last two weeks, and I am continuing to see this pattern of vulnerability in the knees of my students who have extra flexibility. 

You may be asking yourself what to do with this new information? If you are a stiff practitioner like me, you won’t need to do anything with it personally, unless you teach. Then I’d suggest you confirm this observation for yourself in some of your students. But if you have flexible knees yourself, you might observe your Warrior 3 from a side view in a mirror or have a trusted friend or teacher watch you in each Warrior 3 variation and see what happens in your knees.

If you do note a significant increase in hyperextension in the full pose, you might skip it (doing only the version with arms out to the side) or do it less frequently. Alternatively, check with your yoga teacher to see if he or she has techniques that you can use the bring your standing leg in full Warrior 3 into a healthier alignment. If so, try using those techniques to adjust the alignment of your standing leg in Warrior 3 both in class and when you practice at home. After all, this is a modern yoga pose, and in my book that means you can modify and adapt it to suit your unique needs. I hope this information is useful in the ever-changing exploration of your yoga practice.

Cautions: If you have low back pain, you may have to drop your lifted leg a bit lower or bend your back knee to reduce the weight stress this pose puts on your lower back (even a micro-bend to the lifted leg can be helpful). If you have arthritis of the neck, you may want to avoid lifting your head to face forward. As always, use common sense. It if hurts to do the pose, come out and ask your teacher for some feedback about what you’ve been doing. If balancing is a big problem and you’re just getting frustrated, return to the wall version.

If you’re having a lot of trouble and want to work your way gradually into the pose, you can do the pose at an angle instead of parallel. For more tips, see Nina’s post Taking on a Yoga Challenge. For additional instructions, read our entire post on Warrior 3 Variations.

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No Control: Watching Your Breath As It Is During Asana

by Jill Satterfield

The Gust of Wind by Pierre-Auguste Renoir

As most yogis know, the breath is a most nuanced and dimensional reflection of our minds. Our breath can be an intimate guide to our psyches, and observing its movements and patterns is a revealing and direct path to understanding our most subtle behavior and disposition. Whether we watch our breath or manipulate it can mean the difference between insights or cover up—and only by practicing both can we surely know for ourselves.

Controlling and Manipulating vs. Letting Go and Observing 

There are many reasons to utilize breath techniques when practicing asana: it deepens a shallow breath, calms the nervous system and mind, and may keep an otherwise wandering mind in check and in the body. But just like the Buddhist parable of a man who constructs a raft to cross over a river and then continues to carry the raft overhead on dry land, it’s as important to be able to utilize a technique as much as it is to be able to let it go. 

Easier said than done. Once we are comfortable utilizing a technique, it becomes a friend and a companion on our path towards being more peaceful, calm, steady, kind. A technique trains the mind to stay on something, such as in meditation, when we watch the natural rhythm of breath to train or tame the wandering mind. So asking this familiar friend not to accompany us can be quite difficult because it has become a habit—skillful, but a habit nonetheless—and letting it go can be wrought with emotions of all kinds. A crutch is a crutch and attachment is attachment, and anything that becomes unconsciously habitual is not liberating; it can act as a shield against seeing what is naturally, without any kind of manipulation or conscious control. We can’t see things as they are if we are constantly fiddling, manipulating, fixing or changing them. As we practice to become more and more free of unconscious patterns, it is an important step in spiritual maturation to examine how we practice, and why. For any technique can keep us contentedly on the surface by enabling us to steer the ship of the mind, rather than observing its path when let loose in the uncharted waters of the unconscious. 

It can radically change a yoga asana practice to be a passive observer of your breath, rather than in any kind of control. In my experience, asking students to let go of a beloved breath technique can illicit everything from anger to sadness to confusion. Many yoga teachers are rather rigid in their instructions of breathing (breath goes from bottom to top, or top to bottom, or is only in this style, or as heavy handed as counting the beats of one inhale, and one exhale). Suggesting that someone just observe breath can be a radical departure to being constantly instructed, but how revealing it can be! 

Notice for instance where your breath goes when you are experiencing an uncomfortable stretch somewhere in a pose. If you have tight hamstrings, this can be obvious. Usually—unless we are trained to be aware of this reaction—the breath will move as far away from a place of discomfort as possible. If your hamstrings are tight, your breath might be high up in your chest. Genetically, we are inclined to quickly remove ourselves from danger, and this is a very skillful habit to have. But, as in many types of patterned behavior that have become unconscious and unquestioned, this reaction is too easily triggered, often to no real benefit. The urge to run from danger or discomfort can turn into a habit of fleeing anything even remotely unpleasant. Our minds are so habitually prone to check out, to find a distraction, or search for something/anything to take away the pain or discomfort that we’ve taken the initially life-prolonging habit a bit too far, over-stressing our system and depleting our life force. 

In the body then, there can be vast areas that we no longer inhabit because of an injury (discomfort), a trauma (discomfort), or tightness (discomfort), and we don’t even recognize that these parts have become off limits energetically, mentally and physically. We avoid these places with both breath and mind, and when practicing a posture we subsequently explore the breath in certain areas while avoiding others. But as breath and mind ride together we have the opportunity to recognize the areas of the body we aren’t consciously connecting to. 

Direct Experience Exercise

Practice three different postures that you like and are relatively easy for you. Hold each pose for five to ten breaths. While in each posture pay close attention to your breath—where it is full and easy, where it isn’t. After each posture, reflect and note (either mentally or write it down) before moving on to the next pose. Eventually you may notice a pattern.

If noticing the areas into which your breath doesn’t flow is difficult, try breathing into the nooks and crannies of each posture, for instance, the inside rim of each hip, behind your heart, the right side of your ribs, your kidney area, or the bottom of your pelvic bowl. Be as inquisitive and investigative as possible.

Once you’ve noticed where you don’t breathe so easily, practice poses that open that area of your body, and gently, kindly begin breathing into those areas. Take your time and treat yourself as you would your best friend. If anything emotionally painful comes up, you could try practicing some gentle restorative poses or any other form of conscious relaxation to quiet your nervous system. And if you feel like you’d benefit from talking with someone about it, consider talking with a family member, a friend, or, if you have one, your spiritual teacher or therapist. The tissues of the body hold thoughts and emotions, and we all need support from time to time.

Jill Satterfield is the founder of Vajra Yoga + Meditation, a synthesis of yoga and Buddhism that combines meditation, yoga and contemplative practices. Named “one of the 4 leading yoga and Buddhist teachers in the country” by Shambhala Sun Magazine, Jill has instigated mindful and creative educational programs for over 28 years.

She is also the founder and Director of the School for Compassionate Action: Meditation, Yoga and Educational Support for Communities in Need, a not-for-profit that trains teachers, psychologists and health care providers to integrate mind and body practices into their professions. SCA also provides classes to people in chronic pain, with illness, those suffering from PTSD, and at-risk youth. Jill teaches workshops internationally, is a faculty member of Spirit Rock Meditation Center’s Mindfulness for Yoga Training  and the Somatic Training in Marin, California, and is a guest teacher for many other training programs. To find out more about Jill, visit her website vajrayoga.com.

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Friday Q&A: Is Women's Flexibility a Liability in Yoga? Baxter's Response to William Broad (Rerun)

The Flexible Melina Meza!

Q: So, Baxter, what do you think of William Broad’s latest claim that women’s flexibility is a liability in yoga?

A: Firstly, I want to thank Shari for her level-headed look at New York Times science writer and author of The Science of Yoga William Broad’s most recent assertion that women who do yoga are at great risk of injury due to their flexibility (see Women's Flexibility is a Liability in Yoga).  Thanks, as always, Shari, for your practical experience as a physical therapist and a long-time yoga practitioner and yoga teacher. I think your insights will go a long way in helping clarify articles like these that may have an unstated agenda that colors and lessens their credibility. I’d also direct some of you to this balanced response by yoga teacher Paul Grilley to the article as well. As always, William Broad’s articles do get us thinking and talking about yoga. 

But if I read Broad’s most recent article and his latest assault on yoga accurately, am I to understand correctly that both men’s tightness and women’s flexibility are liabilities in yoga? So is yoga now safe only for animals and children? I have always encouraged men to try yoga because they seem to hold so much tightness in their bodies. And women often master the more challenging poses in yoga from a seemingly more inherent flexibility. But I also have plenty of incredibly flexible male students and an equally large number of stiff and inflexible women in my classes. 

As a yoga teacher and also a student of yoga for several decades, I find most teachers today are cautionary to their students to be mindful of the feedback their bodies give them as they approach more physically challenging yoga poses. And yet, as if to throw one more barb of accusation at yoga and its teachers, the author offers this final warning: Unfortunately, yoga teachers too often encourage students to “push through the pain.” 

With all the supposed statistics the writer offers in the article, none are offered with this statement, and I am not certain where this impression comes from. I know that this can happen in some classes and styles of yoga, but this generalization, I believe, does not represent the overall state of yoga teaching in the US today.

And the tone used by the author implies that he has uncovered some hidden or unknown risk to yoga practitioners, and, more pointedly, women, that some of them could be at risk of hip injuries or impingements. As far back as 2009, the International Journal of Yoga Therapy published an article by Elaine Goodall "Preventing and Healing Injuries in Yoga: Acetabular Labral Tears.” In her detailed article, Ms. Goodall notes that gymnasts and dancers may have a predisposition for these kinds of injuries as well as some in yoga. So much for breaking news! 

One of my difficulties with the statistics—if they can be called statistics—that are offered in the New York Times article to back up the assertion that women are at a significant risk of hip injuries of a very specific kind is statements like this:

“Each year, he (Dr. Kelly) said, roughly 50 to 75 of his patients who danced or did yoga underwent operations. Most, he noted, were women.” 

The author goes to the effort of interviewing a surgeon, getting a guesstimate from said doctor, and never follows up with: how many were yoga related and how many dance related, and how many were a combination (as many yoga students, men and women, danced when younger)? And how many were men? What meaningful conclusions can a yoga teacher make from such superficial exploration?

In addition, the author points to a 2008 study done in Switzerland that looks at the kind of unique arthritis/traumatic changes to the hip called Femoral Acetabular Impingement, or FAI. However, he fails to mention that the women in that study had unusual hip anatomy, considered abnormal, though subtly so. The authors of the study go on to say, “The focus of the new concept (the theory on what underlies FAI) addressed those remaining cases of hip OA (osteoarthritis) in which the deformity (FAI) was considered mild, slight or even, in the eyes of casual observers, nonexistent.” 

So women and men who develop this impingement injury to the hip (prior to starting yoga) already had an anatomical reason that movements in the hip joint could lead to injury. Interesting. Developmental abnormalities that usually arose prior to adulthood were present in most cases. And this kind of FAI occurs in men and women, not women alone. Only once does this study mention that the pincer-type of injury is to women with underlying anatomically abnormal hips. And that these women often participate in “yoga and aerobics.” The authors don’t say the yoga caused the problem. As Paul Grilley so astutely points out, correlation does not mean causation! In fact, yoga is never mentioned again in the fairly lengthy article, and not at all in the final wrap up discussion that usually highlights the facts they find most compelling. They also don’t give statistics that clearly outline what percentage of women, with hip pain that requires surgery, have this kind of injury (FAI). So, again, the practical applicability for us in-the-trenches teachers is very unclear.

And statements like this are just mystifying: “I found that hundreds of orthopedic surgeons in the Mediterranean region heard a conference presentation in 2010 that linked F.A.I. to middle-aged women who do yoga.” If this was true, why does he not cite the study or the “presentation”? What was the presentation based on? Who made the presentation? Was there any study to back up these assertions?

And quotes like this: “Michael J. Taunton, an orthopedic surgeon at the Mayo Clinic, told me that he first learned of the danger a half decade ago and now annually performs 10 to 15 hip replacements on people who do yoga. About 90 percent, he added, are women.” This again does not help me much, as I don’t know how many hip surgeries this doctor does each year (about 20-30 a month, I would guess), so this may represent a small percentage of his annual surgeries, but the way it is presented seems really worrisome, if not epidemic, if you don’t have all the facts.

I have been teaching about the risks and benefits of yoga to future yoga teachers now for over 10 years. Some sort of classroom instruction on the topic is included in many 200-hour beginning level teacher trainings. So, from my personal experience and perspective, the yoga community is aware of potential dangers of certain aspects of the physical practices of asana and is better defining and sharing that information with each passing day.

Despite the author’s initial statements on the wonderful potentials of yoga in the first paragraph, little that follows in his article supports this assertion. I reminded myself that the final chapter of The Science of Yoga does give some insight into the author’s feelings and motivations regarding yoga:

“Yoga can grow up or remain an infant—a dangerous infant with a thing for handguns.” 

And a bit later in the epilogue, when discussing his concerns for the commercialization of yoga, he seems to pushing for huge government oversight of yoga with the following:

“Imagine if Big Pharma had no Food and Drug Administration and other regulatory agencies looking over its shoulder. The marketing of fake diseases and bogus cures…would be much worse.” 

And in the time since the release of his book, the three articles Mr. Broad has published have only dealt with potential negative aspects of yoga: the two on the dangers of yoga to men and women and one on the sexual scandals of yoga teachers.

How about a story from this self described yoga practitioner on the benefits of yoga next next time instead of sensationalist fearmongering?

—Baxter

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Is Women's Flexibility a Liability in Yoga? Shari's Response to William Broad (Rerun)

by Shari

The latest New York Times article from William Broad Women’s Flexibility is a Liability (in Yoga) sparked a conversation between Nina and me, both whom are long-term yoga practitioners who have grappled with orthopedic injuries. Broad states that he has recently learned that women are at higher risk of hip injuries in a yoga class because of their inherent flexibility compared to men. He quotes a single yoga teacher, Michaelle Edwards, saying that “women’s elasticity became a liability when extreme bends resulted in serious wear and tear on their hips. Over time the chronic stress could develop into agonizing pain and, in some cases, the need for urgent hip repairs.” He also says of arthritis researchers:

The investigators found that extreme leg motions could cause the hip bones to repeatedly strike each other, leading over time to damaged cartilage, inflammation, pain and crippling arthritis. They called it Femoroacetabular Impingement — or F.A.I., in medical shorthand. The name spoke to a recurrence in which the neck of the thigh bone (the femur) swung so close to the hip socket (the acetabulum) that it repeatedly struck the socket’s protruding rim.

I personally can’t stand sensationalism of any type and particularly sensationalism of the fear and scare tactics kind. When I first saw this article, I groaned inwardly. But I then proceeded to read it carefully, including the related links, and then went on to do some additional research of my own. After all that, my response is: maybe.

First of all, I, as a long-term yoga practitioner, am not sure what exactly he means. We all can be overly flexible in some areas of our bodies and conversely overly tight in other areas of our bodies. The biomechanical model of structure and function is a beautiful yin and yang interplay between forces that influence our bodies, and yes, can ultimately change our structure and function. Some changes may not be as beneficial as others so we need to be consciously selective and astute to observe what changes occur with function.

I also think, as in the past, Broad is careless in his citations of his evidence and is vague about these ER records of hip injuries. However, he does cite some orthopedists and one international study that do substantiate his observation that women who put their hips into extreme ranges of motion can injure their hips. Well, this is blatantly obvious to anyone who may be neurologically intact. When a joint is taken into an extreme position there is a pain response recognized by the central nervous system that warns the person to back off. Of course, if we choose to ignore the pain response, then is it the yoga that is causing the injury or is it the person who is foolishly not listening to the feedback their body is providing?

I also think that to address William Broad’s assertion that women are more flexible than men, we need a better working definition of (biomechanical) flexibility:

Flexibility is the range of motion in a joint or group of joints, or, the ability to move joints effectively. Flexibility is related to muscle strength. Flexibility is also the ability to move through a full range of motion.

Flexibility is a conscious movement that has an intricate feedback mechanism between the muscles and the nerves innervating the muscles and the joints and the central nervous system. There are significant protective mechanisms that prevent the individual from overstretching if they PAY ATTENTION to the sensation of pain rather than ignoring it.

So are women “inherently” more flexible than men? Well, it depends who you ask. But all sports attract a body type, and if yoga is considered a “sport” then there is a body type that is drawn to yoga. We all like to do things that are “easy” and for some flexible bodies yoga is “easy.” The rub here is that this isn’t “yoga” but athleticism masquerading as yoga!

So now let us look at his assertion that yoga is the root cause of “femoracetabular impingement”. The literature that I read, including one of his references, states that the subjective symptoms are deep anterior groin pain with associated intermittent catching and locking of the hip joint. In addition, there is a significant decrease in hip internal rotation. The morphology is that there is a breakdown of the hip labrum (how the head of the femur is connected into the cup of the pelvic acetabulum) and the articular surfaces of the femur and acetabulum. There is a structural change in how the head of the femur is sitting and facing, and movement of the hip will continue to tear the tissue structures with a loosening of the integrity of the hip joint. The problem is that a lot of individuals who have this condition are pain free, asymptomatic and don’t know they have it. The concern is that this condition may be a precursor to developing hip arthritis down the road. There are four types of femoracetabular impingement and one type is more common in women and one type more common in men!

Another article that I read stated that the condition is caused by internal rotation of the hip while in 90 degrees of hip flexion. Yes, this can be Uttanasana (Standing Forward Bend)! So is the problem the combination of these two movements? I don’t know, but does that mean you need to stop doing Uttanasana? I don’t think so unless it is causing pain. And, yes, there are some pretty extreme hip positions in yoga which only some of could do when we were younger (maybe can still do them now) but the bottom line is that we need to practice with intention and attention to form, function and our own bodies' abilities and not soldier on through the pain. Yoga, as we have mentioned time and time again, can be physically and mentally challenging, but is not supposed to hurt. So don’t be scared off again by a sensational journalist who claims he is a yogi.

In a future post I would like to present some of the inherent differences between male and female pelvis and hips that might also help to put into perspective the allegation of the differences between men and women.

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