Injurious yoga moves and why alignment matters
Yoga is often presented as a safe, gentle form of exercise. Yet, there are many aspects that we need to be aware of, hence this section!
To read: Blog post on what I think of yoga
The lumbar spine
Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management.
https://www.spine-health.com/video/spinal-compression-fracture-video
https://onzspine.com/spine-conditions/spondylolisthesis/
https://www.verywellhealth.com/facet-arthropathy-treatment-190440
To read: Blog post on what I think of yoga
The lumbar spine
Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management.
https://www.spine-health.com/video/spinal-compression-fracture-video
https://onzspine.com/spine-conditions/spondylolisthesis/
https://www.verywellhealth.com/facet-arthropathy-treatment-190440
Six yoga poses and how to make them sustainable
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BRIDGE
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BOAT
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SEATED FORWARD BEND
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PLOW
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SEATED TWIST
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WARRIOR 1
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Hyperflexion = end range of flexion of a joint for the individual (vs end range that is the anatomical norm) - injury causing
Hyperextension = end range of extension of a joint for the individual (vs end range that is the anatomical norm) - injury causing
Capacity of an individual vs what the move requires
The above study doesn't say which particular moves are associated with which injuries.
Two types of injuries:
Axial non-bony injuries - associated with spinal flexion and extension. Soft tissue injuries (nerve, disk, slipped/herniated disk). Most common.
Bony injuries: wedges, compression fractures.
Wedge: a shift in vertebral shape. As you're curling forward (spinal flexion), the anterior surface (front of the vertebra) becomes shorter than the posterior surface (back of the vertebra). See picture below.
1. BRIDGE (modified version that reduces torque compression loads)
Lie down on your back and place a block under your sacrum. => iliacus release. Gently tuck and untuck the pelvis.
Bring knees in - more lower back flexion.
Feet back down. Gently tuck, untuck.
Start lifting pelvis up. Remove the block. Keeping ribs down. You're keeping your pelvis up using the strength in your legs.
Put block up back, higher this time.
With hyperkyphosis, in this simple lying down position, there is hyperextension in the neck. Head has to be supported in a forward head position, to keep ribs down. The shoulders may also have to be supported if there is a high degree of hyperkyphosis (if, with head supported, the ribcage is up)
With a lack of hip extension, focus on the posterior tilt, so you don't increase the lumbar lordosis
Bring knees in. Shift side to side.
Watch the rib thrust when lifting pelvis up.
Reaching one knee away, then the other.
Work within a smaller section of the bridge. Not the full bridge.
Walk shoulders down towards feet. Try to relax the ribs.
If you keep lifting your pelvis with your ribs while keeping the upper part of the thoracic spine fixed, you will be increasing the degree of the hyperkyphosis. You are increasing the cervical flexion.
Go onto the balls of the foot, block high under sacrum, keeping feet pelvis width apart, knees stable, feet pointing forward (watch tibial rotation) = supported bridge practice
See if you can get stay into same height that you can hold actively without the rib thrust. Put something underneath your head to avoid increasing hyperkyphosis. How high can you get using the hips, not the ribcage.
See if you can take the block out. Go down or up, keeping the ribcage down. Scoot shoulders towards feet.
The unmodified bridge creates excessive forces to the spine of someone with hyperkyphosis (+ osteoporosis).
One solution, as above, is to keep the bridge from the ribcage down rather than avoid it altogether (which is what the paper suggests).
Comments: squeezing the glutes doesn't lift the pelvis up in the air. Try it for yourself. You can try squeezing the glutes to go a little higher and help the hamstrings along.
Thoracic vertebrae are fractured the most often. They are the least mobile. There are more of them. They are some of the most taken out of alignment. They are held too rigid. L1 can also be fractured.
Hyperextension of the atlas on the axis
Lie down on your back and place a block under your sacrum. => iliacus release. Gently tuck and untuck the pelvis.
Bring knees in - more lower back flexion.
Feet back down. Gently tuck, untuck.
Start lifting pelvis up. Remove the block. Keeping ribs down. You're keeping your pelvis up using the strength in your legs.
Put block up back, higher this time.
With hyperkyphosis, in this simple lying down position, there is hyperextension in the neck. Head has to be supported in a forward head position, to keep ribs down. The shoulders may also have to be supported if there is a high degree of hyperkyphosis (if, with head supported, the ribcage is up)
With a lack of hip extension, focus on the posterior tilt, so you don't increase the lumbar lordosis
Bring knees in. Shift side to side.
Watch the rib thrust when lifting pelvis up.
Reaching one knee away, then the other.
Work within a smaller section of the bridge. Not the full bridge.
Walk shoulders down towards feet. Try to relax the ribs.
If you keep lifting your pelvis with your ribs while keeping the upper part of the thoracic spine fixed, you will be increasing the degree of the hyperkyphosis. You are increasing the cervical flexion.
Go onto the balls of the foot, block high under sacrum, keeping feet pelvis width apart, knees stable, feet pointing forward (watch tibial rotation) = supported bridge practice
See if you can get stay into same height that you can hold actively without the rib thrust. Put something underneath your head to avoid increasing hyperkyphosis. How high can you get using the hips, not the ribcage.
See if you can take the block out. Go down or up, keeping the ribcage down. Scoot shoulders towards feet.
The unmodified bridge creates excessive forces to the spine of someone with hyperkyphosis (+ osteoporosis).
One solution, as above, is to keep the bridge from the ribcage down rather than avoid it altogether (which is what the paper suggests).
Comments: squeezing the glutes doesn't lift the pelvis up in the air. Try it for yourself. You can try squeezing the glutes to go a little higher and help the hamstrings along.
Thoracic vertebrae are fractured the most often. They are the least mobile. There are more of them. They are some of the most taken out of alignment. They are held too rigid. L1 can also be fractured.
Hyperextension of the atlas on the axis
2. SEATED FORWARD BEND
Create a ramp to sit on in an untucked position (neutral pelvis), so as not to create excessive load on the lumbar spine
Skill of moving forward from your hip
Then move a little from the lumbar spine, not from the thoracic spine (if the aim is to NOT increase the degree of kyphosis)
Head stabilisation - ramping/lengthening the neck, to stabilise the thoracic spine (you can hang from there) so as not to increase the forward bend of the thoracic spine.
Watch out for ribs thrusted forward (shearing)
As you move forward, keep ribcage in line with pelvis
Forward bend standing => greater load
Try a a head ramp, followed by a head hang.
Create a ramp to sit on in an untucked position (neutral pelvis), so as not to create excessive load on the lumbar spine
Skill of moving forward from your hip
Then move a little from the lumbar spine, not from the thoracic spine (if the aim is to NOT increase the degree of kyphosis)
Head stabilisation - ramping/lengthening the neck, to stabilise the thoracic spine (you can hang from there) so as not to increase the forward bend of the thoracic spine.
Watch out for ribs thrusted forward (shearing)
As you move forward, keep ribcage in line with pelvis
Forward bend standing => greater load
Try a a head ramp, followed by a head hang.
3. WARRIOR ONE
Warm-up: forward bend, standing, followed by a couple of lunges - shifting forward and back
Warrior 2: Back foot facing forward, hips pointing forward, knee centered over the ankle (move it back as needed)
For warrior 1, turn back foot a little more forward (less hip external rotation), turn the pelvis towards the front knee (hyperextension of the lumbar spine (deepening of the lordosis) due to lack of hip extension, which is very common)
Focus on neutral pelvis and neutral ribcage, then turn (to reduce the shear)
Decrease the distance between the feet, to decrease the lumbar and lower thoracic loads as it requires less hip extension (meeting the body where it is)
posterior tilt of the pelvis
Keep ribcage and pelvis in line as they move back from the midline
Then add reaching up with the arms, keeping the ribcage down (which is difficult for many)
Practise the individual parts individually.
Don't let your head flop back ("uncontrolled head") - lift your chin a little as you head ramp. Watch the loads on the cervical vertebrae in hyperkyphotic bodies
Sacrum effect of warrior 1 - the more anterior tilt you have, the greater the load on the sacrum. One way to reduce this is to aim for a neutral pelvis.
Watch the torque on the back ankle and knee
Warm-up: forward bend, standing, followed by a couple of lunges - shifting forward and back
Warrior 2: Back foot facing forward, hips pointing forward, knee centered over the ankle (move it back as needed)
For warrior 1, turn back foot a little more forward (less hip external rotation), turn the pelvis towards the front knee (hyperextension of the lumbar spine (deepening of the lordosis) due to lack of hip extension, which is very common)
Focus on neutral pelvis and neutral ribcage, then turn (to reduce the shear)
Decrease the distance between the feet, to decrease the lumbar and lower thoracic loads as it requires less hip extension (meeting the body where it is)
posterior tilt of the pelvis
Keep ribcage and pelvis in line as they move back from the midline
Then add reaching up with the arms, keeping the ribcage down (which is difficult for many)
Practise the individual parts individually.
Don't let your head flop back ("uncontrolled head") - lift your chin a little as you head ramp. Watch the loads on the cervical vertebrae in hyperkyphotic bodies
Sacrum effect of warrior 1 - the more anterior tilt you have, the greater the load on the sacrum. One way to reduce this is to aim for a neutral pelvis.
Watch the torque on the back ankle and knee
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Warrior 2
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Warrior 1
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4. SEATED TWIST
NEUTRAL = place from which you can move the most. Not limited.
If your spine is flexed when sitting on the floor, you won't be able to twist as far.
Sit up on a stack of blankets to create a ramp and find "neutral pelvis" and "neutral ribcage". Head ramping to the best of your ability.
Least mobile vertebrae (thoracic) may be trapped between cervical and lumbar vertebrae, where the twist is happening.
NEUTRAL = place from which you can move the most. Not limited.
If your spine is flexed when sitting on the floor, you won't be able to twist as far.
Sit up on a stack of blankets to create a ramp and find "neutral pelvis" and "neutral ribcage". Head ramping to the best of your ability.
Least mobile vertebrae (thoracic) may be trapped between cervical and lumbar vertebrae, where the twist is happening.
5. BOAT
Start with the click-clack:
Start with the click-clack:
Sit on your sitting bones, then a little further towards the sacrum but not as far back as the sacrum.
Tendency to flex the lumbar spine - best avoided.
Go on your toes and find the point where you can lift them up without rolling into lumbar flexion.
You can hold your legs underneath if it helps.
Practise tucking and untucking.
If you have hyperkyphosis, because so much of your upper body weight is forward, the only way to move will be to flex your lumbar spine. So best avoided as the extra load as you tense your rectus abdominis increases the torque compression.
In the click-clack, the focus is on keeping the chest up, keeping the ribcage down, ramping your head while the pelvis is moving. Then it's a lot easier to find the balance point.
Sit on a stack of blankets or a bolster would help pick the feet up without compressing the spine.
Stay off your sacrum!
! You can have lumbar flexion and rib thrusting at the same time. The head is a giant weight that adds a lot of flexion.
Need to align ribcage with pelvis and ramp the head (chin tuck and lengthening the very top of the neck) to better mind the upper back. = you're learning to stabilise your upper back.
Tendency to flex the lumbar spine - best avoided.
Go on your toes and find the point where you can lift them up without rolling into lumbar flexion.
You can hold your legs underneath if it helps.
Practise tucking and untucking.
If you have hyperkyphosis, because so much of your upper body weight is forward, the only way to move will be to flex your lumbar spine. So best avoided as the extra load as you tense your rectus abdominis increases the torque compression.
In the click-clack, the focus is on keeping the chest up, keeping the ribcage down, ramping your head while the pelvis is moving. Then it's a lot easier to find the balance point.
Sit on a stack of blankets or a bolster would help pick the feet up without compressing the spine.
Stay off your sacrum!
! You can have lumbar flexion and rib thrusting at the same time. The head is a giant weight that adds a lot of flexion.
Need to align ribcage with pelvis and ramp the head (chin tuck and lengthening the very top of the neck) to better mind the upper back. = you're learning to stabilise your upper back.
6. PLOW
Sit on the floor with your feet in front of you, legs straight, and fold forward.
It's a much bigger load in plough and your head is pinned to the ground.
Fold forward without form: flexion of the lumbar spine, of the thoracic spine, of the cervical spine - feel that.
It's the same move in plow, but instead of this curve being generated by the weight of your head and your shoulders against gravity, it's the weight of your lower body pulling all the way over.
Rolling like a ball to get into it gently = can be contra-indicated for spinal compression is not necessarily because of the loads happening against the floor but it's the fact that people will use kyphosis as a propulsion system to get back up, leading with a forward head. The lower body should be the pump, not the head, neck and thoracic spine.
Careful not to throw the head back to initiate the roll! Neck pain is likely, and mid-back pain.
A portion of the plow is the trapeze abdominal exercise - where you hold a belt with arms straight and touch it with straight legs
In a full plow, the injuries are more likely to be at the cervical spine (neck) or thoracic spine (mid back).
Plow forces bodies that don't have a great range of motion into a great range of motion very quickly and under a high (compressive) load.
When using hands to support the back, the load is reduced but the amount of flexion is still (too?) great.
Fused spine - fusion creates stress risers either side of the fused part (articulating surfaces or connective tissue).
Sit on the floor with your feet in front of you, legs straight, and fold forward.
It's a much bigger load in plough and your head is pinned to the ground.
Fold forward without form: flexion of the lumbar spine, of the thoracic spine, of the cervical spine - feel that.
It's the same move in plow, but instead of this curve being generated by the weight of your head and your shoulders against gravity, it's the weight of your lower body pulling all the way over.
Rolling like a ball to get into it gently = can be contra-indicated for spinal compression is not necessarily because of the loads happening against the floor but it's the fact that people will use kyphosis as a propulsion system to get back up, leading with a forward head. The lower body should be the pump, not the head, neck and thoracic spine.
Careful not to throw the head back to initiate the roll! Neck pain is likely, and mid-back pain.
A portion of the plow is the trapeze abdominal exercise - where you hold a belt with arms straight and touch it with straight legs
In a full plow, the injuries are more likely to be at the cervical spine (neck) or thoracic spine (mid back).
Plow forces bodies that don't have a great range of motion into a great range of motion very quickly and under a high (compressive) load.
When using hands to support the back, the load is reduced but the amount of flexion is still (too?) great.
Fused spine - fusion creates stress risers either side of the fused part (articulating surfaces or connective tissue).
General notes
Disconnect between the relaxing effect of a general yoga class and injuries that sometimes emerge.
The aim of a yoga class is rarely to fine-tune the body.
Side-planks - risk for shoulders and wrists.
Population targeted in the paper: a "healthy" population. Post-menopausal women with lower bone density (osteoporosis, osteopenia). 27% have cancer.
The aim of a yoga class is rarely to fine-tune the body.
Side-planks - risk for shoulders and wrists.
Population targeted in the paper: a "healthy" population. Post-menopausal women with lower bone density (osteoporosis, osteopenia). 27% have cancer.
