Yoga is physiology's favorite sport. It integrates multiple body systems to improve both physical and mental health by impacting the release of hormones, strengthening muscles and bones, and improving cognitive performance. Yet, health care providers need to be cautious when recommending yoga to their patients.
To start, let me provide a brief history of yoga. Yoga is an ancient practice from India that bloomed sometime between 500 B.C. to 800 A.D. It has since then evolved to include a variety of styles, vigor, audiences, and equipment, but the foundation still utilizes breath work, posture, and discipline (Basavaradii, 2015). Yoga is relevant because you or someone you know may be a yogi. It is also important to understand that different variations of yoga affect people differently.
In a literature review conducted in 2011, Field writes that yoga stimulates pressure receptors under the skin and, in turn, decreases cortisol levels and stimulates the vagus nerve. People who do yoga have reported decreased anxiety, depression, fatigue, and stress, and report fewer sleep problems. Yoga has helped individuals with low back problems and arthritis. In a group of patients with heart failure, yoga had improved their cardiovascular endurance. In another group of patients with heart failure, yoga decreased their cholesterol and triglyceride levels (Field, 2011). The list of health benefits from yoga seems endless.
So, no wonder that more and more providers are turning to yoga to aid them with caring for their patients. Seems simple, right? A patient comes in with high blood pressure and instead of prescribing them Candesartan (8 mg), you send them to CorePower and sooner or later, your patient is in the following pose:
And then they're coming right back to you with neck or hip pain.
A cross-sectional study surveying 1,702 German yogis reported that 20 percent of participants experienced acute injuries. Most common acute injuries were musculoskeletal injuries from head-, shoulder-, and handstands, as well as forward and back bends. Additionally, 10 percent of participants reported chronic injuries. The risk for chronic injuries was higher for people with pre-existing chronic illnesses and for people who practiced yoga on their own. The most common chronic injuries were musculoskeletal injuries of the back, neck, shoulder, and sciatic nerve. Other chronic adverse events included sleep problems, depression, and headaches (Cramer, et al., 2019).
This poses an ethical dilemma for us future providers: to have your patient do yoga and feel good (beneficence), or recommend against your patient doing yoga and... feeling good (non-malfeasance)? Prior to recommending yoga to anybody, it is important to consider any pre-existing health conditions. When recommending yoga, perhaps recommend a less rigorous form (Hatha yoga) over strenuous yoga (Power yoga). If you recommend against yoga, you may recommend another low impact sport, like swimming. As a provider, it is important to stay informed on the latest trends that may impact your patient, like yoga.
References
Basavaraddi, IV. (2015, April 23). Yoga: Its Origin, History, and Development. Public Diplomacy. https://www.mea.gov.in/in-focus-article.htm?25096/Yoga+Its+Origin+History+and+Development#:~:text=The%20practice%20of%20Yoga%20is,first%20Guru%20or%20Adi%20Guru.
Field, T. (2011, October 14). Yoga clinical research review. Complementary Therapies in Clinical Practice. https://doi.org/10.1016/j.ctcp.2010.09.007
Cramer, H., Quinker, D., Schumann, D., Wardle, J., Dobos, G., Lauche, R. (2019, July 29). Adverse effects of yoga: a national cross-sectional survey. BMC Complementary and Alternative Medicine. https://doi.org/10.1186/s12906-019-2612-7
It would be interesting to see if those injuries from people who practiced on their own were a novice or experienced yoga goers primarily. I agree with your recommendation that when considering yoga as a possible treatment you need to consider any pre-existing. For example, elderly patients with calcium deficiencies it would be a good idea to start them off with the less rigorous form of yoga to prevent possible injury and rejection of the treatment altogether.
ReplyDeleteIn recent years yoga has also been incorporated into many professional athletes’ training regiments. Some of the biggest names confirmed using yoga including Lebron James, Aaron Rodgers, and Russell Wilson(Wold, 2022). These athletes use it for a competitive edge and to prolong their careers. Yoga conditioning is good for these athletes’ muscles as well as their minds. It is said to bring calmness and clarity. (Hollingshead, 2002) There is also the belief in injury prevention. Just like pre-game stretching, it is thought that by stretching your muscles as part of your workout you build flexibility and loosen your muscles. Tight muscles are believed to be brittle and lack elasticity. The question becomes, what is the right amount of yoga to achieve the max benefit with reducing the possibility of injury?
Hollingshead, S. (2002). Yoga for sports performance. Advanced Sports Conditioning for Enhanced Performance, 55.
Wold, R. (2022, March 11). 10 pro athletes and teams that practice yoga. Sportsnaut. Retrieved October 2, 2022, from https://sportsnaut.com/xx-pro-athletes-teams-that-practice-yoga/
It seems as though yoga presents with a great variety of benefits, which you mentioned, but can unfortunately include risks to those partaking in the activity, especially older patients or those who have pre-existing conditions. I wonder if different aspects of yoga align with each benefit differently, and, if so, if these can be practiced independently in a way that reduces risk.
ReplyDeleteFor example, in my personal experience with yoga, I felt as though I most strongly benefitted from the stretching portion of the exercise, along with the breathing practice, which I believe helped lower my stress levels during and for some time afterwards. According to Clarke et. al, five minutes of slow and spaced breathing increased parasympathetic nervous system activity and decreased perceived anxiety levels in adults. Steffen et. al highlighted similar breathing techniques may lower blood pressure and aid in lowering heart rate, similar to the effects of stimulating the vagus nerve, which is found to occur within a yoga practice, also. Additionally, you mentioned that yoga is beneficial as it can activate pressure receptors under the skin, leading to a slew of benefits. Recent literature supports the idea that slow breathing may itself improve baroreceptor sensitivity (arterial, at least) (Chacko, 2005).
All of this is to say, I think it may be appropriate to suggest activities with a lower risk (deep breathing, light stretching) in place of yoga for patients whom may benefit from a yoga practice. This could, in turn, allow for similar health benefits, without having your patient injure themselves wrapping themselves into the original pose you mentioned above (phew).
Clark ME, Hirschman R. Effects of paced respiration on anxiety reduction in a clinical population. Biofeedback Self Regul. 1990;15:273–284. doi: 10.1007/BF01011109.
Steffen PR, Austin T, DeBarros A, Brown T. The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure, and Mood. Front Public Health. 2017 Aug 25;5:222. doi: 10.3389/fpubh.2017.00222. PMID: 28890890; PMCID: PMC5575449.
Joseph, C. N., Chacko N. Joseph From the Department of Internal Medicine (C.P., Porta, C., Cesare Porta From the Department of Internal Medicine (C.P., Casucci, G., Gaia Casucci From the Department of Internal Medicine (C.P., Casiraghi, N., Nadia Casiraghi From the Department of Internal Medicine (C.P., Maffeis, M., Mara Maffeis From the Department of Internal Medicine (C.P., Rossi, M., Marco Rossi From the Department of Internal Medicine (C.P., Bernardi, L., Luciano Bernardi From the Department of Internal Medicine (C.P., & Bernardi, C. to L. (2005, August 29). Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension. Retrieved October 3, 2022, from https://www.ahajournals.org/doi/full/10.1161/01.HYP.0000179581.68566.7d
I agree that proper guidance is necessary. One thing that the study done by Cramer et al. study pointed out was that using props significantly decreased the chances of adverse events, so that's just another suggestion providers can keep at the back of their minds.
DeleteI think yoga represents an excellent practice for our physical and mental health. Even just one quick sun salutation cycle leaves me feeling refreshed. Also, the cobra pose and cat and cow is excellent for us modern humans. The cobra pose is basically the complete opposite of our usual sitting position which can do a lot of damage (Levine, 2015). Doing the cobra pose counteracts the effects of prolonged sitting and reduces rounded shoulders and poor posture. Despite all of this, it's important to do everything in moderation! There's a BBC article I linked that talks about the risk that yoga instructors have when it comes to their joints, specifically their hips. It reminds me of a yoga instructor I met about a month ago who stated they can't do yoga anymore after they got both of their hips replaced! Regardless, I don't think patients will have this problem, most people have trouble sticking to even a 10-20 minute routine on a daily basis.
ReplyDeleteLevine, J. A. (2015). What are the risks of sitting too much. Mayo Clinic. Retrieved from http://www. mayoclinic. org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005.
https://www.bbc.com/news/health-50181155
I originally wrote this post because my old masseuse and acupuncturist told me that he sees eight yoga teachers on average every month that need double hip replacements. Thanks for sharing Dorian.
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