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The Impact of Hatha Yoga Practice on Flexibility: A Pilot Study
Maja Petrič*, Renata Vauhnik and Miroljub Jakovljević
Cesta v log 24, Ljubljana, Slovenia
*Corresponding author: Maja Petrič, Cesta v log 24, Ljubljana, Slovenia 1351,Slovenia, Tel: +386-31-744-564; E-mail: maja.53c@gmail.com
Rec date: Feb 19, 2014; Acc date: Apr 09, 2014; Pub date: Apr 11, 2014
Copyright: © 2014 Petrič M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited
Abstract
Background: In modern times people have to cope daily with various challenges that can leave an impact on
their body flexibility. Physical inactivity is one of the reasons for the diminishment of our natural body flexibility. The
consequence of physical inactivity is decreased flexibility of soft tissues surrounding joints. Simple yoga techniques
including body postures and breathing techniques can restore natural body flexibility.
Methods: Our study involved 9 young healthy females (mean age 23.8 ± 2.9 years). The training program was
held twice a week over a period of five months. The program included therapeutic yoga exercises, with the aim of
increasing joint mobility as well as stretching shortened skeletal muscles. We used goniometric measurement
procedures for measuring joint mobility (for shoulder, hip and ankle joints), linear measurement procedures for
measuring the active mobility of the thoracolumbar part of the spine and specific assessing tests for evaluating
skeletal muscle shortness. Measurements of body flexibility were taken three times over the five months period.
Results: The results obtained by measuring joint mobility showed significant increase of mobility in elevation
through abduction, shoulder retroflexion, hip flexion, internal and external hip rotation, dorsal flexion and inversion of
the ankle. The mobility of the thoracolumbar part of the spine was increased in all the measured movements: flexion,
extension, lateral flexion and rotation of the spine. There was also a significant improvement in the flexibility of m.
Soleus, m. Gastrocnemius, m. Rectus femoris, knee flexors and m. Pectoralis major. A significant improvement in
body flexibility was also confirmed by the “Back Scratch Test” and the “Sit and Reach Test”.
Conclusion: Improved body flexibility is one of the most obvious and quickly achieved effects of regular hatha
yoga practice. The results of this study confirm that regular practice of yoga has a significant effect on body flexibility
in young healthy women, which is particularly obvious in measurements of the increase of the flexibility of skeletal
muscles.
Keywords: Yoga; Flexibility; Therapeutic effects
Introduction
Regular physical activity is one of the bases of a healthy lifestyle. It
creates and maintains general well-being, physical and mental health,
as well as promoting human performance in all areas of life. Physical
inactivity is one of the reasons for the diminishment of our natural
body flexibility and strength; it dulls our senses and generally reduces
the awareness of our own body. Eventually, all this results in poor
posture, which, by it, can lead to pain and injury. In addition to
reduced physical activity, stress has a large and equally negative impact
on health, and stress is becoming quite common nowadays. We are
not always able to influence the external environment, but we can
control our body, breathing, mind and emotions, and thus can prevent
or at least mitigate the negative effects of stress on our health. This is
probably the most common reason why yoga and other similar forms
of exercise are so accepted and popular in modern societies. Yoga
enables us to reconnect the body, breath and mind into a whole and
thus improve awareness of our own body [1].
Mobility is defined as the ability to move body structures or parts of
the body through the existing range of motion for a functional activity
(functional range of motion) [2]. Mobility referring to the functional
range of motion is strongly associated with joint integrity as well as
flexibility. The term flexibility in this context means the elasticity of
soft tissues that cross or surround joints (muscles, tendons, fascia,
articular capsule, ligaments, nerves, blood vessels, skin), and is
absolutely necessary for painless movement of the body [2]. In most
situations flexibility does not depend solely on the actual length of soft
tissues, for example muscle or muscle fibers forming the muscles. The
length of an active muscle, its tone and the length of its stretch also
depend on proprioceptive nerve endings in the muscle [3]. The length
of stretch, regarding the adequacy, safety and functionality of stretch,
is therefore controlled by the nervous system, which consequently
affects the range of motion of the joint surrounded by the soft tissue
[3].
There can be many different reasons for reduced range of motion,
but one of them definitely is muscle shortness, which occurs as a result
of physical inactivity and putting irregular or excessive pressure on
muscles and other soft tissues crossing or surrounding joints.
However, not all the muscles respond to the above-mentioned
pathological stimuli with shortening. This response is typical for
predominantly tonic, postural muscles whose main function is to
maintain the posture [4]. Another group of muscles, mainly phasic
muscles, is involved in carrying movements in daily activities. Those
muscles respond by weakness under incorrect or excessive pressure
[4]. If there is shortness of tonic muscles, this aggravates the weakness
of phasic muscles, and vice versa. Therefore there has to be a balanced
Alternative & Integrative
Medicine Petric et al., Altern Integ Med 2014, 3:2
http://dx.doi.org/10.4172/2327-5162.1000160
Research Article Open Access
Altern Integ Med
ISSN:2327-5162 AIM, an open access journal Volume 3 • Issue 2 • 160
and coordinated action of both muscle groups for the normal
functioning of the musculoskeletal system.
Improved flexibility is one of the most obvious and quickly
achieved effects of regular yoga practice, since this is based on gradual
stretching of muscle and connective tissue around bones and joints
[5], static retention of yoga poses and movements of joints throughout
the entire existing range of motion [6]. The latter provide straight-line
compression and lubrication of articular cartilage by the synovial fluid,
thereby bringing fresh nutrients and oxygen to those parts of joint
cartilage which are rarely used in everyday activities [6].
In this research we examine the quantitative impact of regular yoga
practice on body flexibility in young healthy females. Most of the
published studies of the impact of yoga practice on flexibility only
measure the general flexibility of the upper and/or lower part of the
body. The most commonly used tests are versions of the “Sit and
Reach Test” [7-10] and the “Back Scratch Test” [8]. Among the studies
taken into consideration none observes changes in mobility of
individual joints by goniometric measurement procedures, isolated
flexibility of the spine or the impact of yoga practice on the flexibility
of individual skeletal muscles.
Materials and Methods
Healthy, young subjects were recruited by flyer from our local
community. No incentives were offered other than the yoga classes
and physiotherapeutic testing. Following approval of The National
Medical Ethics Committee of the Republic of Slovenia, written
informed consent was obtained from 10 young healthy females who
volunteered to participate. All participants were healthy, and did not
present recent skeletal or muscle injuries. Furthermore, all participants
fulfilled the condition for participation in this study, namely that they
had not participated in yoga or any other activities aimed at increasing
flexibility for a period of 6 months prior to the start of our training
program. Nine females (mean age 23.8 ± 2.9 years) completed the
study; one subject dropped out during the second half of the study and
declined to perform last testing.
In present study we performed the so-called hatha yoga. The
training program of hatha yoga was held twice a week (in 75 minutes
sessions) over a period of five months, performed solely for the
purposes of this study. The training was led by certified yoga teachers.
The program included therapeutic yoga exercises aimed at increasing
joint mobility as well as stretching shortened skeletal muscles. Each
training session consisted of 10 minutes of pranayama (controlled
breathing exercises), 10 minutes of warm-up exercises, 45 minutes of
asana practice (yoga poses) and 10 minutes of relaxation.
We used goniometric measurement procedures [11] for measuring
joint mobility. An universal goniometer (Baseline measurement
instruments, ZDA) was used to measure the range of motion at the
shoulder (elevation through anteflexion, elevation through abduction,
retroflexion, internal and external rotation), hip (flexion, extension,
abduction, adduction, internal and external rotation) and ankle joints
(dorsal/plantar flexion, eversion and inversion) bilaterally. All
goniometric measurements were passive, performed by examiner [11].
The active mobility of the thoracolumbar part of the spine was
measured by linear measurement procedures [11]. Flexion, extension
and lateral flexion range of motion recorded was difference between
initial and final measurement of distance between the spinous process
of C7 and S1 vertebra in an erect posture and final flexion/extension/
lateral flexion of the spine. For measuring rotation of the
thoracolumbar spine a measuring tape was aligned with 0 cm at
acromion and maintained against subject's back to pelvic opposite
spina iliaca anterior superior. Rotation range of motion was difference
between length measured at erect sitting posture (initial measurement)
and length measured at end of rotation motion (final measurement)
[11].
Specific muscle length tests were used for evaluating skeletal muscle
shortness [4,11]. For measurement of m. Soleus length the ankle dorsal
flexion with the knee flexed was performed [11]. Same motion, but
with the knee extended, was used for measuring the length of m.
Gastrocnemius. The shortness of m. Rectus femoris was assessing by
knee flexion while hip was extended in supine position [11].
Hamstring muscles (m. Semimembranosus, m. Semitendinosus and
m. Biceps femoris) shortness were assessing with maximal hip flexion
maintaining the knee extended [11]. With shoulder elevation through
abduction we tested the flexibility of m. Pectoralis major [11]. For
subject all motions at muscle length testing were passive, performed by
examiner [11].
We also used the “Back Scratch Test” [11,12] for evaluating overall
shoulder flexibility, and the “Sit and Reach Test” [11,13,14] for low
back and hamstring flexibility. The “Back Scratch Test” involves
reaching behind the head with one hand and behind the back with the
other. We measure the distance between (or overlap of) the middle
fingers behind the back [12]. The “Sit and Reach Test” was performed
by having the subject assume the long sitting posture and reach
forward with both hands as far as possible, not allowing the knees to
flex. A score was given based on the most distant point reached by
both hands [14].
All the above-mentioned measurements of body flexibility were
taken three times over the five months period; first at the beginning of
the training program, next after 2 months of training and finally, at the
end of the 5 months training program. All the measures were taken
prior the yoga session or at least one day after it. Since the flexibility of
soft tissues in women is subject to minimal changes in relation to the
phase of the menstrual cycle [15], we measured all participants in the
same phase of the cycle, on the 6th day of the ovulation.
The results are presented with descriptive statistics (mean range of
motion ± standard deviation (SD)). We compared baseline
measurements to the results obtained after two months of training,
and after five months of training (change of motion in °/cm).
Clinically significant changes in flexibility were ≥ 5°. To analyze the
differences between periods we used the analysis of variance for
repeated measurements (ANOVA, p ≤ 0.05) and Student’s »post hoc« t
test with Bonferroni correction (p ≤ 0.05). The analysis was performed
with the statistical program MedCalc (version 11.1.0.0).
Results
The average attendance at the training was 77.5% (27.9 ± 4.0 hours
of a total of 36 hours of yoga practice). The attendance was higher in
the first part of the training program (before the 2nd measurement).
As shown by the first measurement, all participants had some
deviations from the normal range of motion [11] at the beginning of
the training program (Table 1). For most of the measurements the
flexibility increased steadily on both measured sides and there was a
reduction in the differences between the range of motion on the left
and right measured side through the research.
Citation: Petric M, Vauhnik R, Jakovljevic M (2014) The Impact of Hatha Yoga Practice on Flexibility: A Pilot Study. Altern Integ Med 3: 160. doi:
10.4172/2327-5162.1000160
Page 2 of 5
Altern Integ Med
ISSN:2327-5162 AIM, an open access journal Volume 3 • Issue 2 • 160
The results obtained by measuring joint mobility showed significant
increase of mobility in elevation through abduction, shoulder
retroflexion, hip flexion, internal and external hip rotation, dorsal
flexion and inversion of the ankle (Table 1).
Joint mobility (°) 1. 2. 3.
Shoulder elevation through abduction 164.4 ± 6.2 167.5 ± 8.5 172.5 ± 5.8*
Shoulder retroflexion 44.7 ± 5.4 47.8 ± 4.5 50.0 ± 4.4*
Hip flexion 107.8 ± 7.9 112.8 ± 5.3 114.4 ± 6.4*
Internal hip rotation 38.6 ± 4.3 42.2 ± 5.1 43.9 ± 6.6*
External hip rotation 31.1 ± 3.9 35.0 ± 6.0 36.1 ± 4.9*
Ankle dorsal flexion 7.8 ± 3.0 12.5 ± 6.3* 17.2 ± 6.3*
Ankle inversion 20.0 ± 6.0 24.7 ± 6.8 26.7 ± 6.2*
Table 1: Improvements in mobility (mean values ± SD) of shoulder, hip and ankle joints before training (1. measurement), after two months of
training (2. measurement) and at the end of the 5 months training program (3. measurement).
The mobility of the thoracolumbar part of the spine was increased
in all the measured movements: flexion, extension, lateral flexion and
rotation of the spine (Table 2).
Spine mobility (cm) 1. 2. 3.
Flexion 11.1 ± 1.5 12.0 ± 1.8 12.7 ± 1.6*
Extension 6.9 ± 2.6 7.7 ± 2.0 8.4 ± 2.8*
Lateral flexion 1.2 ± 0.5 1.7 ± 0.6* 2.3 ± 0.7*
Rotation 6.2 ± 1.6 6.9 ± 1.2* 7.2 ± 1.0*
Table 2: Improvements in mobility (mean values ± SD) of thoracolumbar part of the spine before training (1. measurement), after two months of
training (2. measurement) and at the end of the 5 months training program (3. measurement).
There was a significant improvement in the flexibility of m. Soleus,
m. Gastrocnemius, m. Rectus femoris, knee flexors and m. Pectoralis
major (Table 3).
Muscle flexibility (°) 1. 2. 3.
m. Soleus
(ankle dorsal flexion with the knee
flexed)
7.8 ± 3.0 12.5 ± 6.3* 17.2 ± 6.3*
m. Gastrocnemius
(ankle dorsal flexion with the knee
extended)
0.6 ± 2.8 3.9 ± 4.9* 7.2 ± 6.3*
m. Rectus femoris
(knee flexion with the hip extended) 55.6 ± 9.7 58.6 ± 8.1 63.6 ± 6.2*
knee flexors
(hip flexion with the knee extended) 80.3 ± 7.9 93.9 ± 8.1* 102.5 ± 12.7*
m. Pectoralis major
(shoulder elevation through abduction) 164.4 ± 6.2 167.5 ± 8.5 172.5 ± 5.8*
Table 3: Improvements in flexibility (mean values ± SD) of skeletal muscles before training (1. measurement), after two months of training (2.
measurement) and at the end of the 5 months training program (3. measurement).
Citation: Petric M, Vauhnik R, Jakovljevic M (2014) The Impact of Hatha Yoga Practice on Flexibility: A Pilot Study. Altern Integ Med 3: 160. doi:
10.4172/2327-5162.1000160
Page 3 of 5
Altern Integ Med
ISSN:2327-5162 AIM, an open access journal Volume 3 • Issue 2 • 160
A significant improvement in body flexibility was also confirmed by
the “Back Scratch Test” for the upper body and the “Sit and Reach
Test” for the lower body (Table 4).
General flexibility (cm) 1. 2. 3.
Back Scratch Test 4.9 ± 7.5 6.2 ± 6.7* 7.4 ± 6.3*
Sit and Reach Test 0.1 ± 10.0 7.8 ± 8.0* 12.9 ± 6.6*
Table 4: Improvements in general flexibility (mean values ± SD) of the upper and lower part of the body before training (1. measurement), after
two months of training (2. measurement) and at the end of the 5 months training program (3. measurement).
Discussion
Improved body flexibility is one of the most obvious and quickly
achieved effects of regular hatha yoga practice, which was confirmed
also by the results of our study. As found in previous studies, regular
yoga practice helps to increase joint mobility primarily in older people
[16]. Thus in our study, focusing on young and healthy participants, a
significant improvement in joint mobility had not been expected.
However, the mobility of some joints did increase significantly. Given
that the participants were young, healthy persons with no recent
skeletal or muscle injuries, we may assume that the cause of initially
limited joint mobility was not reduced sliding of articulating surfaces.
The reasons can be found in the shortness of the soft tissues
surrounding the joints, especially in reduced skeletal muscle flexibility.
Among all the forms of yoga, hatha yoga is the one that gives the
most priority to the importance of physical fitness. Based on the
interpretation of the word hatha – in Sanskrit the syllable “ha” means
the sun, male energy, strength, and “tha” means the moon, female
energy, flexibility [1] – it can be summarized that hatha yoga is a
dynamic balance between strength and flexibility, which concerns the
physical, mental and also emotional level [1].
Some of the published research papers studied the effect of regular
yoga practice on the general flexibility of the upper and/or lower body.
Some of these studies lasted for 8 weeks [7-9], so their results can be
compared with the results of our first mid-term measurement, which
was also carried out after 8 weeks of practicing yoga. In the above-
mentioned studies lower body flexibility improved by 4.1 cm [7], 0.9
cm (used test version: “Chair Sit and Reach Test”) [8] and 10.0 cm [9]
after 8 weeks of training program. One study also measured flexibility
of the upper body by “Back Scratch Test” and there the increase of
flexibility was 1.3 cm [8]. Our results at the 2nd measurement (after 8
weeks training program) showed for 7.7 ± 5.4 cm greater flexibility in
"Sit and Reach Test" and by 1.3 ± 1.5 cm greater flexibility in "Back
Scratch Test". We found no other similar research monitoring the
impact of regular yoga practice on joint and spine mobility or specific
skeletal muscle flexibility, to compare with the results obtained in this
study.
With yoga practice we can relax many physical dysfunctions and
improve the flexibility of the body. Compared to physiotherapy
procedures, yoga, with its static-dynamic procedures, can also be
discussed as a means of “self-mobilization” of the nervous system and
joints of spine and extremities [17]. In general yoga practice is
performed slowly and gradually, in a closed kinetic chain (specific
poses or static postures), which may include active stretching,
isometric muscle contractions, enhancing concentration and proper
breathing patterns. Conceptually, we can conclude that both
physiotherapy and yoga, each through its own procedures, improve
muscle strength, increase joint mobility and soft tissue flexibility,
mobilize the nervous system, improve body posture, improve
proprioception and thereby encourage better awareness of the body,
releasing trigger points and relieving pain [17]. The National Institutes
of Health (NIH) and the National Center for Complementary and
Alternative Medicine (NCCAM) acknowledged yoga as a form of
complementary and alternative medicine in the category of “Mind and
Body Practices” [18]. According to the NCCAM’s definition yoga
therapy is defined as a process of empowering individuals to progress
toward improved health and well-being through the application of the
philosophy and practice of yoga [19].
In recent years there have been a growing number of studies
showing that regular exercise of hatha yoga increases muscle strength
and flexibility [20]. Of course, various styles of yoga can differ greatly.
And depending on the intensity of each yoga style the effects (e.g.
increase of mobility) can be very different as well. One study compares
the effects of two different styles of yoga: ashtanga and hatha yoga
[21]. Ashtanga yoga is a physically demanding form of yoga in which
the majority of poses are dynamically linked in sequences, such as Sun
Salutation, also used in hatha yoga [22]. The study used the “Sit and
Reach Box” test for measuring the flexibility. A group which had
practiced ashtanga yoga improved the flexibility of the body by 20
percent, while a group which had practiced hatha yoga improved it by
14 percent.
Most of the measurements in our study showed greater
improvement in the first part of the training program compared to the
period between the intermediate and the final measurements. There
may be several reasons for that. Most participants in the study
practiced yoga for the first time. Therefore a possible explanation for
the difference in the progress between the periods is that the
participants’ bodies responded better and more quickly to stretching
and relaxation in yoga practice in the first weeks of training, and then
at some point their bodies got used to this kind of exercise and the
progress slowed. Another reason may be higher attendance in the first
part of the training program (8 percent higher attendance). And the
third reason could be a few days break of guided exercise in the second
part of the research program, because of the holidays.
In terms of increasing flexibility the aim of yoga is not
hypermobility but an adequate level of flexibility enabling us to easier
and better use our muscles in everyday activities. For this we need
appropriate flexibility of muscles that maintain posture (tonic
muscles) and adequately strengthened muscles which are responsible
for the movement of the distal segments of the body (phasic muscles)
[4]. In our study yoga proved an effective form of exercise, at least
from the viewpoint of the postural muscles.
The disadvantages of the majority of research of the effects of yoga
on the body (including ours) are a small sample of subjects, varying
duration of the research and different methods of measuring body
Citation: Petric M, Vauhnik R, Jakovljevic M (2014) The Impact of Hatha Yoga Practice on Flexibility: A Pilot Study. Altern Integ Med 3: 160. doi:
10.4172/2327-5162.1000160
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ISSN:2327-5162 AIM, an open access journal Volume 3 • Issue 2 • 160
flexibility. Therefore it would be important to explore this area
through studies of standard duration using standard measurement
procedures, especially on a larger sample of subjects. It would also be
meaningful to further explore the effects of regular yoga practice on
flexibility as well as its impact on stability and protection of the joints
in which mobility is increasing. Further research into the effects of
yoga practice in various pathologies and injuries meant to enhance the
usefulness of yoga techniques in physiotherapy would also be
welcome.
Conclusion
The results of this study confirm that regular practice of hatha yoga
has a significant effect on body flexibility in young healthy women.
This is particularly obvious in measurements of the increase of the
skeletal muscles flexibility.
Acknowledgements
The author thanks to the Faculty of Health Sciences Ljubljana,
Miroljub Jakovljević, PhD, PT, and Renata Vauhnik, PhD, PT, for
inspiring attitude and professional assistance in the creation of this
research. Special thanks are due to yoga teacher Blaž Bertoncelj who
has enabled the implementation of the training program and take care
of the professional conducting of yoga practice.
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Citation: Petric M, Vauhnik R, Jakovljevic M (2014) The Impact of Hatha Yoga Practice on Flexibility: A Pilot Study. Altern Integ Med 3: 160. doi:
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ISSN:2327-5162 AIM, an open access journal Volume 3 • Issue 2 • 160
