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A Survey of Musculoskeletal Injury among Ashtanga Vinyasa Yoga Practitioners

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Context: Ashtanga Vinyasa Yoga is a popular and physically demanding Yoga style. Although there is growing concern about the potential risk of injury from Yoga practice, there has been no research to date on the relationship between this form of Yoga and musculoskeletal injuries. Objectives: The first objective of this survey was to determine the proportion of Ashtanga Vinyasa practitioners who are injured and the injury rate per 1,000 hours of practice. The secondary objective was to determine the location, type, and outcome of musculoskeletal injuries. Design: Data was collected via a survey questionnaire from two Yoga centers in Helsinki, Finland and one Yoga center in Tampere, Finland in 2005. All Ashtanga Vinyasa Yoga practitioners at these centers (estimated total of 300) were invited to complete the survey, whether or not they had suffered from injuries. Setting: Certified and authorized Ashtanga Vinyasa Yoga teachers teach at these centers, and they all follow the Ashtanga Vinyasa Yoga method as authorized by the Ashtanga Vinyasa Yoga Research Institute (Director Sri K Pattabhi Jois). Participants: Practitioners (approximate total N = 300) from three different Finnish Ashtanga Vinyasa Yoga centers were invited to complete the questionnaires. Of these, 110 (37%) completed surveys were received. Main outcome measurements: Primary outcome measurements were the number of injured practitioners and injury rate per 1,000 hours of practice. Secondary outcome measurements were the location, type, and outcome of injuries. Results: Of the 110 practitioners surveyed, 68 (62%) reported having had at least one injury lasting longer than one month, and some practitioners reported more than one injury. A total of 107 musculoskeletal injuries were reported. The rate of new practice-related injuries was 1.18 injuries per 1,000 hours of practice. If recurrence of pre-existing injury and non-specific low back pain of unknown origin were included, the injury rate became 1.45 injuries per 1,000 hours of practice. Injuries related to the practice of Yoga were most common in the lower extremities, especially in the hamstrings or knees. None of the practitioners reported suffering permanent impairment from their injuries; however, this may be a consequence of the sampling procedure (see Limitations of the sample and survey, below). Conclusions: Musculoskeletal injuries generally occur during activity, and Ashtanga Vinyasa Yoga is no exception. 62% of survey participants had suffered one or more musculoskeletal injuries that lasted in excess of one month. The three most common injury locations were hamstring, knee, and low back. Implications for Yoga teachers and practitioners are discussed.
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INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008) 59
Research
A Survey of Musculoskeletal Injury among
Ashtanga Vinyasa Yoga Practitioners
Jani Mikkonen, Palle Pedersen, DC, MPhil, DPMSA,
Peter William McCarthy, PhD
Welsh Institute of Chiropractic, University of Glamorgan, Pontypridd, CF37 1DL, Wales, UK
Abstract:
Context: Ashtanga Vinyasa Yoga is a popular and physically demanding Yoga style. Although there is growing concern about
the potential risk of injury from Yoga practice, there has been no research to date on the relationship between this form of Yoga
and musculoskeletal injuries.
Objectives: e first objective of this survey was to determine the proportion of Ashtanga Vinyasa practitioners who are injured
and the injury rate per 1,000 hours of practice. e secondary objective was to determine the location, type, and outcome of
musculoskeletal injuries.
Design: Data was collected via a survey questionnaire from two Yoga centers in Helsinki, Finland and one Yoga center in
Tampere, Finland in 2005. All Ashtanga Vinyasa Yoga practitioners at these centers (estimated total of 300) were invited to
complete the survey, whether or not they had suffered from injuries.
Setting: Certified and authorized Ashtanga Vinyasa Yoga teachers teach at these centers, and they all follow the Ashtanga
Vinyasa Yoga method as authorized by the Ashtanga Vinyasa Yoga Research Institute (Director Sri K Pattabhi Jois).
Participants: Practitioners (approximate total N = 300) from three different Finnish Ashtanga Vinyasa Yoga centers were
invited to complete the questionnaires. Of these, 110 (37%) completed surveys were received.
Main outcome measurements: Primary outcome measurements were the number of injured practitioners and injury rate per
1,000 hours of practice. Secondary outcome measurements were the location, type, and outcome of injuries.
Results: Of the 110 practitioners surveyed, 68 (62%) reported having had at least one injury lasting longer than one month,
and some practitioners reported more than one injury. A total of 107 musculoskeletal injuries were reported. e rate of new
practice-related injuries was 1.18 injuries per 1,000 hours of practice. If recurrence of pre-existing injury and non-specific low
back pain of unknown origin were included, the injury rate became 1.45 injuries per 1,000 hours of practice. Injuries related to
the practice of Yoga were most common in the lower extremities, especially in the hamstrings or knees. None of the practitioners
reported suffering permanent impairment from their injuries; however, this may be a consequence of the sampling procedure (see
Limitations of the sample and survey, below).
Conclusions: Musculoskeletal injuries generally occur during activity, and Ashtanga Vinyasa Yoga is no exception. 62% of
survey participants had suffered one or more musculoskeletal injuries that lasted in excess of one month. e three most common
injury locations were hamstring, knee, and low back. Implications for Yoga teachers and practitioners are discussed.
Keywords: Yoga, musculoskeletal injury, Ashtanga Vinyasa
Acknowledgments: e first author would like to thank Tom Cunningham for help with manuscript preparation and data interpreta-
tion, Juha Javanainen for guiding me on the Ashtanga Vinyasa Yoga path and for help with data collection, Klaus Kautto for help with
data collection, and Drew Heusch for help with data interpretation.
60 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008)
Introduction
Recent research on Yoga has concentrated on its health
benefits and therapeutic effects.
1-4
Although there has been
an increasing amount of research on the physical and thera-
peutic effects of Yoga posture and breathing practices, it ap-
pears that the musculoskeletal risks of Yoga practice have
not been well studied. ere is an increasing awareness of
Yoga-related musculoskeletal injuries in the popular press,
mainly in the U.S. However, most of these reports have been
based on a smaller number of teachers’ personal views and
individual cases.
5-11
Yoga has become increasingly popular in the Western
world in the past ten years,
12,13
with Ashtanga Vinyasa Yoga
becoming one of the most popular Yoga styles. is style
of Yoga emphasizes the importance of standardized physical
posture practice with synchronized breathing.
14
ˉ
18
In recent
decades, teachers have been certified and/or authorized by
the director of the Ashtanga Vinyasa Yoga Research Institute,
Sri K Pattabhi Jois. Certified or authorized teachers in
Europe can be found in 15 countries, including Finland.
19
e Ashtanga Vinyasa Yoga School of Finland is lead by
certified and authorized Ashtanga Vinyasa Yoga teachers,
and the documented and traditional Ashtanga Vinyasa Yoga
method is followed in the Yoga schools that were involved
in this study.
e rigid adherence of Ashtanga Vinyasa Yoga practitio-
ners to a standardized and documented posture series makes
it a strong candidate for scientific study. However, research
into Ashtanga Vinyasa Yoga appears to be limited to two re-
cent studies. One study concluded that practitioners bene-
fited from statistically significant improvements in muscular
strength in the upper body and core, endurance, flexibility,
and health perception, as well as decreased diastolic blood
pressure and perceived stress, in a six-week period of regu-
lar practice.
3
A second study reported that heart rate dur-
ing Ashtanga Vinyasa practice can be compared to heart rate
during moderate exercise, and therefore possibly leading to
improved cardiac and respiratory fitness.
4
e Present Study
e primary objective of this study was to survey the in-
jury rate among current Ashtanga Vinyasa Yoga practitioners
in Finland, and, further, to determine the rate of injuries
per 1,000 hours of practice. We chose to limit the survey
to musculoskeletal injuries with at least a one-month dura-
tion, to place more emphasis on longer duration injuries.
Short-lived “injuries from Yoga practice or other activi-
ties can change presentation and come and go without an
obvious reason. We also wanted to exclude from the study
short-term overuse pain such as delayed onset muscle sore-
ness (DOMS), which is a regular occurrence in any exercise
program.
20
e secondary objective of this study was to
determine the location, type, and outcome of musculosk-
eletal injuries in this population. We conducted a survey of
participantshistory of musculoskeletal injuries during the
previous three years, irrespective of cause. e survey speci-
fied that all injuries listed should be musculoskeletal injuries
of more than one month duration and have occurred during
the participant’s period of Ashtanga Vinyasa Yoga practice.
e survey questionnaire adhered to the guidelines stated
in the Epidemiology of Sport Injuries categorization sys-
tem.
21
e study was ethically reviewed and approved by
the research project module team at the Welsh Institute of
Chiropractic (WIOC), University of Glamorgan.
Methods
Participant Recruitment
Retrospective reports of injuries were collected from
students at the Yoga schools of Helsinki and Tampere dur-
ing the period of January 6, 2006 to May 20, 2006. We
also posted advertisements about the survey in the areas
around the Helsinki and Tampere Yoga schools. e poster
included contact details, stipulated the voluntary and con-
fidential nature of study, and stated the aim (prevalence of
musculoskeletal injuries incurred by Ashtanga Vinyasa Yoga
practice) and target participants of the survey. e posters
and information section attached to the questionnaire ex-
plicitly requested that all practitioners complete the survey
whether you have or have not suffered any injuries.e
questionnaires were anonymous, and the Yoga teachers at
the centers were not aware of who had completed a ques-
tionnaire and who had not. ere was no time limit or pres-
sure placed on participants, as the completed questionnaires
could be placed into a collection box in the communal areas
at any time during the collection period (16 weeks).
Participant Selection
Practitioners were required to meet the following inclu-
sion criteria:
Because previous reports have cited incompetent teach-1.
ers and/or unregulated Yoga teaching qualifications as
the most common causes of Yoga injury,
7,8
we limited
the study to participants who were practicing under
the guidance of a certified or authorized teacher in the
Ashtanga Vinyasa Yoga method of Sri. K. Pattabhi Jois.
61INJURY AMONG ASHTANGA VINYASA PRACTITIONERS
e practitioners needed to have practiced for at least 2.
one hour, twice a week, for more than six months. ese
criteria were used to ensure that practitioners were pri-
marily following the Ashtanga Vinyasa Yoga method,
and not cross-training with other Yoga styles or differ-
ent physical exercises. e criteria also excluded practi-
tioners who had limited experience of regular Ashtanga
Vinyasa Yoga practice.
Based on conversations with teachers of Ashtanga
Vinyasa Yoga in Finland, the number of practitioners meet-
ing the inclusion criteria was approximately 300 at the time
of the survey. 112 questionnaires were returned. Two ques-
tionnaires were excluded due to incomplete or missing data,
leaving a sample size of 110 practitioners.
Measures and Survey Design
e survey questionnaire was first prepared in English
and then translated into Finnish. e translation was made
by a Finnish and English language specialist. Face valid-
ity and translation accuracy were assessed by two Ashtanga
Vinyasa Yoga practitioners, who fulfilled the inclusion crite-
ria of the study and were fluent in Finnish as well English.
e questionnaire had four sections: Section A was de-
signed to gather general demographic data about the partici-
pants, such as age and sex. Section B asked about aspects of
the participants’ Yoga history, including the Ashtanga Vinyasa
Yoga school where the student practiced, and the number
of years and frequency of regular practice. Section C was
concerned with musculoskeletal injuries that had persisted
for more than one month. Space was made available for the
description of up to seven different injuries. Participants were
asked to specify the location of injury by choosing among the
following categories: 1) Head and trunk, sub-divided into
head, neck, upper back, middle back, low back, chest, and
ribs; 2) Upper extremity, sub-divided into shoulders, elbows,
wrists, hands, and fingers; and 3) Lower extremity, sub-di-
vided into hips, upper thighs, hamstrings, knees, ankles, feet,
and toes. e side of the injury was also specified; that is, left,
right, or both sides of the body. e type of injury was divided
into sprain, strain, dislocation (including intervertebral disc
injuries), bone fracture, abrasion, concussion, and other inju-
ry types. If other injury typewas specified, more details were
requested. If the injury had occurred before starting Ashtanga
Vinyasa Yoga practice, it was categorized as a recurrent, old
injury. ere was an additional section concerned with injury
outcome (divided into full/partial recovery or permanent im-
pairment). Section D was for further, open-ended comments
relating to any injury in section C and for injuries that were
not included within the scope of this report.
Data analysis
Research into the epidemiology of sports injuries
commonly cites both injury rate per practitioner (point
prevalence) and injury rate per 1,000 hours of practice.
We conducted both types of analysis. To determine injury
rate per 1,000 hours, the total number of hours practiced
was calculated from the participants’ self-report of practice
time by multiplying the average number of weeks of regular
practice by the frequency of practice per week. e average
practice time was taken as 1 hour. e data was statistically
analyzed using SPSS version 14.0 for Windows.
Results
112 questionnaires were returned. Two questionnaires
were excluded due to incomplete or missing data, leaving a
sample size of 110 practitioners. As the number of practi-
tioners meeting the criteria for inclusion in this survey was
estimated at 300 in 2005, the estimated response rate was
37%. Of these respondents, 31 were male and 79 female.
e age distribution is shown in Table 1. e mean age for
this group was 35.9 (± 10.8) years.
Table 1. Age distribution of the respondents.
Age in years 16-30 31-40 41-50 51-65
Number of
respondents
46 34 18 12
e mean years of Ashtanga Vinyasa Yoga practice was
2.54 (+/-1.1) years, with a range from 6 months to 8 years.
e mean frequency (times per week) of Ashtanga Vinyasa
Yoga practice was 3.59 (+/-1.2) times per week, with a range
from 2 to 6 times per week. e level of Ashtanga Vinyasa
Yoga practice ranged from first (primary) series through ad-
vanced series, with the majority of participants practicing
primary series.
Sixty-eight of the 110 participants (62%) reported hav-
ing had at least one injury, with the total number of injuries
among participants being 107. Eleven of these injuries were
re-occurrences of old injuries (pre-Ashtanga Vinyasa Yoga).
e distribution of injuries per respondent was as follows:
42 reported no injury, 40 reported only 1 injury occurrence,
22 reported 2 injuries, 5 reported 3 injuries, and only 2
respondents reported 4 injuries. None of the respondents
reported suffering more than 4 injuries. Table 2 shows the
distribution of injuries according to the level/series of prac-
tice, ranging from level 1 (partial primary series) through
level 4 (advanced series). e most common site of injury
62 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008)
Table 2. Distribution of injuries by level of practice. Levels 1
and 2 refer to primary series, and levels 3 and 4 refer to in-
termediate or advanced series. Number of injuries reported
refers only to injuries of greater than 1 month duration.
Sprains (n = 29) and strains (n = 34) were the most
common form of injury, with a small number of disloca-
tions (n = 2) and abrasions (n = 1), but no bone fractures
or concussions. e most common injury was hamstring
sprain or strain (n = 28). e majority of hamstring-injured
practitioners (70%) were practicing at the primary series
level only. Forty-one injuries were reported in the other
injury” category. Nineteen (20%) low-back injuries were
placed in this category, and further described as unspecific
pain of unknown origin.
Fifty-four respondents reported a full recovery of all in-
juries, and 53 respondents reported a partial recovery (i.e.,
healing in progress). ere were no reports of any perma-
nent impairment.
Discussion
Injury Rates
Although this study has a number of limitations, it is
the first to estimate the injury rate in those people actively
participating in this physically demanding style of Yoga
under appropriate training. At first glance, the rate of injury
found here appeared to be high. A large proportion of the
practitioners (62%) reported having a Yoga-related injury of
more than one months duration, and the risk of new injury
or re-injury was 1.45 per 1,000 hours of practice.
When putting this data into perspective, it must be re-
membered that both non-specific low-back pain and injuries
that were incurred before starting Ashtanga Vinyasa practice
may be seen as general problems in the population, and not
specifically related to Yoga practice. Indeed, on this basis it
might be justifiable to remove them from the estimate of in-
jury rates. When these types
of injury were excluded,
the risk of injury was 1.18
per 1,000 hours of practice,
which is probably more
reflective of the actual in-
jury rate related to Ashtanga
Vinyasa Yoga practice.
e relative importance
of these figures can only be
appreciated when seen in
light of comparison with
data on injury rates from
other activities. For example,
the Study of Active Living
Risks in Finland
22
looked at
activity-related injuries in a
randomly selected cohort of
3,363 participants (ages from15-74 years). Participants were
followed over a one-year period, and a wide range of ac-
tivities were tracked, including walking, cycling, gardening,
home repair, hunting, fishing, golf, dancing, swimming, and
rowing. For everyday activities (such as walking, cycling,
and gardening), the risk of injury ranged from 0.19 to 1.5
per 1,000 hours of activity. For athletic activities, the risk of
injury was much higher, ranging from 6.6 to 18.3.
e main methodological difference between the Study
of Active Living Risks in Finland
22
and our survey is that
participants were interviewed by phone on three occa-
sions at four-monthly intervals. Consequently, the results
of that study were presumably less affected by participants
recall bias. e retrospective nature of our study could
Level of practice in series 1 2 3 4
Number of respondents 56 22 21 11
Number of respondents
reporting injury
31 12 18 7
Number of injuries reported 38 26 34 9
was in the lower extremities (69 injuries), followed by the
head and trunk (27 injuries), and upper extremities (11 in-
juries). A more detailed distribution of injuries can be found
in Table 3.
Lower extremity
injuries
Hips Upper
thighs
Hamstrings Knees Ankles Feet Toes
Total = 69 7 0 28 25 5 2 2
Head and trunk
injuries
Head Neck
and
upper
back
Mid-back Low-
back
Chest
and
ribs
Total = 27 0 4 1 20 2
Upper extrem-
ity injuries
Shoulders Elbows Wrists Hands Fingers
Total = 11 6 0 5 0 0
Table 3. Distribution of injury by body region.
63INJURY AMONG ASHTANGA VINYASA PRACTITIONERS
have affected our estimate of injury rate for practitioners.
23
Musculoskeletal injuries of more than one months dura-
tion were chosen because we assumed that these would have
been more memorable than shorter-term transient events.
However, this important difference in study methodology
makes direct comparison of the injury rates for Yoga and
other activities impossible.
Types of Injury
It is interesting to note that the most common injury
reported was hamstring strain or sprain. Most participants
reporting hamstring injuries were practicing the primary
series, which emphasizes forward-bending postures which
in most Yoga systems would be considered advanced. e
reported hamstring sprains and strains could be related to
overuse and overstretching of the hamstrings caused by the
repetitive forward-bending.
Forward-bending is commonly considered a class of
poses that may put the lower back at risk, so it is worth
considering the rate of low-back injuries in our study. Low-
back injuries were reported by 20% of the respondents,
and 19% were classified as non-specific low-back injuries
of unknown origin. A 20% rate of low-back pain compares
favorably to statistics from the general population, where in
one year up to 50% of the population would be expected to
have suffered from an episode of low-back pain.
24
It must
be noted that the percentage of back-pain sufferers in our
sample was based on total injury over slightly more than
three years, rather than one year. Although this could lead
to an overestimate of the size of this problem in Ashtanga
Vinyasa Yoga practitioners, it is interesting to note that the
proportion still compares favorably with expectations based
on population statistics; in fact, this result might suggest
that a slightly lower incidence of back pain is present in this
group compared to the general population.
Limitations of the sample and survey
e response rate (approximately 37%) for our survey
might not represent the total population of Ashtanga Vinyasa
practitioners in Finland. ere was a bias in the sample
toward female respondents (79, in comparison with 31
males). Whether this was representative of the sex distribu-
tion within the Ashtanga Vinyasa discipline is unknown, as
no data on this is available at present. ere was a relatively
short average length of practice (approximately three years),
which could have affected the distribution of expertise
within the group of respondents: 71% had practiced part
or full primary series only, and only 29% had progressed to
intermediate or advanced series.
e injury rate reported by practitioners might have
been affected by a number of other factors. It is possible
that those who had experienced a Yoga-related injury might
have seen this survey as an opportunity to “speak out.
Additionally, those without injury might not have thought
they could add anything to the survey.
25
In an attempt to
address this, the advertising/recruitment posters and invi-
tations emphasized the importance of participation by all
practitioners, irrespective of injury status. However, it is im-
possible to know whether there was a biased response rate
without directly sampling those who did not initially reply.
e validity of self-recall is another methodological
issue to consider. Past reports of self-recall validity have
shown that the longer the time-frame and higher the level of
detail requested, the more the accuracy of recall declined.
23
However, although recall of past injuries is not completely
accurate, in another report 61% of participants showed
completely accurate recall over a one-year period.
23
One issue that cannot be stressed enough is the poten-
tial of this study to under-represent the number of serious
injuries occurring in practitioners of Ashtanga Vinyasa Yoga.
Although no evidence is available to support this, it is likely
that seriously injured practitioners would no longer be at-
tending the Yoga schools. us they would not have been
aware of the survey or included and this therefore leading to
an under-representation of this level of injury.
Conclusions
Musculoskeletal injuries often occur during exercise,
and Ashtanga Vinyasa Yoga appears to be no exception.
e three most common injury locations were hamstrings
(n=28), knees (n=25), and the lower back (n=20). None of
the respondents in the current study reported permanent
impairment from their injuries, but this may have been due
to a sampling anomaly. Although the results of this survey
cannot easily be compared to other studies, it is possible to
conclude that the injury rate and number of injuries per
1,000 hours of practice fall closer to those found for every-
day activities like gardening and cycling than to common
sporting activities such as squash and basketball.
Although the current study does not answer the ques-
tion of risk-to-benefit ratio for Ashtanga Vinyasa Yoga prac-
tice, it did show that the risk of injury is not inordinately
high. Further research is needed to determine the physi-
ological and psychological benefits practitioners of Ashtanga
Vinyasa Yoga experience. Additionally, more appropriate
design for future studies should consider a prospective study
of randomly selected practitioners to increase both accuracy
64 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 18 (2008)
of the information and determine the risk with respect to all
severities of injury.
e results from this survey appear to support the conclu-
sion that Ashtanga Vinyasa Yoga practice under appropriate
supervision does not dramatically increase the risk of injury
to its practitioners. e most commonly reported injuries
(hamstring strains and sprains) may be related to the posture
sequence of the primary series, and appropriate instruction
and practice may reduce this risk. As Ashtanga Vinyasa Yoga
includes standardized series of postures, a greater emphasis
on individual needs and the importance of relaxed non-
goal-oriented practice could prevent some injuries. In the
Ashtanga Vinyasa Yoga schools in Finland, the trend has been
towards emphasising the importance of the internal experi-
ence and mind-body cooperation during practice.
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00358400467324. Email: jani@selkakuntoutus.fi.
... A group of yoga practitioners with diagnosed bipolar disorder had an injury prevalence of 25.6% (Uebelacker et al., 2014). Higher injury prevalence was observed in hot yoga (52.2%) (Mace and Eggleston, 2016) and Ashtanga (61.8%) (Mikkonen et al., 2008) practices. This wide range of injury prevalence reflects differences in practice intensities, frequency, and how studies defined an injury as well as specific population subsets and geographical locales that could influence injury outcomes. ...
... Sprains and strains tend to be the most common injuries sustained during yoga (Cramer et al., 2018(Cramer et al., , 2019Mikkonen et al., 2008;Swain and McGwin, 2016;Wiese et al., 2019). The knee joints, hamstrings muscle group, and hip joints are regularly documented injury sites, and some studies estimate that these regions account for between one third to over half of yoga injuries (Fishman et al., 2009;Mikkonen et al., 2008;Wiese et al., 2019). ...
... Sprains and strains tend to be the most common injuries sustained during yoga (Cramer et al., 2018(Cramer et al., , 2019Mikkonen et al., 2008;Swain and McGwin, 2016;Wiese et al., 2019). The knee joints, hamstrings muscle group, and hip joints are regularly documented injury sites, and some studies estimate that these regions account for between one third to over half of yoga injuries (Fishman et al., 2009;Mikkonen et al., 2008;Wiese et al., 2019). Understanding mechanisms of these injuries and effective methods to reduce injury risks would benefit the entire yoga community and allow many more people to enjoy the benefits of yoga. ...
Article
Background Limited biomechanical data exist describing how yoga asanas (postures) load the limbs and joints, and little evidence-based recommendations for yoga injury prevention are available. This study aimed to establish joint loading metrics for an injury-prone, yet common yoga pose, the Triangle asana (Trikonasana) by identifying how stance width adjustments alter lower extremity loading. Methods Eighteen yoga practitioners underwent 3D motion analysis while performing Trikonasana with self-selected (SS) stance width and −30, −20, −10, +10, +20, and +30% of SS stance width. Ground reaction forces (GRFs), joint forces, and joint moments were calculated for the leading and trailing limb ankle, knee, and hip. One-way repeated-measures analysis of variance determined differences in loading due to stance width. Results GRFs, net joint forces, and net joint moments were significantly affected by stance width where increasing stance width increased leading limb loading but decreased trailing limb loading. Conclusions Altering stance width of Trikonasana influences lower extremity limb loading, and these loading responses were limb-dependent. Yoga practitioners and instructors can use this information to objectively support increasing or decreasing stance width to reduce or increase limb loading according to their goals or to make accommodations to groups such as beginners or at-risk populations for safer, more accessible yoga practices. Cuing a wider or narrower stance width will not have the same effect on both limbs.
... Ashtanga Vinyasa Yoga (Ashtanga for short) is a popular and physically demanding yoga style [33][34][35]. It is known for its vigorous flow, which may be why some adaptations of the practice are known as power yoga [36]. ...
... It is known for its vigorous flow, which may be why some adaptations of the practice are known as power yoga [36]. In Ashtanga, physical postures (asanas) are linked by flowing movements (vinyasas) and synchronous breathing techniques (pranayama) [35][36][37]. An Ashtanga session begins with sun salutations as a warmup, followed by a predefined sequence of postures, and a closing sequence. ...
... Due to this highly focused attention during bodily movements, yoga is often called "meditation in motion" [30]. The rigid adherence to a standardized and documented posture series makes Ashtanga a strong candidate for scientific study [35]. ...
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Functional near-infrared spectroscopy (fNIRS) is often praised for its portability and robustness towards motion artifacts. While an increasing body of fNIRS research in real-world environments is emerging, most fNIRS studies are still conducted in laboratories, and do not incorporate larger movements performed by participants. This study extends fNIRS applications in real-world environments by conducting a single-subject observational study of a yoga practice with considerable movement (Ashtanga Vinyasa Yoga) in a participant’s natural environment (their apartment). The results show differences in cognitive load (prefrontal cortex activation) when comparing technically complex postures to relatively simple ones, but also some contrasts with surprisingly little difference. This study explores the boundaries of real-world cognitive load measurements, and contributes to the empirical knowledge base of using fNIRS in realistic settings. To the best of our knowledge, this is the first demonstration of fNIRS brain imaging recorded during any moving yoga practice. Future work with fNIRS should take advantage of this by accomplishing studies with considerable real-world movement.
... Systematic reviews have summarized yoga safety findings from case reports [17], longitudinal studies [20], and randomized controlled trials [21]. Further cross-sectional studies have also been conducted to capture adverse reactions reported by yoga users themselves [22][23][24], or by data collected routinely in emergency departments [25,26]. However, to date no data on yoga-associated adverse events in Germany were available. ...
... This is the first study reporting adverse effects of yoga in German yoga users. Previous studies have been conducted internationally, and have reported injury prevalence ranging from 2.4% (Australia) [24] to 62% (Finland, 110 participants surveyed) [23]. The differences in reported injury prevalence rates are significant, and are likely to be due to the survey format and the time frame in which participants experienced adverse effects. ...
... Power yoga, a physically demanding yoga style using flowing sequences of yoga postures, was found to be the most associated with adverse effects and was associated with 1.50 injuries per 1000 h of practice in our study. Similar rates of injuries have been reported previously [23]. A common factor with the yoga types associated with the most adverse effects in our study was that they emphasized postures over other aspects such as meditation or breathing exercises (or at least promoted more vigorous physical postures). ...
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Background: While yoga is increasingly used for health purposes, its safety has been questioned. The aim of this cross-sectional survey was to analyze yoga-associated adverse effects and their correlates. Methods: A cross-sectional anonymous national online survey among German yoga practitioners (n = 1702; 88.9% female; 47.2 ± 10.8 years) was conducted from January to June 2016. Participants were queried regarding their yoga practice, i.e. yoga styles used, length and intensity of yoga practice, practice patterns, and whether they had experienced acute or chronic adverse effects of their yoga practice. Independent predictors of acute or chronic adverse effects were identified using multiple logistic regression analyses. Results: Ashtanga yoga (15.7%), traditional Hatha yoga (14.2%), and Sivananda yoga (22.4%) were the most commonly used yoga styles. 364 (21.4%) yoga users reported 702 acute adverse effects, occurring after a mean of 7.6 ± 8.0 years of yoga practice. The most commonly reported yoga practices that were associated with acute adverse effects were hand-, shoulder- and head stands (29.4%). Using Viniyoga was associated with a decreased risk of acute adverse effects; practicing only by self-study without supervision was associated with higher risk. One hundred seventy-three participants (10.2%) reported 239 chronic adverse effects. The risk of chronic adverse effects was higher in participants with chronic illnesses and those practicing only by self-study without supervision. Most reported adverse effects concerned the musculoskeletal system. 76.9% of acute cases, and 51.6% of chronic cases reached full recovery. On average 0.60 injuries (95% confidence interval = 0.51-0.71) per 1000 h of practice were reported, with Power yoga users reporting the highest rate (1.50 injuries per 1000 h; 95% confidence interval = 0.98-3.15). Conclusions: One in five adult yoga users reported at least one acute adverse effect in their yoga practice, and one in ten reported at least one chronic adverse effect, mainly musculoskeletal effects. Adverse effects were associated with hand-, shoulder- and head stands; and with yoga self-study without supervision. More than three quarters of of cases reached full recovery. Based on the overall injury rate per 1000 practice hours, yoga appears to be as safe or safer when compared to other exercise types.
... There is limited published evidence on injury rates and characteristics in yoga. [2][3][4][5][6][7] These include heterogeneous populations of yoga practitioners of various skill levels. [3][4][5][6][7] The majority of yoga injury investigations report mostly lower extremity (LE) injuries. ...
... [2][3][4][5][6][7] These include heterogeneous populations of yoga practitioners of various skill levels. [3][4][5][6][7] The majority of yoga injury investigations report mostly lower extremity (LE) injuries. 4 6 Less frequently reported injuries include upper extremity (UE) injuries. ...
... One study classified an injury as pain lasting >1 month. 6 Another paper qualified an injury as discontinuance due to side effects or an adverse event requiring medical attention. 3 The most basic definition implied was an adverse event causing musculoskeletal pain. ...
Article
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Importance Yoga is a very popular sporting activity across the world. There is limited information on the epidemiology and characteristics of yoga-related injuries. Objective To determine the incidence and prevalence of musculoskeletal injuries sustained in yoga. Evidence review A systematic review was registered with PROSPERO and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Level I–IV evidence studies reporting the incidence and prevalence of musculoskeletal injuries in male and female yoga practitioners were eligible for inclusion. The number and types of injuries were extracted from each study. Duplicate patient populations within separate distinct publications were analysed and reported only once. Injury rates were recorded and calculated on the basis of gender and nature of injury. Incidence was defined as the number of injuries sustained over a specific time duration. Prevalence was defined as the proportion of subjects with an injury at a given point in time. Findings Five studies were analysed that reported injury incidence or prevalence in yoga (7453 subjects). In four of these studies, the type of yoga was not specified, but Mikkonen et al focused solely on Ashtanga Vinyasa practitioners. There were 6544 female (88%) and 909 male (12%) yoga practitioners analysed (49.1±13.6 years of age). The incidence of injury among yoga practitioners was 1.18 injuries per 1000 yoga hours. Only four studies provided prevalence data, displaying 6.6% injury prevalence in 7415 yoga practitioners overall (up to 62% in Ashtanga Vinyasa). Overall, lower extremity injuries comprised 64% of total injuries; specifically the hip, hamstring, knee, ankle, feet and toe. The upper extremity and head and trunk injuries account for 13% and 23%, respectively. Conclusions and relevance There is limited quantity heterogeneous evidence reporting the characteristics of yoga injuries. The overall injury incidence is 1.18 injuries per 1000 yoga hours. The prevalence of injury is poorly characterised. However, the weighted mean prevalence is 7%. The majority of yoga injuries are lower extremity injuries. Level of evidence Level IV, a systematic review of level I–IV studies.
... Although most yoga injuries tend to be minor and patients recover well, there are some who sustain more significant injuries and may not achieve full recovery. 7 Tendon tears of the Achilles, supraspinatus, and peroneus brevis have been reported from yoga participation. 8 Fibrocartilaginous injuries have also been reported, including medial meniscus tears, hip labrum tears, shoulder labrum tears, and lumbar disk annular tears with disk extrusion. ...
... Adverse events often occur in yoga teachers who presumably practice more intensely and more often than do nonteachers. 7 Yoga teacher trainees also appear to be at higher risk, as during training, the duration, intensity, and frequency of yoga practice typically increases. ...
... A pilot experiment of an Ashtanga Vinyasa Yoga practice (ashtanga for short) was conducted to further test robustness and flexibility of the setup in studies with movement. Ashtanga is a moving yoga practice consisting of a standardized sequence of physical postures, connected by flowing movements and synchronized breathing patters, performed the same way every time (Mikkonen et al., 2008). Two participants practiced the half primary series by following instructions from a free online class (Ashtanga Yoga Full Primary Series with Ty Landrum, 2020) in their own living room. ...
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We developed a wearable experimental sensor setup featuring multimodal EEG+fNIRS neuroimaging applicable for in situ experiments of human behavior in interaction with technology. A low-cost electroencephalography (EEG) was integrated with a wearable functional Near-Infrared Spectroscopy (fNIRS) system, which we present in two parts. Paper A provide an exhaustive description of setup infrastructure, data synchronization process, a procedure for usage, including sensor application, and ensuring high signal quality. This paper (Paper B) demonstrate the setup';s usability in three distinct use cases: a conventional human-computer interaction experiment, an in situ driving experiment where participants drive a car in the city and on the highway, and an ashtanga vinyasa yoga practice in situ. Data on cognitive load from highly ecologically valid experimental setups are presented, and we discuss lessons learned. These include acceptable and unacceptable artefacts, data quality, and constructs possible to investigate with the setup.
... These injuries include hamstring tears, spinal stresses, and shoulder dislocations, and can occur during self-practice, when being adjusted, or when doing something else. A survey of 110 certified or authorised Ashtanga teachers in Finland found that 62% had experienced one or more musculoskeletal injury lasting over a month, mostly in hamstrings, knees, and lower back (Mikkonen et al. 2008). ...
Article
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Yoga is widely regarded as beneficial for physical and emotional health, and as a safe ancillary intervention for managing a range of psychological conditions. Evidence of injury, harm, and abuse in yoga traditions is difficult to square with this emphasis on healing. Drawing mainly from on online memoirs by long-term practitioners of Ashtanga yoga, this paper examines the relationship between suffering and healing in yoga, showing how long-term abuse can be perpetuated and injury sustained in a system widely understood and labelled by its practitioners as therapeutic. The paper argues that elements of healing and harm are present in the rituals of practice, the concepts that support it, and the power structure of the Ashtanga system. The system’s organizational dynamics together with a therapeutic discourse that links suffering to its transcendence enabled the same kinds of abuse and trauma that Ashtanga yoga is purported to heal. The analysis raises questions about the overarching narrative of yoga as safe and healthy, and about the connections between healing and harm within therapeutic traditions.
... However, in a national survey of yoga participants in Australia headstands, shoulder stands, lotus (seated crosslegged) position, forward and backward bends, and handstands were reported to be the yoga postures most commonly associated with injuries [10]. In earlier studies, the lotus position was in particular linked with yoga-related knee injuries due to the shearing forces that it poses on the knee joints increasing the risk of osteoarthritis and meniscal injuries [25,26]. Advanced yoga postures such as headstands and shoulder stands can push the limits of even the most experienced yoga practitioner's flexibility, stability, strength, and endurance. ...
Article
Objectives: Despite being considered a low-intensity exercise, concerns have been raised about the risk of injuries associated with yoga. This study aimed to analyse the characteristics and trend of yoga-related emergency department (ED) presentations from July 2009 to June 2016 in Victoria, Australia. Methods: The Victorian Emergency Minimum Dataset (VEMD) was used to collect the de-identified data. The data were first analysed using descriptive statistics and Spearman`s correlation. Further injury trend was analysed by calculating percentage change of the number of yoga-related injuries during the seven-year study period. Results: There were 118 yoga-related injury cases that significantly (p < .05) increased by 357% from July 2009 to June 2016. Most of the cases were female (n = 96; 81.4%) and between 20-39 years old (n = 68, 57.6%). Most common injuries comprised dislocations/sprains/strains (n = 60, 51.7%) followed by fractures (n = 17, 14.4%), and injury to muscle/tendon (n = 15, 12.7%). Conclusion: The findings warrant future nationwide research as well as an investigation into the risk management strategies of yoga service providers to minimize the risk of injury.
... Seguidas por lesões fibrocartilaginosas em meniscos e discos intervertebrais na região lombar. Mikkonen et al. 6 obtiveram resultados semelhantes em seu estudo, onde 62% dos sujeitos tiveram uma ou mais lesões musculoesqueléticas com duração superior a um mês. Foi observado nesse mesmo estudo que as localizações mais afetadas são isquiotibiais, joelhos e coluna vertebral lombar. ...
Article
O ioga chega ao Ocidente encantando pela beleza estética e benefícios. Porém poucos se dedicam a investigar os riscos desta prática. Alguns estudos demonstram a região lombar e joelho como os mais lesionados, no entanto não há dados sobre o assunto em nossa região. Este estudo se propôs a verificar a incidência e correlações ao risco de lesão e regiões lesadas nesta prática. O método usado foi de um questionário semiestruturado, contendo questões de dados pessoais e da rotina dentro das atividades do ioga, aplicado em praticantes maiores de dezoito anos, de ambos os sexos, já praticando há um mês, no mínimo uma vez por semana, com ou sem lesões. Questionários incompletos ou não datados foram excluídos do resultado da pesquisa. Os resultados da amostra válida de 21 sujeitos mostram uma incidência de lesão em 19,05%, confirmando as regiões de coluna lombar e joelho como as mais lesionadas. Os fatores tempo de prática (p=0,003) e idade (p=0,030) obtiveram uma significância estatística relevante, porém com baixa correlação à lesão (r= -0,347 e r= -0,360, respectivamente). Os achados mostraram que o pouco tempo de prática e praticantes de idade mais baixas têm maiores chances de se lesionarem. Apesar da pesquisa não atingir todos os seus objetivos ela abre caminho para a discussão do assunto para futuros estudos que possam ser mais conclusivos.
Article
Background: The risk of injury from modern yoga asana practice is poorly characterized in the scientific literature, but anecdotal reports in the lay literature and press have posed questions about the possibility of frequent, severe injuries. Design: We performed a cross-sectional survey of yoga asana participants assessing their experience with yoga-related injury, using a voluntary convenience sample. Results: A total of 2620 participants responded to our survey. Seventy-nine percent were between ages 31 and 60 and 84% were female. The majority of respondents lived in North America or Europe. Forty-five percent of participants reported experiencing no injuries during the time they had been practicing yoga. Of those who did experience an injury from asana practice, 28% were mild (e.g., sprains or nonspecific pains not requiring a medical procedure, with symptoms lasting less than 6 months) and 63% were moderate (e.g., sprains or nonspecific pains not requiring a medical procedure, with symptoms lasting from 6 months to 1 year). Only 9% of those reporting injuries (4% of the total sample) had a severe injury. The strongest predictors for increased probability of reporting an injury over a lifetime of yoga practice were greater number of years of practice (p < .0001) and teaching yoga (p = .0177). Other aspects of participant demographics or yoga practice habits were not related to likelihood of reporting a yoga-related injury. Conclusions: We found the number of injuries reported by yoga participants per years of practice exposure to be low and the occurrence of serious injuries in yoga to be infrequent compared to other physical activities, suggesting that yoga is not a high-risk physical activity. More work is needed to clarify the causal relationships between the yoga participant characteristics, the asana practice style, and the risk of significant injury.
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Although yoga is historically a spiritual discipline, it has also been used clinically as a therapeutic intervention. A bibliometric analysis on the biomedical journal literature involving research on the clinical application of yoga has revealed an increase in publication frequency over the past 3 decades with a substantial and growing use of randomized controlled trials. Types of medical conditions have included psychopathological (e.g. depression, anxiety), cardiovascular (e.g. hypertension, heart disease), respiratory (e.g. asthma), diabetes and a variety of others. A majority of this research has been conducted by Indian investigators and published in Indian journals, particularly yoga specialty journals, although recent trends indicate increasing contributions from investigators in the U.S. and England. Yoga therapy is a relatively novel and emerging clinical discipline within the broad category of mind-body medicine, whose growth is consistent with the burgeoning popularity of yoga in the West and the increasing worldwide use of alternative medicine.
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Low participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project. Follow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65-84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected. 54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific. An expression of non-consent does not necessarily mean that a fully informed evaluation of the pros and cons of participation and non-participation has taken place. The meaningfulness of expressions of non-consent may therefore be a cause for concern and should be subject to further research. Many reasons for non-participation may be specific to a particular research topic or population. Information sheets should reflect this by going beyond standardised guidelines for their design and instead proactively seek out and address areas of concern or potential misunderstanding. The use of established behavioural theory in their design could also be considered.
Article
Twenty-six healthy adults age 20–58 (Mean 31.8) participated in six weeks of either astanga yoga or hatha yoga class. Significant improvements at follow-up were noted for all participants in diastolic blood pressure, upper body and trunk dynamic muscular strength and endurance, flexibility, perceived stress, and health perception. The improvements differed for each group when compared to baseline assessments. The astanga yoga group had decreased diastolic blood pressure and perceived stress, and increased upper body and trunk dynamic muscular strength and endurance, flexibility, and health perception. Improvements for the hatha yoga group were significant only for trunk dynamic muscular strength and endurance, and flexibility. The findings suggest that the fitness benefits of yoga practice differ by style.
Article
Yoga is often recommended for stress relief, yet some of the more fitness-oriented styles of yoga can be vigorous forms of exercise. The purpose of this study was to investigate differences in heart rate during the physical practice of yoga postures, breathing exercises, and relaxation. Sixteen participants were led through three different styles of yoga asana practice. Polar S610 heart rate monitors were used to measure one minute average heart rates throughout each session. Repeated measures analysis of variance indicated that there was a significant difference (P<0.05P<0.05) in heart rate between astanga yoga (M=95M=95, SD=12.84) and the other two styles, but not between the hatha (M=80M=80, SD=9.32) and gentle (M=74M=74, SD=7.41) yoga styles. These results indicate that there may be different fitness benefits for different styles of yoga practice.
A comprehensive compilation and critical analysis of injury data from a wide range of sports. For each 24 athletic endeavours, the text details: injury incidence; injury characteristics; injury severity; and injury risk factors. Suggestions for injury prevention and directions for future research are also provided in the sport-specific chapters. Two overview chapters giving a broader perspective on sports injuries cover: injury prevention measures that are applicable across sports; and guidelines for evaluating future research in epidemiology of sports injuries.
Article
Background: Many people stretch before or after engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic performance. This is an update of a Cochrane review first published in 2007. Objectives: The aim of this review was to determine effects of stretching before or after exercise on the development of delayed-onset muscle soreness. Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to 10 August 2009), the Cochrane Central Register of Controlled Trials (2010, Issue 1), MEDLINE (1966 to 8th February 2010), EMBASE (1988 to 8th February 2010), CINAHL (1982 to 23rd February 2010), SPORTDiscus (1949 to 8th February 2010), PEDro (to 15th February 2010) and reference lists of articles. Selection criteria: Eligible studies were randomised or quasi-randomised studies of any pre-exercise or post-exercise stretching technique designed to prevent or treat delayed-onset muscle soreness (DOMS). For the studies to be included, the stretching had to be conducted soon before or soon after exercise and muscle soreness had to be assessed. Data collection and analysis: Risk of bias was assessed using The Cochrane Collaboration's 'Risk of bias' tool and quality of evidence was assessed using GRADE. Estimates of effects of stretching were converted to a common 100-point scale. Outcomes were pooled in fixed-effect meta-analyses. Main results: Twelve studies were included in the review. This update incorporated two new studies. One of the new trials was a large field-based trial that included 2377 participants, 1220 of whom were allocated stretching. All other 11 studies were small, with between 10 and 30 participants receiving the stretch condition. Ten studies were laboratory-based and other two were field-based. All studies were exposed to either a moderate or high risk of bias. The quality of evidence was low to moderate.There was a high degree of consistency of results across studies. The pooled estimate showed that pre-exercise stretching reduced soreness at one day after exercise by, on average, half a point on a 100-point scale (mean difference -0.52, 95% CI -11.30 to 10.26; 3 studies). Post-exercise stretching reduced soreness at one day after exercise by, on average, one point on a 100-point scale (mean difference -1.04, 95% CI -6.88 to 4.79; 4 studies). Similar effects were evident between half a day and three days after exercise. One large study showed that stretching before and after exercise reduced peak soreness over a one week period by, on average, four points on a 100-point scale (mean difference -3.80, 95% CI -5.17 to -2.43). This effect, though statistically significant, is very small. Authors' conclusions: The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.
Article
A past injury history is one of the most commonly cited risk factors for sports injury. Often, injury history data are collected by self report surveys, with the potential for recall bias. To assess the accuracy of a 12 month injury history recall in a population of 70 community level Australian football players. The retrospective, self reported injury histories of 70 community level Australian football players were compared with prospective injury surveillance records for the same 12 month period. The accuracy of the players' recall of the number of injuries, injured body regions, and injury diagnosis was assessed. Recall accuracy declined as the level of detail requested increased. All players could recall whether or not they were injured during the previous year. Almost 80% were able to accurately recall the number of injuries and body regions injured, but not the diagnoses, whereas only 61% were able to record the exact number, body region, and diagnosis of each injury sustained. The findings of this study highlight the difficulty of using retrospectively collected injury data for research purposes. Any injury research relying on self reported injury history data to establish the relation between injury history and injury risk should consider the validity of the self report injury histories.
Article
The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3 657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3 363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1 000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.
Article
Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.
Complementary and alternative medicine (CAM) use by US adults increased substantially between 1990 and 1997, yet little is known about more recent trends. Compare CAM therapy use by US adults in 2002 and 1997. Comparison of two national surveys of CAM use by US adults: (1) the Alternative Health/Complementary and Alternative Medicine supplement to the 2002 National Health Interview Survey (NHIS, N = 31,044) and (2) a 1997 national survey (N = 2055), each containing questions about 15 common CAM therapies. Prevalence, sociodemographic correlates, and insurance coverage of CAM use. The most commonly used CAM modalities in 2002 were herbal therapy (18.6%, representing over 38 million US adults) followed by relaxation techniques (14.2%, representing 29 million US adults) and chiropractic (7.4%, representing 15 million US adults). Among CAM users, 41% used two or more CAM therapies during the prior year. Factors associated with highest rates of CAM use were ages 40-64, female gender, non-black/non-Hispanic race, and annual income of dollar 65,000 or higher. Overall CAM use for the 15 therapies common to both surveys was similar between 1997 and 2002 (36.5%, vs. 35.0%, respectively, each representing about 72 million US adults). The greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine (12.1% vs.18.6%, respectively), and yoga (3.7% vs. 5.1%, respectively),while the largest relative decrease occurred for chiropractic (9.9% to 7.4%, respectively). The prevalence of CAM use has remained stable from 1997 to 2002. Over one in three respondents used CAM in the past year, representing about 72 million US adults.