- Table of Contents -

Click on Title to Navigate Directly to Each Section

1. Article Overview | High Level Summary

2. Origins of Modern Yoga| Foundational History

3. Not All Yoga Is Created Equal

4. The Good, Bad, & Ugly of Yoga

5. Recommendations Based on Above Findings

6. Extreme & Improper Movement Do Exist

7. A Realistic Look at Yoga Injuries

8. Yoga as Exercise and Caloric Expenditure

9. Physicians vs. Researchers

10. Narrowing It Down - Making Sense of it all

11. Boundaries of Movement Explained

12. Personal Recommendations

13. Eccentric Isometrics Examples & Yoga Alternatives

14. What about Increasing Mobility and Flexibility?

15. End Range Training & False Assumptions

16. What About PAILS, RAILS & FRC

17. From Chronic to Acute Injuries

18. Personal Findings

19. My Final Suggestions Regarding Yoga

20. Quick List to determine if your yoga instructor is up to snuff

21. The Path Forward

22. Fear Mongering or Thoughtful Admonishments

23. Final Points On Proper Movement, Flexibility & ROM

24. References

Several months ago, I posted a quick write-up on social media about the potential damage that could be caused by extreme yoga movements, flexibility training, mobility drills or any other form of training, including strength training (e.g. ass-to-grass squats), that involves extreme range of motion and pushing one’s mobility boundaries to the limit. While I knew this would inevitably trigger outrage amongst various practitioners, particularly those who advocate extreme mobility, I was pleasantly surprised by the number of positive comments I received from not only from many trainers and fitness enthusiasts but also many yoga practitioners. In fact, I had many yoga teachers and enthusiasts send me emails, messages, and comments expressing how strongly they agreed with my post. Such divergent responses amongst yoga practitioners, trainers, and fitness enthusiasts alike was quite fascinating, prompting me to research this topic further.

This article will highlight my research findings and what I believe to be the truth about yoga, flexibility training, mobility drills, and “range of motion” topics, supported by scientific research, observational data, and my own experiential findings. With that said the topic of yoga will be more heavily emphasized in this article as doing so will inevitably shed greater light on the topics of flexibility, mobility, and “range of motion”.

To understand current methods and practice of modern yoga we must first have a brief understanding of its origins. Although the exact chronology of yoga is not fully known, it appears that yoga dates back at least several thousand years, and was introduced in various regions of India and Asia as a form of meditation, enlightenment, consciousness, and spiritual practice [1, 2]. Additionally, it is thought that exercise and the typical body positions (asanas) we currently associate with modern yoga, played little to no part with the ancient practice of yoga. Instead, ancient yoga emphasized the philosophical, meditative, and spiritual practices of Hinduism, Buddhism, and Jainism. In fact, up until the last century, asanas and even standing positions were not central to any form of yoga despite the many different forms of yoga that evolved over the millennia. Furthermore, yoga as a form of exercise was relatively nonexistent prior to the 1920s – 1950s which is when postures from Hatha yoga began to be blended with gymnastic exercises, and what we now know as Modern Yoga was popularized, eventually making its way into Hollywood circles in the 1960’s.

Simply put, most forms of “modern” exercise-yoga were not developed based on the original tenets of ancient yoga practice nor were they developed based on the fundamental elements of kinesiology such as neuromuscular physiology, biomechanics, functional anatomy, or structural muscular physiology.  Instead, these forms of yoga appear to have evolved through the somewhat haphazard, rather than deliberate, application of various forms of physical activity and exercise to an ancient concept that was designed primarily for meditative purposes, not physical activity.  So yes, to say that modern yoga, as we know it, was developed as a fitness fad is not farfetched. If, in fact, we in the fitness industry wanted to be fair to the ancient practice of yoga and attempt to preserve it’s historical origins, it would be considerate of us to re-label what are “modern yoga” methods and give it a different name that has nothing to do with the ancient practice of yoga. 

That being said, does this suggest that all modern yoga training methods are flawed?  Of course not.  However, it does highlight the fact that many of the positions and poses currently used are not based on the ancient practices they originated from, nor are they grounded in the foundational elements of the science of movement and biomechanics previously mentioned. As a consequence, it’s easy to see that what many of the current modern yoga practices offer is a mixed bag of training methods and results. 

Examining the origins of yoga and its evolution it is clear there are many different forms of yoga that differ significantly from each other both in terms of intensity as well as body positions. As I made quite clear in my original post on social media, when I recommend individuals refrain from certain poses or forms of training, I’m obviously not referring to “all” forms of yoga.  What I’m referring to are the extreme positions oftentimes practiced in modern yoga that have become more and more commonplace over the years. The same goes for other forms of training, be it Pilates, mobility drills, flexibility poses, strength training, gymnastics, or dance etc.  Any form of training that emphasizes extreme range of motion, excessive mobility, over-flexibility, or contortionistic movements with exaggerated positions are movements that trainers, therapists, and practitioners should be careful when teaching and, in fact, in most cases should avoid. 

Now, this inevitably leads to some important questions such as, “is there truly such a thing as excessive ROM?”, and if so “what constitutes as extreme ROM?  Before we answer these questions it’s important to examine the many facets of yoga, including scientific studies, observational data, and my personal experiential findings. These will be broken down into what I refer to as “The Good, the Bad, & the Ugly” of yoga.

The Good

There aren’t just dozens of studies demonstrating the benefits of yoga; there are literally hundreds [3-6].  Some of the benefits range from improvements in stress, anxiety, pain, depression, cardiovascular disease, blood pressure, joint stiffness, respiratory conditions, blood glucose control, diabetes, and more. Additionally, there are countless individual reports from yoga practitioners reporting the benefits they’ve obtained from yoga as well as the positive impact it’s had on others. However, these benefits aren’t unique to the practice of modern yoga.  Research studies indicate similar benefits can also be obtained from many other forms of exercise and physical activity including running, biking, walking, stretching, hiking, strength training, and even gardening [7-11].

The Bad

Although most of the research to date has focused on the many health benefits of yoga as noted above, in recent years the subject of potential risks and injuries from the various forms of yoga practice has come under increasing scrutiny. In fact, a recent report using data from the National Electronic Injury Surveillance System shows the injury rate for yoga per 100,000 participants has been steadily rising over the last two decades [12]. Read more about pain science & injuries here.

A large systematic review published in 2018 showed that compared to non-yoga practitioners, those who practiced yoga had a higher risk of meniscus injuries [13].  Furthermore, compared to non-yoga practitioners, yoga practitioners did not show any less risk of falling or falling-related injuries, suggesting balance and muscle function improvements such as body awareness may not be as strongly correlated with yoga as once thought. Additionally, the study authors reported that a considerable proportion of yoga practitioners experienced injuries or other adverse events, although most of these were relatively mild and similar to those incurred in other forms of exercise.

Another recent study demonstrated that 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 [14]. Additionally, nearly 25% of participants did not achieve full recovery from their injuries.

A study examining Ashtanga Vinyasa yoga found 62% of surveyed 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 [15].

In yet another recent study 55% of yoga participants reported experiencing injuries during the time they had been practicing yoga [16]. Of those who did experience an injury from asana practice, 63% experienced moderate injuries with symptoms lasting from 6 months to 1 year and 28% had mild injuries with symptoms lasting less than 6 months. Additionally, 9% of those reporting injuries had a severe injury. The strongest predictors for increased probability of reporting an injury over a lifetime of yoga practice was greater number of years participating in yoga (i.e. practice and teaching).        

Similar results were reported by Zhu et al. who found that while more time spent participating in yoga may improve body composition (i.e. leanness) it was associated with greater risk of meniscus injuries [17]). In fact, yoga was found to be associated with a higher risk of meniscus injury when compared to badminton, jogging and climbing hills.

That more time spent practicing yoga is associated with greater risk and number of injuries would not be surprising if one considers yoga as a form of exercise. However, viewed as a therapeutic, restorative, or rehabilitative modality, one would not expect it to be associated with an increased risk or number of injuries over time.

Various case studies also provide unique insight into the potential risks of yoga.

When practiced in a population at increased risk of fracture, certain yoga poses may increase fracture risk, particularly at the spine. This is in contrast to recent reports suggesting that daily yoga practice may increase bone mineral density. In one particular study 9 subjects ages 53-87, developed vertebral compression fractures one month to six years after initiating yoga-associated spinal flexion exercises [18].

Another study showed similar findings in several osteopenic patients who were in good health and pain-free prior to participating in yoga [19]. While they initiated yoga exercises to improve musculoskeletal health, new pain and fracture areas occurred after engaging in various yoga exercises, particularly those that involved spinal flexion. The study authors suggested that these risks and adverse effects may be even greater in those with osteoporosis.

These and other research findings have led to the recommendation that individuals, particularly those with increased risk of fracture, e.g. populations with osteopenia and osteoporosis, modify or avoid yoga poses that involve extreme positions with large degrees of flexion and extension of the spine [20].  Unfortunately, even with these precautions and modifications, the main problem lies in the subjectivity of what constitutes an optimal range of motion and extreme range of motion for the spine, not only in these populations but in others as well. The fact that most forms of modern yoga involve positions with significant levels of spinal flexion and extension makes it even more difficult to address such issues.

While not all research on yoga and spinal health is negative, the levels of evidence in support of the use of yoga as treatment for low back pain are not quite as significant as is commonly believed. For instance, a recent large systematic review of yoga as treatment for chronic low back pain found only low certainty evidence that yoga, when compared to non-exercise conditions, produced small improvements in low back pain after 12 months of yoga practice. In contrast, the authors found moderate levels of evidence for the risk of adverse events in yoga participants (primarily increased back pain) when compared to non‐exercise controls [21].

Similarly, when comparing yoga to other forms of non-yoga exercise the authors found very low certainty evidence of little or no difference in back‐related function at three months when comparing yoga to non-yoga exercise. Comparing yoga added to exercise vs. exercise alone, the results of the systematic review found very‐low‐certainty evidence of little or no difference in back‐related function after 10 weeks.

While there was low to moderate evidence suggesting that yoga compared to non‐exercise results in small to moderate improvements in back‐related function and back pain at three and six months, the authors concluded that the effect size for many of the criteria did not meet predefined levels of minimum clinical importance. There was also uncertainty as to whether there is any difference between yoga and other exercise for back‐related function or pain, or whether yoga added to exercise is more effective than exercise alone. Finally, they concluded that while yoga is associated with more adverse events than non‐exercise controls, it may have similar risk of adverse events as other back‐focused exercise.

Taken together, these data suggest that modern yoga is perhaps not the therapeutic modality or source of healing it is believed to be by some, but should be viewed as a form of exercise that, much like other forms of exercise, if taken to extremes or practiced improperly, can have serious adverse effects and result in injury. Read more about pain science, body mechanics, and injuries here.

The Ugly

Based on the previously mentioned studies it’s obvious that while yoga provides many health-related benefits, there are also potential risks. Insight into the nature of the risks can be gained by examining a combination of empirical research, anecdotal evidence, experiential findings, and observational data particularly as reported by researchers, orthopedic surgeons, qualified yoga instructors and experienced health practitioners. This section highlights articles that provide key findings, statements, and quotes from reputable sources, so much so that rather than paraphrasing or summarizing what others have reported, I believe the reader will gain the most insight by reading specific quotes in their original unedited form.  Results are presented in chronological order to illustrate how reports of yoga-related injuries have evolved over the last few decades.

One of the earliest reports in mainstream news regarding the potential ramifications of yoga practice can be found in an article in Time Magazine from 2007 [22].  As reported by author Pamela Paul:

Amy Toosley was standing in a split pose when her yoga instructor gave her leg a little prod. "I heard the loudest pop I've ever heard, and the instructor said, 'Ooh! Good release, huh?'" Toosley recalls. "Not really--I could hardly walk." With her hamstring muscle snapped, Toosley, 32, avoided yoga for the next three months, and almost a year later, she is still in pain.

...Part of the problem is that increasingly, the people teaching yoga don't know enough about it.  Yoga was traditionally taught one-on-one by a yogi over a period of years but today instructors can lead a class after just a weekend course.

The author goes on to highlight several key statements from a reputable yoga instructor:

..."Yoga means bring together mind, body, and spirit, but in Western yoga, we've distilled it down to body," says Shana Meyerson, an instructor in Los Angeles. "That's not even yoga anymore. If the goal is to look like Madonna, you're better off running or spinning."

In an article from the New York Times in 2012 [23], journalist William Broad investigated the potential risks associated with yoga by interviewing several renowned yogis as well as physicians and orthopedic surgeons.  He first reached out to yoga guru Glenn Black, an internationally recognized yoga teacher of nearly four decades, who studied in Pune, India, at the institute founded by the legendary B. K. S. Iyengar. During his interviews Black gave a number of insightful and quite frankly stunning statements.

As reported by Broad:

“Black, I’d been told, was the person to speak with if you wanted to know not about the virtues of yoga but rather about the damage it could do. Many of his regular clients came to him for bodywork or rehabilitation following yoga injuries. This was the situation I found myself in. In my 30s, I had somehow managed to rupture a disk in my lower back and found I could prevent bouts of pain with a selection of yoga postures and abdominal exercises. Then, in 2007, while doing the extended-side-angle pose, a posture hailed as a cure for many diseases, my back gave way. With it went my belief, naïve in retrospect, that yoga was a source only of healing and never harm.

…He gave me the kind of answer you’d expect from any yoga teacher: that awareness is more important than rushing through a series of postures just to say you’d done them. But then he said something more radical. Black has come to believe that “the vast majority of people” should give up yoga altogether. It’s simply too likely to cause harm.

Not just students but celebrated teachers too, Black said, injure themselves in droves because most have underlying physical weaknesses or problems that make serious injury all but inevitable. Instead of doing yoga, “they need to be doing a specific range of motions for articulation, for organ condition,” he said, to strengthen weak parts of the body. “Yoga is for people in good physical condition. Or it can be used therapeutically. It’s controversial to say, but it really shouldn’t be used for a general class.”

“To come to New York and do a class with people who have many problems and say, ‘O.K., we’re going to do this sequence of poses today’ — it just doesn’t work.”

Broad goes on to report some interesting statistical findings related to Black’s statements:

Many come to yoga as a gentle alternative to vigorous sports or for rehabilitation for injuries. But yoga’s exploding popularity — the number of Americans doing yoga has risen from about 4 million in 2001 to what some estimate to be as many as 20 million in 2011 — means that there is now an abundance of studios where many teachers lack the deeper training necessary to recognize when students are headed toward injury. “Today many schools of yoga are just about pushing people,” Black said. “You can’t believe what’s going on — teachers jumping on people, pushing and pulling and saying, ‘You should be able to do this by now.’ It has to do with their egos.”

…When yoga teachers come to him for bodywork after suffering major traumas, Black tells them, “Don’t do yoga.”

“They look at me like I’m crazy,” he goes on to say. “And I know if they continue, they won’t be able to take it.” I asked him about the worst injuries he’d seen. He spoke of well-known yoga teachers doing such basic poses as downward-facing dog, in which the body forms an inverted V, so strenuously that they tore Achilles tendons. “It’s ego,” he said. “The whole point of yoga is to get rid of ego.” He said he had seen some “pretty gruesome hips.” “One of the biggest teachers in America had zero movement in her hip joints,” Black told me. “The sockets had become so degenerated that she had to have hip replacements.” I asked if she still taught. “Oh, yeah,” Black replied. “There are other yoga teachers that have such bad backs they have to lie down to teach. I’d be so embarrassed.”

…Among devotees, from gurus to acolytes forever carrying their rolled-up mats, yoga is described as a nearly miraculous agent of renewal and healing. They celebrate its abilities to calm, cure, energize and strengthen. And much of this appears to be true: yoga can lower your blood pressure, make chemicals that act as antidepressants, even improve your sex life. But the yoga community long remained silent about its potential to inflict blinding pain. Jagannath G. Gune, who helped revive yoga for the modern era, made no allusion to injuries in his journal Yoga Mimansa or his 1931 book “Asanas.”

Broad goes on to give further history of some of the earliest cases of injury relating to yoga as reported by the medical industry and neurophysiologist Ritchie Russell:

… a growing body of medical evidence supports Black’s contention that, for many people, a number of commonly taught yoga poses are inherently risky. The first reports of yoga injuries appeared decades ago, published in some of the world’s most respected journals — among them, Neurology, The British Medical Journal and The Journal of the American Medical Association. The problems ranged from relatively mild injuries to permanent disabilities.

...Once the student gave up the pose, he improved rapidly. Clinicians recorded a number of similar cases and the condition even got its own name: “yoga foot drop.”

…In 1973 Oxford neurophysiologist, W. Ritchie Russell, published an article in The British Medical Journal arguing that, while rare, some yoga postures threatened to cause strokes even in relatively young, healthy people. Russell found that brain injuries arose not only from direct trauma to the head but also from quick movements or excessive extensions of the neck, such as occur in whiplash — or certain yoga poses. Normally, the neck can stretch backward 75 degrees, forward 40 degrees and sideways 45 degrees, and it can rotate on its axis about 50 degrees. Yoga practitioners typically move the vertebrae much farther. An intermediate student can easily turn his or her neck 90 degrees — nearly twice the normal rotation.

Extreme motions of the head and neck, Russell warned, could wound the vertebral arteries, producing clots, swelling and constriction, and eventually wreak havoc in the brain.

Russell also worried that when strokes hit yoga practitioners, doctors might fail to trace their cause. The cerebral damage, he wrote, “may be delayed, perhaps to appear during the night following, and this delay of some hours distracts attention from the earlier precipitating factor.”

Healthy individuals could seriously damage their vertebral arteries, they warned, “by neck movements that exceed physiological tolerance.” Yoga, they stressed, “should be considered as a possible precipitating event.” In its report, the Northwestern team cited not only Nagler’s account of his female patient but also Russell’s early warning. Concern about yoga’s safety began to ripple through the medical establishment.

Broad goes on further to highlight additional findings in the medical field:

“These cases may seem exceedingly rare, but surveys by the Consumer Product Safety Commission showed that the number of emergency-room admissions related to yoga, after years of slow increases, was rising quickly.

... Around this time, stories of yoga-induced injuries began to appear in the media. The Times reported that health professionals found that the penetrating heat of Bikram yoga, for example, could raise the risk of overstretching, muscle damage and torn cartilage. One specialist noted that ligaments — the tough bands of fiber that connect bones or cartilage at a joint — failed to regain their shape once stretched out, raising the risk of strains, sprains and dislocations.

…The respondents noted four cases in which yoga’s extreme bending and contortions resulted in some degree of brain damage. The numbers weren’t alarming but the acknowledgment of risk — nearly four decades after Russell first issued his warning — pointed to a decided shift in the perception of the dangers yoga posed.

Broad continues with additional insight into experiential findings from doctors and yoga practitioners:

“In a 2003 article in Yoga Journal, Carol Krucoff — a yoga instructor and therapist who works at the Integrative Medicine center at Duke University in North Carolina — revealed her own struggles. She told of being filmed one day for national television and after being urged to do more, lifting one foot, grabbing her big toe and stretching her leg into the extended-hand-to-big-toe pose. As her leg straightened, she felt a sickening pop in her hamstring. The next day, she could barely walk. Krucoff needed physical therapy and a year of recovery before she could fully extend her leg again. The editor of Yoga Journal, Kaitlin Quistgaard, described reinjuring a torn rotator cuff in a yoga class. “I’ve experienced how yoga can heal,” she wrote. “But I’ve also experienced how yoga can hurt — and I’ve heard the same from plenty of other yogis.”

…But modifications are not always the solution. Timothy McCall, a physician who is the medical editor of Yoga Journal…

Similar to how the article began, Broad closes with additional insights from Glenn Black:

…“Almost a year after I first met Glenn Black at his master class in Manhattan, I received an e-mail from him telling me that he had undergone spinal surgery. “It was a success,” he wrote. “Recovery is slow and painful. Call if you like.”

The injury, Black said, had its origins in four decades of extreme backbends and twists. He had developed spinal stenosis…Black said that he felt the tenderness start 20 years ago when he was coming out of such poses as the plow and the shoulder stand. Two years ago, the pain became extreme. One surgeon said that without treatment, he would eventually be unable to walk. He would eventually be fine but was under surgeon’s orders to reduce strain on his lower back. His range of motion would never be the same.

Black is one of the most careful yoga practitioners I know. When I first spoke to him, he said he had never injured himself doing yoga or, as far as he knew, been responsible for harming any of his students. I asked him if his recent injury could have been congenital or related to aging. No, he said. It was yoga. “You have to get a different perspective to see if what you’re doing is going to eventually be bad for you.”

Black recently took that message to a conference at the Omega Institute…But his warnings seemed to fall on deaf ears…“My message was that ‘Asana is not a panacea or a cure-all. In fact, if you do it with ego or obsession, you’ll end up causing problems.’ A lot of people don’t like to hear that.”

Although many have been skeptical of these articles particularly due to the extreme positions taken (no pun intended) and statements made by the interviewees, various studies over the last decade appear to confirm many of the observations. A 2012 retrospective analysis of radiologic imaging findings in 38 patients with yoga related injuries found a wide array of injuries throughout the musculoskeletal system [24]. Additionally, the authors note that simply because various positions do not cause immediate pain or acute injury does not necessarily indicate they won’t eventually cause damage or chronic injury: 

Musculoskeletal injuries related to yoga can occur as a chronic repetitive strain injury, an acute event, or a combination of an acute event superimposed on chronic strain. Anatomically, tendons, myotendinous junctions, and fibrocartilages are the most vulnerable structures to injury…Even if a movement or posture does not elicit immediate injury, if performed incorrectly, it can strain structures over time at the weakest point, which eventually may progress to a frank injury.

In a subsequent New York Times article in 2013 [25], journalist William Broad reported additional findings from data he collected from various sources including hospitals and emergency rooms:

…To my surprise, reports from hospital emergency rooms showed that, proportionally, men got injured more often than women and suffered damage that was far worse, including fractures, dislocations and shattered backs.

…the picture of female superiority began to blur when a prominent yoga teacher in Hawaii wrote me about a poorly known threat to women. The teacher, Michaelle Edwards, said that women’s elasticity became a liability when extreme bends resulted in serious wear and tear on their hips. Over time, she said, the chronic stress could develop into agonizing pain and, in some cases, the need for urgent hip repairs. Ms. Edwards sent me her book, “YogAlign.” It described her own hip pain long ago and how she solved it by developing a gentle style of yoga.

Her warning contradicted many books, articles and videos that hailed yoga’s bending and stretching as a smart way to fight arthritic degeneration.

Broad goes on to describe how a number of top surgeons corroborated these findings:

…To my astonishment, some of the nation’s top surgeons declared the trouble to be real — so real that hundreds of women who did yoga were showing up in their offices with unbearable pain and undergoing costly operations to mend or even replace their hips.

“It’s a relatively high incidence of injury,” Jon Hyman, an orthopedic surgeon in Atlanta, told me. “People don’t come in often saying I was doing Zumba or tai chi” when they experienced serious hip pain, he said. “But yoga is common.”

Dr. Hyman said his typical yoga patient was a middle-aged woman, adding that he saw up to 10 a month — or roughly 100 a year. “People need to be aware,” he said. “If they’re doing things like yoga and have pain in the hips, they shouldn’t blow it off.”

Bryan T. Kelly, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan, echoed the warning, saying yoga postures were well known for throwing hips into extremes. “If that’s done without an understanding of the mechanical limitations of the joint, it can mean trouble,” he said in an interview.

The same kind of damage, Dr. Kelly added, can strike dancers who overdo leg motions. Each year, he said, roughly 50 to 75 of his patients who danced or did yoga underwent operations. Most, he noted, were women.

Following the above, Broad decided to dig a bit deeper to gain a more thorough understanding of the topic:

Curious about the back story, I found that medical detectives in Switzerland had pinpointed the origin of the hip trouble more than a decade ago. Arthritis is usually associated with old age, but they discovered it can also strike the young and active.

Women’s hips showed particular vulnerability. By nature, their pelvic regions support an unusually wide range of joint play that can increase not only their proficiency in yoga but, it turned out, their health risks. The investigators found that extreme leg motions could cause the hip bones to repeatedly strike each other, leading over time to damaged cartilage, inflammation, pain and crippling arthritis. They called it Femoroacetabular Impingement — or F.A.I.,

The main investigator was Reinhold Ganz, an orthopedic surgeon at the University of Berne, in Switzerland. Between 2001 and 2008, his team published many studies, the 2008 one noting that women between 30 and 40 years of age whose activities made “high demands on motion” tended to show the hip damage more often. The paper specifically cited yoga.

The discovery resonated. I found that hundreds of orthopedic surgeons in the Mediterranean region heard a conference presentation in 2010 that linked F.A.I. to middle-aged women who do yoga.

Michael J. Taunton, an orthopedic surgeon at the Mayo Clinic, told me that he first learned of the danger a half decade ago and now annually performs 10 to 15 hip replacements on people who do yoga. About 90 percent, he added, are women.

Another complication is that yoga probably does help millions of people cope with arthritis, which can strike not just the hips but fingers, knees and shoulders. Scientists have long reported that yoga’s movements can help fight joint inflammation.

Gentle yoga probably helps the hips, too. But, as Dr. Taunton put it, the bending can become “too much of a good thing.”

Surgeons agree that women who moderate their practice can probably avoid hip trouble.

Unfortunately, yoga teachers too often encourage students to “push through the pain.” That’s not smart. Pain is nature’s warning system. It’s telling you that something has gone awry.

Better to do yoga in moderation and listen carefully to your body. That temple, after all, is your best teacher.

In 2017 another fascinating article was published with a fairly shocking title considering it was published in the popular Magazine, Yoga Journal [26].  However, given the undeniable trend over the prior decade it made sense that even the yoga industry could no longer ignore the problem. The title of the article was  “Why Are So Many People Getting Yoga Injuries?” While the overall gist is fairly straightforward and includes recommendations for avoiding painful positions and painful ROM, progressing slowly through the positions, and finding the right yoga teacher, the article cites additional findings that appear to echo those from the previous articles, as noted in this particular case:

"It was a competitive environment, and I became fairly aggressive in it. I wanted to be really good," Aronson says. "So if something hurt a lot it didn't stop me from trying to do it. I was excited and just wanted to go for it—that's the culture of the gym I was in."

Within six months Aronson had begun to experience the debilitating hip pain that eventually drove her off the mat and into the office of an orthopedic surgeon. The journey, with stop-offs at a variety of alternative and traditional health-care practitioners, was excruciating. "When walking home after a long day, there were times I would be in so much pain I could not breathe," Aronson recalls.

As an MRI confirmed, the source of Aronson's pain was not tendonitis or soft tissue problems—the misdiagnoses of a movement therapist and rheumatologist, respectively—but a torn labrum, the band of fibrous tissue that surrounds the socket of the hip joint. Two weeks after the test, Aronson underwent arthroscopic surgery to repair the tear.

According to Aronson's orthopedist, Dr. Bryan Nestor of the Hospital for Special Surgery in New York, "We can't be sure yoga is what caused it, but the extreme positions of the hip she assumed with yoga postures likely contributed to the injury."

Although the general recommendation by the author is reasonable and appears to be the consensus amongst qualified professionals, i.e. that avoiding pain or painful positions is critical to the practice of yoga, other findings suggest it may not be entirely sufficient.  As noted in several of the previous reports, oftentimes those who are able to achieve the extreme positions most easily, without apparent significant discomfort or acute injuries at the time, are often the one’s who end up doing the greatest damage and injuries to their joints particularly in the form of chronic injuries.

A powerful 2-part article series from one of the nation’s top yoga experts Jill Miller, drives this topic home [27]. In these articles, Miller, who was previously heralded as one of the most flexible and advanced yoga practitioners in the nation, describes her personal journey. She went from practicing extreme yoga poses & stretches daily until these very exercises forced her to have total hip replacement. In her own words;

"When did I first feel the real pain? Somehow I was led to stop stretching myself from limb to limb around 2003/4. That was when I consciously named my work Yoga Tune Up and pulled back on a practice of daily asana (yoga poses). I turned to anatomy texts instead of yogic texts for information. I started working on the particulars of my movements. I had to re-examine my addiction to stretching. My dependency on my yoga practice was shackling me to the mat and consuming up to 2 hours every morning, if I didn’t practice, I didn’t feel right in my skin. Going without my ritual left me feeling unhinged, irritable and anxious. My need to stretch was no longer expanding my mind, it had trapped it."

As odd as this may sound, this “addiction to stretching” appears to be an increasingly common issue not only with yoga practitioners but other athletes, fitness enthusiasts, and even weightlifters. In all likelihood what this illustrates is a phenomenon supported by fundamental principles of neuromuscular physiology [28], i.e. the fact that oftentimes stretching and extreme positions provide only temporary relief, as in the aftermath of stretching the muscles will snap back even more tightly, necessitating another cycle of stretching to again achieve only temporary relief, thereby setting up an endless cycle of, and ‘addiction’ to stretching. 

In the second part of the article series [29], Miller gives more specific information about what led to her yoga-related injury and eventual surgery:

“Those lateral splits. Every damn day I would do lateral splits like a gymnast, sliding my legs apart from one another until at a certain predictable angle the inside of my left hip would audibly POP. There it was, every single day, that familiar pop. That pop caused no pain, but it was not a normal sound. Sure it was “normal” for me, but since it caused no pain, I literally let it slide (well not really slide), I let that joint distract and readjust to the overloaded pressures I enforced day after day, month after month, year after year.

…That hip “pop” was an indicator that I was damaging my hip. I was sliding the femoral head way out of range. It was during that time that I probably began a deformation process that led me where I am today. But my need to stretch and do my routine was my crutch of safety… The demons I ran from inside my head told me to fold, breathe, lengthen, pause, breathe, twist, bend over, lighten up, breathe and rest.

When did I first feel the real pain? I had an on again off again nagging pain that began 7 years ago on the outside of my left hip. My tensor fascia latae muscle would spasm during sleep and it would feel sticky after I sat for long periods of time. Cars and planes were the worst.

…I had a hunch that I might have a labral tear when I started to feel the head of my femur shifting with no borders when I loaded that hip in certain ranges (flexion coupled with adduction.) The golf ball shape of the femur would grind against the acetabulum and make the sound of a giant emery board. None of this shifting was painful, but I knew it was NOT normal.

She goes on to conclude the article series by mentioning how the yoga-related injury and surgery forced her to take a more sound approach to her training & what she refers to as “retiring” many traditional yoga poses. Ironically, if you examine any of her current training methods and videos online, many of her exercises and drills no longer resemble traditional yoga poses but rather basic muscle activation drills & corrective exercises with a slight yoga twist. 

Furthermore, and as previously alluded to in several of the other articles, many of the positions Miller practiced during her early years, didn’t cause pain. Instead it took years for the extreme positions to manifest themselves as chronic injury.  Simply put, current pain levels may not be the best indicators of safe movement or proper exercise protocols but rather an early warning of the need to examine the optimal parameters of movement further so as to specifically lay out exactly what constitutes proper and improper movement. More on this topic in later sections below.

Another article from Medical News Today [30],  highlights similar findings as those previously described, referencing a fairly recent research study by professor Evangelos Pappas [31]. The article cites various statistics, many of which are quite alarming yet also not that surprising given the articles discussed above.  Here are some of the more powerful statements from the author:

Yoga is often hailed as an effective practice for pain relief. A new study, however, notes that yoga can also cause pain, and yoga-related injuries are much more common than one may think.

…The research suggests that every year, more than 10 percent of people who practice yoga in a recreational capacity experience musculoskeletal pain, particularly in the upper limbs, as a result.

What is more, the study found that yoga actually worsens more than a fifth of existing injuries.

Lead study author Prof. Evangelos Pappas, of the Faculty of Health Sciences at the University of Sydney in Australia, and colleagues recently reported their findings in the Journal of Bodywork and Movement Therapies.

... Pappas and team suggests that caution should be applied when practicing yoga, as it could do more harm than good.

The author goes on to give more specific statistics reported from the study:

The data revealed that 10.7 percent of participants experienced musculoskeletal pain as a result of yoga.

..."In terms of severity, more than one third of cases of pain caused by yoga were serious enough to prevent yoga participation and lasted more than 3 months," notes Prof. Pappas.

...For subjects with pre-existing musculoskeletal injuries, around 21 percent of these injuries were exacerbated by yoga participation, the team reports.

…"However people consider it to be a very safe activity. This injury rate is up to 10 times higher than has previously been reported." Prof. Evangelos Pappas

Pappas does report that the incidence of pain caused by yoga (roughly 10%)," is comparable to the injury rate of all sports injuries in physically active populations."

However given yoga is considered by many as a “therapeutic healing modality” rather than a sport, these numbers are somewhat unexpected.

In fact, the authors themselves, while admitting the numbers are still comparable to other sports and forms of exercise state " Yoga participation however, with therapeutic intensions may therefore require a different standard" suggesting that while numbers are comparable to other sports and exercises, these numbers are fairly extreme for a therapeutic modality that's intended to provide a healing effect, joint pain relief, and musculoskeletal rehabilitation.

Furthermore, what makes this study unique is that the rate of yoga-related injuries (10.7%) is substantially higher than most other investigations. However, the researchers are careful to note that all other investigations up to that point had looked only at acute injuries. Including chronic or “gradual & acute onset” in their investigation appeared to double current numbers, likely making the findings more accurate and indicative of current yoga participation. As stated by the investigators:

…There have been few studies on this topic overall and this is the first prospective cohort study to examine musculoskeletal pain and recreational yoga practice.  Prospective cohort studies are uncommon in musculoskeletal epidemiology and the current study design allowed for the examination of incident cases…. additionally a multidimensional definition of musculoskeletal pain related to yoga participation was used.  By examining musculoskeletal pain rather than just acute events, the full spectrum of effects of yoga practice on pain was captured.

A more recent literature review sheds light on potential causes of injury in yoga and possible modifications for preventing them [32].  The article highlights 13 popular yoga asana poses noting the most common injuries associated with each position illustrating the fact that there appears to be enough evidence and data linking various positions with specific injuries. The researchers go on to give further statements that are quite interesting and insightful:

Despite the risk of injury and the relative high percentage of participants who are injured during the practice of yoga, yogis do not appear to abandon the discipline. … less than 1% of those injured during yoga discontinued participation permanently.

…While any style can cause injury, evidence has shown that the more intense forms of yoga are associated with higher rates of adverse events.

The researchers gave additional feedback regarding specific forms of injuries and ways to prevent them:

Participants with preexisting degenerative joint disease are particularly susceptible to spinal injury. Excessive pressure on the intervertebral discs during spinal flexion maneuvers can lead to disc herniation.

…Experts recommend that patients rotate their pelvis and not flex their spine in order to prevent injury. Similarly, twisting positions that combine flexion with rotation put considerable strain on the lumbar vertebrae and can lead to lower back injury.

…Hamstring sprains and strains are some of the more commonly reported yoga injuries. Repetitive forward-bending postures can cause stretching and overuse of the hamstrings. Knee injuries can occur in both standing and seated positions. 

…Due to the wide range of severity of injuries associated with yoga, patients should be monitored until range of motion is restored in their injured body part and the patient is able to withstand the stress of various positions without pain. Any position inducing pain should be avoided.

…For example, a common complaint of yogis seen at our institution is knee pain, specifically with deep knee bends. 

…Modifications of poses should be taught amongst practitioners "Yoga instructors should be prepared with alternative poses when there is a range of abilities within a class."

Perhaps the most recent report in mainstream news that sparked controversy in the yoga world was an article in BBC news from journalist Caroline Parkinson [33]. What’s most fascinating about this article is that it has less to do with fitness enthusiasts and trainees and more to do with yogis and yoga instructors themselves, as there appears to be an increasing number of reported yoga-related injury incidents in this population.

In many ways this seems to highlight the evolution of yoga-related injuries first reported in mainstream media.  Initially, most reports were centered around novice participants who simply “didn’t practice yoga properly”.  However, it was all but inevitable that the effects would reach actual yoga teachers and yoga experts who would eventually suffer similar fates. Simply put, it appears that it was simply a matter of time before many yoga instructors themselves began to experience the negative ramifications associated with extreme positions. This is where it becomes quite obvious that specific guidelines for what’s constitutes proper and improper body positions based on neurophysiology, biomechanics, muscle physiology, and functional anatomy must be defined by both the fitness and yoga industries alike.  As reported by Parkinson:

…Benoy Matthews, a leading UK-based physiotherapist, warns he is seeing increasing numbers of yoga teachers with serious hip problems - many of whom require surgery - because they are pushing their bodies too hard. 

…Mr. Matthews, a specialist hip and knee physiotherapist and member of the Chartered Society of Physiotherapists, says he sees four to five yoga teachers a month.

…He says the problem lies in people repeatedly pushing their bodies into "prescribed" positions, when their physiology prevents it. 

…About half of the teachers he sees simply need advice on how to moderate the "prescribed" yoga positions, so as not to put too much stress on their joints.

Parkinson goes on to highlight that for many instructors modifying various positions may not be enough if damage has already been done.

…But those with more advanced problems need medical treatment and surgery - including total hip replacements.

…Natalie Gartshore has been a yoga teacher for 16 years, She thinks the popularity of yoga means it's effectively a victim of its own success.

"I don't think you're told very much when you're training as a teacher about physiology or anatomy," she says. "There is an overuse issue.

While there is plenty of research, anecdotal support, and experiential evidence, supporting the therapeutic effects of yoga, there’s increasing evidence highlighting the many potential risks and consequences. With that said, based on the above research studies and experiential findings in the various populations of yoga practitioners, here are 7 obvious steps that can be taken to minimize risks and maximize the benefits of yoga:

1. Yoga must be properly modified and customized for each person based on their body structure

2. Individuals practicing yoga should not push through pain and significant discomfort.

3. More gentle forms of yoga appear to be safer while still providing therapeutic benefits.

4. More aggressive forms of yoga may be linked to more frequent and extreme forms of injury.

5. While choosing the proper type of yoga that’s suitable for your body is important, the competency of the teacher is in many ways more important.

6. Poses that involve significant levels of spinal flexion and spinal extension may produce greater risk of injury particularly in individuals who are more prone to spinal injuries. 

7. Yoga is just as much about the mental and psychological benefits as it is about the physical. Attempting to overemphasize the physical component may lead to greater risk of injury.  

Going Deeper (ROM Excluded)

Although the 7 pointers above highlight fairly obvious steps one can and should implement if they decide to perform yoga, examining the literature more closely reveals several less obvious yet critical findings.

Many in the fitness industry are quick to suggest that there is no such thing as excessive range of motion, improper movement, or extreme positions and that the body simply needs time to adapt and adjust to whatever type of movement one choses to participate in provided they have the appropriate anthropometrics.  However, perhaps the single most important takeaway from all of the yoga findings, research, and data is that there is, in fact, such a thing as extreme positions, excessive ROM, exaggerated mobility, and improper movement that should largely be avoided by most human beings regardless of individual differences. While forcing the body into extreme positions it is not adapted to, or prepared for, is likely to result in early acute injuries, it appears as though pushing mobility boundaries and extreme ROM, regardless of how adapted one’s body is, or the type of anthropometrics you possess, is the very thing that can result in chronic injuries and joint trauma as well as “eventual” acute injuries that may be just as severe if not worse than those that may occur due to a lack of “adaptation”. 

For instance, many of the injuries reported in the above sections highlight that in many instances, yoga teachers and yoga practitioners who’ve been practicing yoga for many years, and whose bodies have presumably adapted, can’t withstand the deleterious effects of extreme positions no matter how advanced or competent they are. Simply put, the effects of improper movement can impact anyone regardless of how much they’ve trained their body to handle those positions or how well suited they are, anatomically, to the training. It may take longer to develop issues, however, those issue may be just as severe, if not worse, than the early acute injuries that occur in less experienced participants and will oftentimes require surgery. 

What follows are additional quotes from the aforementioned sources that further underscore the notion that there is such a thing as excessive ROM and extreme positions as well as potentially serious consequences from practicing such positions:

As reported by William Broad:

...” He said he had seen some “pretty gruesome hips.” “One of the biggest teachers in America had zero movement in her hip joints,” Black told me. “The sockets had become so degenerated that she had to have hip replacements.” I asked if she still taught. “Oh, yeah,” Black replied. “There are other yoga teachers that have such bad backs they have to lie down to teach. I’d be so embarrassed.”

 …Normally, the neck can stretch backward 75 degrees, forward 40 degrees and sideways 45 degrees, and it can rotate on its axis about 50 degrees. Yoga practitioners typically move the vertebrae much farther. An intermediate student can easily turn his or her neck 90 degrees — nearly twice the normal rotation.

Extreme motions of the head and neck, Russell warned, could wound the vertebral arteries, producing clots, swelling and constriction, and eventually wreak havoc in the brain.

…The respondents noted four cases in which yoga’s extreme bending and contortions resulted in some degree of brain damage.

The injury, Black said, had its origins in four decades of extreme backbends and twists. He had developed spinal stenosis…Black said that he felt the tenderness start 20 years ago when he was coming out of such poses as the plow and the shoulder stand. Two years ago, the pain became extreme. One surgeon said that without treatment, he would eventually be unable to walk. He would eventually be fine but was under surgeon’s orders to reduce strain on his lower back. His range of motion would never be the same.

Black is one of the most careful yoga practitioners I know. When I first spoke to him, he said he had never injured himself doing yoga or, as far as he knew, been responsible for harming any of his students. I asked him if his recent injury could have been congenital or related to aging. No, he said. It was yoga. “You have to get a different perspective to see if what you’re doing is going to eventually be bad for you.” 

As reported by Le Corroller et al.:

Anatomically, tendons, myotendinous junctions, and fibrocartilages are the most vulnerable structures to injury...Even if a movement or posture does not elicit immediate injury, if performed incorrectly, it can strain structures over time at the weakest point, which eventually may progress to a frank injury.

 As reported by William Broad:

…Bryan T. Kelly, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan, echoed the warning, saying yoga postures were well known for throwing hips into extremes. “If that’s done without an understanding of the mechanical limitations of the joint, it can mean trouble,” he said in an interview.

As reported by Schneider:

"We can't be sure yoga is what caused it, but the extreme positions of the hip she assumed with yoga postures likely contributed to the injury." Schneider

As reported by Klifto et al., describing the effects of more intense forms of yoga which tend to rely on more extreme positions and larger ROM:

…While any style can cause injury, evidence has shown that the more intense forms of yoga are associated with higher rates of adverse events. 

…Experts recommend that patients rotate their pelvis and not flex their spine in order to prevent injury. Similarly, twisting positions that combine flexion with rotation put considerable strain on the lumbar vertebrae and can lead to lower back injury.

As reported by Parkinson:

…Benoy Matthews, a leading UK-based physiotherapist, warns he is seeing increasing numbers of yoga teachers with serious hip problems - many of whom require surgery

…He says the problem lies in people repeatedly pushing their bodies into "prescribed" positions, when their physiology prevents it.

…About half of the teachers he sees simply need advice on how to moderate the "prescribed" yoga positions, so as not to put too much stress on their joints.

A similar argument made by many in the fitness industry is that it all depends on one’s body structure, anatomical differences, and anthropometrics, as some individuals are better suited for performing more extreme positions than others, suggesting that such positions are perfectly fine for more capable individuals. While this argument seems reasonable, particularly when it comes to avoiding acute injuries, examination of long-term chronic injuries suggests it is highly flawed. In fact, it appears that individuals who have greater proficiency at performing more extreme positions and exaggerated range of motion may be most prone to developing issues from such positions. The statements below further support this notion:

As reported by William Broad: 

…“In a 2003 article in Yoga Journal, Carol Krucoff — a yoga instructor and therapist who works at the Integrative Medicine center at Duke University in North Carolina — revealed her own struggles. She told of being filmed one day for national television and after being urged to do more, lifting one foot, grabbing her big toe and stretching her leg into the extended-hand-to-big-toe pose. As her leg straightened, she felt a sickening pop in her hamstring. The next day, she could barely walk. Krucoff needed physical therapy and a year of recovery before she could fully extend her leg again.

As reported by several prominent yoga teachers in the New York Times:

…the picture of female superiority began to blur when a prominent yoga teacher in Hawaii wrote me about a poorly known threat to women. The teacher, Michaelle Edwards, said that women’s elasticity became a liability when extreme bends resulted in serious wear and tear on their hips. Over time, she said, the chronic stress could develop into agonizing pain and, in some cases, the need for urgent hip repairs. Ms. Edwards sent me her book, “YogAlign.” It described her own hip pain long ago and how she solved it by developing a gentle style of yoga.

The same kind of damage, Dr. Kelly added, can strike dancers who overdo leg motions. Each year, he said, roughly 50 to 75 of his patients who danced or did yoga underwent operations. Most, he noted, were women.

Women’s hips showed particular vulnerability. By nature, their pelvic regions support an unusually wide range of joint play that can increase not only their proficiency in yoga but, it turned out, their health risks. The investigators found that extreme leg motions could cause the hip bones to repeatedly strike each other, leading over time to damaged cartilage, inflammation, pain and crippling arthritis.

Similarly it appears that pain may not be the best indicator of whether or not positions are optimal.

As reported by Jill Miller:

“Those lateral splits. Every damn day…Sure it was “normal” for me, but since it caused no pain, I literally let it slide

As previously alluded to, yoga isn’t the only activity where greater proficiency at extreme positions appears to correlate with greater risk of injuries. For example, many professional gymnasts and dancers develop severe low back, hip, knee, foot and ankle issues during their training and competitive years that persist beyond retirement, often becoming chronic in nature [34-38]. This is likely due to the fact these activities frequently incorporate semi-contortionist-like positions that are aesthetically and visually pleasing, yet most of which are not functional or structurally optimal and oftentimes place the body in biomechanically unsound and faulty positions with excessive ROM. Furthermore, those who are most capable of performing the most extreme (and oftentimes most desirable positions for their craft) end up having the most extreme injuries and joint issues. 

For example, a study examining dancers found that individuals who had shorter range of motion (ROM) and less mobility actually had reduced levels of patellofemoral pain and associated joint issues compared to dancers who were able to achieve those extreme joint positions [39].

In other words, it appears that the inability to produce the exaggerated positions is a blessing in disguise, as it may prevent joint issues associated with extreme range of motion activities.  

Similar trends can be found in the sport of Olympic weightlifting. Dr. Stu McGill, known as one of the foremost experts in the area of spinal biomechanics, has suggested that if we look at the countries around the world that report the highest rates of hip dysplasia, we’ll also see excellence in the sport of Olympic weightlifting, dominated by those that can squat to greater depth. This further highlights the fact that just because the human body can do something doesn’t mean it should. Furthermore, maximal ROM and optimal ROM are two very different things. It might be better, therefore, to be more concerned about using excessive ROM rather than too little ROM [40, 41].

In summary, 5 conclusions can be drawn from these findings: 

1. There is such a thing as improper or suboptimal body mechanics, excessive ROM, and extreme positions for the human body that should largely be avoided or at least used sparingly.

2. Individual’s bodies only adapt so much. Eventually their joints, tissue, and muscles rebel and breakdown resulting in both chronic and acute injuries.

3. Just because someone appears to be capable of performing these extreme positions doesn’t mean they’re beneficial or optimal.

4. Just because you don’t feel sudden or immediate pain (i.e. acute injuries) doesn’t mean you’re not slowly and gradually contributing to chronic overuse injuries or getting closer to an extreme acute injury. Often it’s simply a matter of time.

5. These statements apply not only to Yoga but to any activity, whether weightlifting (ATG squats), ballet, dance, gymnastics, or any form of exercise.  Simply, optimal body mechanics must be employed in any physical activity or exercise in order to maximize the safety and effectiveness while minimizing potential consequences.

Although much of the research suggests that the rate of injuries in yoga is not significantly different than other forms of physical activities or sports, such a comparison may be slightly misleading.

For instance, if we were comparing one sport to another such as American football to rugby, we might expect to see similar results in terms of injury incidence as well as severity. However, a comparison of football to bowling brings up 2 significant points: 1) one would obviously expect to see football have a higher incidence of injury; 2) more importantly and for obvious reasons, the notion of comparing these two sports is somewhat ludicrous in the first place. Nonetheless, if such a comparison were to be made what might be even more ludicrous is if the injury rates for bowling and football were, in fact, similar. Such findings would be quite suspect to say the least.

That being said, the notion of comparing yoga to other sports and physical activities, while perhaps not quite as extreme as the above example, is actually not all that dissimilar either. At its core, yoga was intended to be a therapeutic modality that promotes healing and restoration of the body, not a sport that has an assumed inherent risk of injury as is the case with competitive activities.  

In fact, most athletes and fitness enthusiasts, as well as competitive athletes, use yoga as a means to heal their body and restore it’s natural physiological function, just as they might use massage, dry needling, and other therapeutic modalities. In other words, with yoga there should be absolutely no injuries, only healing and restoration to the body.

So while at first glance the notion that the incidence of yoga is similar to that of other forms of exercise and physical activities might seem acceptable, such a comparison really should not even be up for discussion if, in fact, modern day yoga practice was as therapeutic, restorative, and as low incidence of injury as the industry suggests.

Such a comparison would be similar to suggesting that a 5% risk of injury from massage, dry needling, and physical therapy is admissible. If such numbers were acceptable perhaps it might be to my advantage as a trainer to market my services by advertising that I have only a 2% fatality rate amongst clients. Not too shabby right!!!!

 Many will argue that if, in fact, yoga has a similar rate of injury as some sports and other forms of exercise then, presumably, the caloric expenditure is also similar, therefore, yoga should be an effective alternative as a form of exercise, physical activity, and caloric expenditure. Unfortunately, yoga appears to be a fairly low caloric form of energy expenditure compared to other forms of exercise [42, 43].

Now, if the lower relative energy expenditure associated with yoga was also associated with a lower risk of injury relative to other sports and exercise then, yes, the argument could be made that performing yoga would be an appropriate exercise selection for those wishing to avoid common injuries associated with sports and more intense forms of physical activity. Unfortunately, that association does not hold true, as the injury rate is quite high given the relatively low caloric expenditure. In fact, the injury rate is similar to that of some high impact activities that burn significantly more calories. 

Although the type and intensity of yoga will greatly determine the rate and amount of energy expenditure the jury is still out as to whether or not yoga is the most effective method when it comes to exercise and caloric expenditure.

As quoted in an article from Time Magazine [22]:

 ...According to a study by the American Council on Exercise... dedicated yoga practitioners show no improvement in cardiovascular health.  It's not the best way to lose weight either.  A typical 50 minutes class of hatha yoga, one of the most popular styles of yoga in the US, burns off fewer calories than in three Oreos-- about the same as a slow, 50 minute walk.  Even power yoga burns fewer calories than a comparable session of calisthenics.  And while yoga has been shown to alleviate stress and osteoarthritis, it doesn't develop the muscle-bearing strength needed to help with osteoporosis. 

While I have cited numerous examples of statements and data from various research studies that support the implications laid out in this article, I have also cited many statements from orthopedic surgeons and other physicians. In fact, it appears that many of the statements made by physicians are far more disturbing and extreme than those expressed by researchers. Unfortunately, human subject research studies are often confounded by research bias and other study limitations and as a result don’t always convey the whole picture. This is particularly true of studies that are carried out by individuals and participants who are biased towards yoga. 

Physicians, on the other hand, are likely less biased as they are simply reporting trends they have observed in their patients, therefore, the more extreme and disturbing accounts from doctors may, in fact, be more accurate than the more moderate statements expressed by researchers and scientists. However, overall the data reported in research studies appears to be largely congruent with the statements made by surgeons and other physicians, if perhaps less extreme. 

It’s quite clear that excessive ROM, extreme mobility, and over-stretching do exist. Furthermore, it appears the ramifications from practicing such body positions are more significant than we might have expected initially. Therefore, determining where the boundaries are in terms of implementing proper movement and avoiding improper movement is of the utmost importance. A brief understanding of how the neuromuscular system functions can provide us with deeper insight as the nervous system is integral not only for daily function but for mastering muscle function and movement.

The neuromuscular system not only dictates how and why we move it also provides various forms of sensory feedback for the purposes of fine-tuning movement. In fact, when it comes to determining optimal ROM for the human body, the neuromuscular system essentially provides all of the feedback and sensory information we need through a variety of proprioceptive mechanisms that enhance our kinesthetic awareness (i.e. sense of feel).

With this in mind, how can the body determine what is optimal ROM unless the neuromuscular system is fully engaged?? It can’t!!!!  Of even greater importance, how does one ensure that the neuromuscular system is fully engaged in the first place?  Although a truly thorough answer to such a question would comprise volumes of literature, one key piece of the puzzle that neuromuscular scientists appear to agree on is muscle stiffness.

Muscle stiffness is a key quality that helps optimize proprioception, kinesthetic awareness, motor control, joint stability, and sensory feedback from proprioceptive mechanisms such as muscles spindles and intrafusal muscle fibers [44-46].  The only way to create optimal levels of muscle stiffness is through voluntary muscular contractions and activation, which requires the neuromuscular system to be fully engaged.  Simply put, high levels of muscle stiffness and neuromuscular engagement go hand in hand. To relax completely during movement not only disengages the muscles which act as the primary shock absorbers of the body (i.e. joint protection), it compromises and minimizes the proprioceptive feedback of our sensory receptors thereby limiting our sense of feel and compromising our ability to tune into what is and what isn’t optimal movement. 

That being said, there’s absolutely nothing wrong with going into deep states of mental and physical relaxation as occurs in certain types of yoga.  However, this should not occur under conditions of movement, loading, exercise, postural positions, alignment sequences, or drills that requires significant neuromuscular involvement.  So, yes, if one is doing yoga as mental practice to help relax the mind under stationary conditions that involve limited muscular involvement such as sitting, laying, or various forms of supine positions then, yes, complete relaxation is not only acceptable but in many ways advisable, similar to someone relaxing on a couch or laying in bed.  However, as soon as intense movements that involve significant levels of motor control, stability, loading, alignment and muscular engagement occur, then total relaxation and allowing the body to essentially go limp goes against all the currently accepted foundational elements of neuromuscular physiology, biomechanics, and structural/muscle physiology.

So how do we determine if a movement provides too much, too little, or just the right amount of stretch?? The answer is via our central nervous system as it provides all of the sensory feedback we need for movement.  Ironically, in order to move into and allow extreme positions to occur requires us to sacrifice muscle stiffness and disengage elements of our nervous system.  Simply put, extreme positions don’t promote kinesthetic awareness, instead they diminish it as the movements themselves are performed with minimal levels of proprioceptive feedback, an inevitable consequence of contorting the body in a manner that’s not physiologically or biomechanically optimal.

Now that we’ve resolved that there are in fact precise boundaries of movement for the human body, the key question is what are those boundaries?  Unfortunately, as humans we don’t always like rules and boundaries. But, like most things in life, whether it’s laws, ethics, physiology, or physics, there are, in fact, rules and boundaries we can use to optimize how we live. The same is true of exercise and movement. Yes, the mantra “rules were made to be broken”, does apply to certain man-made principles. However, when it comes to concrete fundamental elements of science that relate to human movement such as physiology, biomechanics, and anatomy (which cannot be altered), if you try to break the rules, it’s your body that will break instead. Read more here.

While some degree of stretch and mobility is not only acceptable but ideal, too much stretch or over-stretching can lead to many physical consequences that may be just as, if not more severe than not having enough mobility or flexibility.

Determining proper levels of mobility, ROM, muscle stretch, and flexibility can only be done by examining the science of movement (i.e. kinesiology), particularly neuromuscular physiology, biomechanics, structural muscle physiology & functional anatomy. Through my own personal studies I’ve found that eccentric isometrics allow the individual to maximize all these aforementioned elements of movement. 

Essentially, eccentric isometrics involve a slow and deliberate eccentric phase of movement (i.e. the lowering phase) followed by a pause in the strongest 90 degree stretched position before forcefully completing the concentric lifting phase. Additionally, the individual should attempt to maintain a neutral spine throughout while maintaining as much full body tension as possible. All of these elements help to maximize somatosensory feedback from muscle spindles and other proprioceptive mechanisms that ultimately allow the individual to fine-tune their positioning and find the optimal stopping point via enhanced kinesthetic awareness.  

This optimal and natural stopping point on most movements inevitably ends up being at approximately 90 degrees, not only for some, but nearly all humans.  Fortunately, you don’t need anyone to tell you where that is as your body is more than capable of feeling exactly where that natural stopping point is, particularly as you use the sensory feedback provided by the eccentric isometrics. In fact, this ends up providing a highly therapeutic form of movement and muscle stretch while also avoiding the common rebound spasticity associated with over-stretching a muscle. Simply put, the stretch is not too much or too little but just the right amount as it is your central nervous system that dictates the degree of stretch, not a random cue from a coach or teacher telling you to stretch farther. Read more about stretching here.

So am I saying that eccentric isometrics are the only way to master your body mechanics and provide the perfect amount of muscular stretch? Of course not!!! Eccentric isometrics are one of potentially many methods that involve the use of optimal or natural ROM based on fundamental principles of exercise science including neuromuscular physiology, biomechanics, structural muscle physiology & functional anatomy. Generally speaking, it takes into account the length tension relationship of muscle fibers, somatosensory feedback, agonist/antagonist co-contraction, muscle spindle/intrafusal muscle fiber activation, reciprocal inhibition, anatomical level arms, principles of elastic energy, autogenic inhibition, post activation potentiation, neuromuscular reflexes, alpha-gamma co-activation, and more.

More specifically, and practically speaking, this involves using movements with slow and controlled eccentrics, 90 degree joint angles, the strongest stretched positions, high level of intramuscular tension, engaged core, relatively neutral spine, slow and controlled eccentric/lengthening contractions, emphasis on a natural therapeutic stretch (not excessive stretch), relatively in-line body alignment, and movements that emphasize joint and muscle centration (equal or proper force distributed across the involved joints and musculature used for a particular movement) .

Any form of movement that implements similar principles, protocols, parameters, and guidelines to that of eccentric isometrics whether it’s yoga, Pilates, weightlifting, dance, mobility drills, callisthenic training, and even gymnastics will, inevitably, provide very similar benefits to that of EI’s by simply appropriating methodologies that are biomechanically, neuromuscularly, and anatomically sound which ultimately will produce a myriad therapeutic effects with very few if any significant consequences. In contrast, any form of movement that significantly deviates from these parameters is sure to provide a very mixed bag of results, the consequences of which will, oftentimes, be directly linked to the degree or extent to which one drifts beyond those boundaries.

On a side note, it’s not necessary to use inordinately heavy loads for any eccentric isometric. Light or moderate loads will, in fact, be just as, if not more suitable for most folks trying to master their body mechanics, technique, mobility, stability, and overall muscle function.  In other words, simply use whatever load you feel will be most effective to help you dial in your body mechanics and muscle activation patterns. Whatever load you use, whether light or heavy, eccentric isometrics should always feel therapeutic, not damaging.

The beauty of eccentric isometrics is that it can be used on any muscle or muscle group, as well as any movement pattern or anatomical function of the human body, as a means of maximizing quality of movement, joint healthy, stability, mobility, and overall muscle function while simultaneously teaching the appropriate range of motion. In other words, the level of flexibility and mobility won’t be too little or too much. Instead, it will be just the right amount as you’re simply relying on innate and inherent physiological mechanisms that are hardwired in your physiology and dictate appropriate and optimal ROM.  Here are a few of literally thousands of possible examples of how to use eccentric isometrics for various movement patterns, exercises, and muscle groups. 

Video Demonstrations

Yoga Alternatives | Eccentric Isometric Examples

Negative versus Beneficial Movements

Too Extreme | Potential issues

Beneficial Alternatives

Am I Self-Promoting?

Is it necessary to buy my book, Movement Redefined, or other materials in order to learn how to master your movement using principles of eccentric isometrics? Absolutely not!!!!  There is more than enough free information on this website and my social media pages to provide any user wishing to master their movement and body mechanics the resources they need to learn about principles of eccentric isometrics, movement mastery, optimal 90 degree joint angles and more. In fact, just about every single article on this website (of which there are hundreds) discusses eccentric isometrics to some extent as well as other methods including balance, stability, core activation, eyes-closed training, posture drills, foot & ankle exercises, and alignment techniques that will help you master your muscle function. Additionally there’s plenty of information on exercise programming, periodization methods, and exercise variety.

Obviously, my book provides even more in-depth explanations and scientific data. However, for a majority of the population, the free content on this website will more than suffice.  Additionally, there are numerous other qualified professionals in this field with comprehensive websites and material that provide similar information to help you maximize your muscle function without damaging your body in attempt to use excessive ROM and unnatural positions. 

So NO!!! This article is not a sales pitch or moneymaking scheme. I’m simply trying to provide free educational information to the general public in order to prevent folks from having to deal with the common forms of injury, pain, and muscle dysfunction that I witness on a daily basis. It’s your choice if you choose to investigate further and apply the information provided.

The popular ideology of gaining more and more mobility and flexibility in an indefinite and unlimited fashion is completely contrary to the laws of human movement and is simply based on the physical therapy myth that “more is better”. Unfortunately, few if any elements of human physiology function under the “more is better” approach as we never want too much or too little of anything when it comes to the human body. Instead what we want is the optimal amount. Simply put, the goal should be to find optimal mobility and maintain it. This applies to nearly all movements including those in yoga, weightlifting, Pilates, or any form of exercise.  

Furthermore, all movements have both a maximal ROM and an optimal ROM. Rarely do the two coincide. The same is true of any athletic skill or basic movement such as punching, sprinting, throwing, kicking, hitting, etc. Each has an optimal range of motion and the goal is to find the perfect balance between overly compact motion and excessive ROM. Gaining too much mobility ultimately requires us to sacrifice joint stability and motor control, as well as strength, force production, and force absorption capabilities.

With that said, I’ve noticed a common trend in my clients and athletes. Once we eliminate extreme range of motion and overly stretched positions (even if the goal is mobility), when they need it, such as during testing, or the occasional everyday activity that calls for it (i.e. picking something up off the floor in an awkward position), they're actually capable of assuming these extreme positions much more easily than when they were actually training with large ROM positions. It's as if their mobility and range of motion, including joint end range positions, are freed up by eliminating all contra-therapeutic positions during training and sticking primarily to therapeutic movements, such as eccentric isometrics with approximately 90-degree joint angles. 

End range training or attempting to find the maximal range of motion for a given joint or joints, has become a very popular trend in the fitness industry. Unfortunately, the notion has evolved from the mindset that maximal ROM and optimal ROM are one and the same. As has been repeatedly pointed out and highlighted in this article and shown to be supported by a variety of data and examples, maximal ROM and optimal ROM are rarely the same. Attempting to move into these maximal ROM positions on a consistent basis appears to be the very issue that plagues yoga practitioners, dancers, and gymnasts, not to mention other fitness enthusiasts practicing these forms of training.

However, many individuals who promote end range training suggest that consistently training to end range positions actually prepares us to tolerate and withstand such positions when exposed to them. Simply put, if we don’t practice these extreme end range positions not only are we likely to lose the ability to move into these positions, we will likely injury ourselves when the situation requires it.

For instance, many folks have commented that if we only strength train with 90-degree joint angles (optimal ROM under loaded conditions), when our body needs to move farther than this it will be unable to do so. This concept operates under one key false assumption, namely that human beings do not inherently and innately posses the ability to move properly into these positions unless they repeatedly practice them.  In other words, human beings are unable to move safely and successfully into extreme positions unless they spend ample time specifically training with these end range positions. 

However, long before the dawn of the modern-day fitness industry and the topic of end range training even existed, human beings were more than capable of moving into any and all positions they needed for functional every day living, including the occasional extreme position everyone periodically encounters. Using 90 degree eccentric isometric training methods does not rid the individual of this ability. It simply provides an additional therapeutic stimulus to the body that restores the natural neurological and structural elements of musculoskeletal physiology that therapeutically improve strength, stability, motor control, symmetry, and alignment without stressing the joints or inducing chronic inflammation. 

Once again, we’re not taking away anything the body is already capable of doing, we’re simply adding to it. Ironically, one of the most effective ways to gain mobility and range of motion is to improve stability, strength, and motor control thereby calibrating the neuromuscular system to handle any and all positions thrown its way. In fact, this is something I witness daily. As clients’ motor control and stability improves they’re more easily able to get into any and all positions, including ones that may not be therapeutic or those they’ve not necessarily trained for or practiced (i.e. deep squats or picking up awkward objects from the floor).

In contrast, one of the quickest ways to lose mobility is to consistently practice extreme ROM. As seen with the yoga examples, over time these positions lead to inflammation in the joints and connective tissue. Inflammation and joint trauma happen to be the very things that actually limit mobility, flexibility, and range of motion as the body will send inhibitory signals to shut these movement downs as a means of protection. As a consequence, it will be more difficult to perform odd maneuvers when they are actually needed as part of a sport or competition, not to mention daily life. In other words, the body is more likely to inhibit these movements in response to the inflammation and extensive breaching of the protective barriers produced by the excessive training positions.

Besides the fact that there’s very little, if any, research suggesting end range of motion is ideal, and the fact that, as mentioned above, the whole concept operates under a false assumption, there is another key flaw in the theory.

When we examine the incidence of injuries in sports we see that a large percentage of injuries are non-contact related and typically occur during running, jumping, landing, throwing, hitting, kicking, skating, cutting, acceleration, and deceleration. Additionally, it’s thought that the severity of most contact injuries appears to be significantly related to the degree of musculoskeletal deformation that occurs during contact (i.e. the extent to which our body is forced into biomechanically unfavorable and/or detrimental positions) as well as the extent to which the incoming force is absorbed. Taken together, these findings point to one key conclusion: our external circumstances don’t dictate our movement mechanics and degree of injury. Rather, it’s our ability to control our muscles and body via neuromuscular activation patterns that truly determines the frequency and severity of injuries.

For instance, an incoming valgus force can cause anywhere from zero collapse with no injury to an extreme collapse and season ending injury. The difference has little if anything to do with your ability to withstand “bad” positions, as an extreme collapse will almost always produce the same result - full ACL tear. Instead, it appears to be linked directly to our ability to prevent such extreme positional deviations in the first place and avoid musculoskeletal deformation into those “bad” positions by using our central nervous system, motor control, and strength.

Additionally, when we look closer at ACL injuries, we see that we really cannot coerce the body or force it to truly adapt to detrimental positions. Otherwise people who demonstrate consistent valgus collapse during training would be less prone to ACL tears as, technically, their bodies should be adapted to these positions. In reality, these are the very people who end up experiencing ACL tears.

So, what does all this suggest? When an athlete is pushed or placed into an unfavorable position, particularly in non-contact injuries, it’s not because it was inevitable or unavoidable, but because they didn’t possess the ability to prevent or avoid such hazardous positions in the first place. And just because we don’t consistently train such poor positions doesn’t mean we won’t be able to tolerate them when they periodically occur. As previously mentioned, before the dawn of the modern fitness revolution, athletes were just as likely then as they are now to be put into precarious situations and extreme positions yet injuries were markedly less frequent (albeit the increase in forces present today obviously plays a role). That is, the fact that they never trained to joint end range of motion (as this concept had not yet been developed) was not reflected in an increased risk of injury when they periodically encountered these positions.

In other words, just because you don’t train end range positions doesn’t mean that the moment you’re placed into positions significantly past 90 degrees you’ll immediately blow your joints out and rip a muscle. If anything, the opposite is true. Save those precarious positions for when you actually need them, such as competitive circumstances or extreme life scenarios. But certainly don’t train for these extreme positions as that will not only break the body down and produce contratherapeutic movement, it will ingrain faulty mechanics and dysfunctional positions into the nervous system, making it exponentially more likely you’ll move into these biomechanically disadvantageous positions that much more frequently, ultimately leading to a greater potential risk of injury.

Based on the principles of neuroplasticity and motor learning, the way we move during training ultimately trickles into how we move during everyday life. In other words, we should not train “bad” positions. We should train proper positions as this prepares the body adequately to handle any situation, including poor positions, while also reinforcing the repeated practice of proper movement, making it more likely that the individual will perform within the parameters of optimal human mechanics during everyday life and/or sport.

In other words, don’t practice getting into faulty positions as this only wears the structures down over time and ingrains faulty mechanics, making it that much more likely that you’ll injure yourself from constantly placing your body, joints, and muscles into biomechanically hazardous and detrimental positions. Learn to ingrain proper body mechanics so that your body consistently operates within the confines of what is proper movement. That way, when placed in a faulty position by necessity, the muscles will be better able to play their role (i.e. absorb force) and the joints and connective tissue will be at peak health instead of worn down, thus reducing the risk of injury.

Following the above discussion, let’s examine some of the movements commonly used when individuals train for maximal ROM and end range training.  For instance the use of various exercises known as PAILS and RAILS associated with Functional Range Conditioning (FRC) oftentimes involve an individual deliberately taking a joint or group of joints through it’s maximal ROM on a basic anatomical function such as internal or external rotation of the hip. Most of these movements involve primarily concentric movements or muscular contractions without any load other than the limb/joint itself.

Unfortunately, under these conditions it is oftentimes difficult to know exactly how far to move the joint or joints as the central nervous system will receive only minimal feedback from muscle spindles due to the lack of eccentric loading. Simply put, optimal somatosensory feedback from muscle spindles (which ultimately tell us a great deal about how to move), requires the presence of some degree of eccentric loading. Without such feedback, it’s very difficult for our body to accurately sense the optimal stopping point, or optimal ROM, not to mention other subtle yet critical elements of the movement such as posture and limb positioning and alignment. We also know from the earlier discussion of yoga related injuries that neither acute discomfort, nor the ability/inability to perform a position provide the most accurate feedback, therefore, in the absence of optimal somatosensory feedback, the chance of going either too far or not far enough is almost a given. 

In fact, most examples of PAILS and RAILS we currently see in the fitness industry often resemble contortionist movements that are just as, if not more, extreme than what we witness in more aggressive yoga classes.  This may or may not have been the original intention of FRC training.  However, the drills themselves, regardless of original intentions, have quickly turned into a contortionist form of training that more closely resembles something we might see at the circus, not sport or everyday life.

With that said, not all PAILS and RAILS involve extreme positions. Additionally, a small fraction of them do involve a degree of eccentric loading.  Simply, any movement including yoga, PAILS, RAILS, or strength training, or any other form of exercise can easily be modified to be therapeutic provided it applies foundational elements of kinesiology, particularly when it comes to optimizing (not maximizing) range of motion.

Unfortunately, and as previously stated, for many movement modalities such as PAILS and RAILS it can be difficult to find the appropriate positions and ROM due to the lack of eccentric loading. Applying the eccentric isometric method to any of these protocols  produces enhanced sensory feedback and helps ensure they are performed with optimal quality of movement and ROM. 

Here’s an example of how to apply eccentric isometrics to internal and external hip rotation by applying load/tension to the positions. Also shoutout to Bethany Shadburne and Austen Cochran as this is an eccentric isometric modification of an exercise I stole from them. Notice the more compact yet optimal range of motion in the hips demonstrated by Ben Lai.  This degree of internal and external rotation represents the natural or optimal levels of movement we might expect to see during everyday life or in sport.  Moving substantially farther than this, although possible for some, reinforces extreme positions we typically associate with injuries, especially to the knees (i.e. extreme valgus collapse), and could increase the risk of injury.

Although previously highlighted, the fact that many acute injuries can be traced back to chronic overuse in which the tissues were stressed inappropriately one too many times is worth re-stating. Tissues adapt only so much. Over time, repeated misuse results in structural weakness until eventually the tissue brakes. This illustrates exactly how many of the ACL injuries we see in sports occur. So, stop training your body to handle faulty and dangerous positions (including end range positions) as the only thing this will achieve is to break down your connective tissue further rather than strengthening it.  Instead, teach your body to avoid these hazardous positions in the first place so as to keep the tissue healthy, rather than worn down and over-manipulated, so that when the body is actually placed in a hazardous position it will handle it much more efficiently. Furthermore, because the length tension relationship has not been negatively altered by over-manipulation and extreme ROM, the muscles will be better able to act as shock absorbers and not limp noodles when in these positions.  In other words, teach proper body mechanics. And yes, in case you were wondering, there is in fact such a thing.  We simply have to closely examine and then integrate the principles underlying structural physiology, biomechanics, motor learning, functional anatomy, and neuromuscular physiology.  The answer is there if we look. 

Still not convinced? Take a look at the research studies on gymnasts, ballet and other dancers. These are folks who’ve been introduced and exposed to end range positions and extreme ROM for many years. If anyone’s body should have adapted it’s theirs given that most of them started training at an early age and have received progressive increases in training volume and stimulus. Unfortunately, their bodies did not adapt because many of these aesthetically pleasing positions represent dysfunctional movements. Instead, over time they break down, as evidenced by the many extreme hip, back, knees, ankles, neck, shoulders, and other joint issues that leave many of them nearly incapacitated during, as well as after their careers.  What’s ironic is that those who are most easily able to assume these extreme positions are the ones who end up having the most joint issues.  Remember, just because the body can do something doesn’t mean it should.

Although I have not conducted any formal research studies on the subject and, therefore, can’t provide any proof, what I do have is 16 years of empirical observations based on my personal experience working with clients and athletes on a daily basis, many of whom, prior to training with me, had engaged in strength movements with max ROM (such as ATG squats), flexibility, yoga, and mobility drills. Over the years what I’ve found is that, time and time again, every person I train ends up feeling more mobile and flexible once we eliminate many of these protocols and I teach them proper body mechanics with eccentric isometric movements using natural ROM. Invariably, the result is significant improvement in their biomechanics, stability, symmetry, activation patterns, strength, muscularity, and motor control, as well as their mobility, flexibility, and end range of motion.  Additionally, prior injuries, areas of tightness or pain all gradually disappear.  In reality there is nothing magical or fancy about their training. The key is to simply focus on mastering the basic foundational movements that ultimately transfer to any sporting activity as well as daily living.

The improvements I have observed in both my athletes and general populations are likely due to the continual therapeutic stimulation of their muscles, tissues, and joints which has ultimately allowed their body to engage, pain free, in whatever form of movement the circumstances require, including more extreme positions if necessary.  In contrast, training with extreme ROMs tends to be the very thing that over time, and with consistent training, can restrict mobility and end range of motion due to the contratherapeutic stimuli, chronic inflammation, and tissue trauma that accompany such movements.

So how much practice is too much practice when it comes to these extreme positions? Honestly, it’s hard to say but in my experience I have yet to see many physiological benefits from such positions although in rare scenarios such as gymnastics, ballet and other forms of dance, exaggerated positions may occasionally be called for in the practice of the craft.

At this point, many of you are probably wondering what my recommendation would be in terms of yoga. Speaking very broadly, when it comes to the practice of modern yoga as a whole, I would not recommend it as a form of intense exercise and training.  However, as a form of mental training, meditation and a means of relaxation that does not emphasize the physical components, physiologically and scientifically speaking, yoga appears to be associated with numerous benefits and few, if any, harms.

Regarding specific forms of yoga, I’m not enough of a yoga expert to make any firm recommendations. And, unfortunately, with no governing body to regulate the teaching of yoga instruction appears to vary dramatically from one instructor to the next.  However, based on current literature, the more gentle forms of yoga are likely to be the most beneficial as, for the most part, they appear to avoid the extreme and exaggerated movements potentially associated with negative consequences.

That being said, while there is not a specific form of yoga I would currently recommend, I believe there are select instructors who are more competent than most and understand the potential pitfalls of modern yoga.  More specifically, these are individuals who are likely to have studied the human body, kinesiology, and exercise science and, as a result, modified and designed yoga movements based on foundational elements of neurophysiology, biomechanics and structural physiology, not just traditional yoga or the yoga hype that’s become so popular. These instructors are few and far between, but I believe they do exist.

Although this is not an extensive list and should only be treated as a quick weeding out process to narrow down your search for an appropriate yoga instructor, the following questions may be a solid starting point:

1. Are the movements functional and do they resemble positions or movements we would see in everyday life (the answer should be yes).

2. Is the concept of mobility taught as something we should continue to gain more and more of on an infinite scale (the answer should be no).

3. Are extreme spinal flexion extension consistently advocated (the answer should be also no).

4. Are foot and hip alignment emphasized or do the poses require the feet to be positioned perpendicular to each other. Slight variance between sides is optimal however to have one foot totally perpendicular to the other is not only a dysfunctional position it’s one that’s likely to contribute to potential injuries due to faulty hip alignment and energy leaks.

5. Do positions that involve intense muscular contractions and joint loading emphasize the use of approximately 90 degree joint angles (the answer should be yes) or are they routinely practiced using joint angles significantly beyond 90 degrees (the answer should be no!)

6. Is motor control, stability, balance, alignment, posture, and strength emphasized as much if not more so than flexibility and mobility (the answer should be yes)

7. Is movement performed with a very relaxed, loose, or flaccid body (the answer should be no), or is the participant encouraged to keep their neuromuscular system engaged (the answer should be yes).

With the start of a new year it is my hope and expectation that in 2020 and beyond, we'll see a shift in the way we approach the concept and training of mobility. For the last decade, strength coaches, therapists and trainers alike have fallen prey to the notion that gaining ever-increasing mobility in their athletes and clients benefits both athletic performance and everyday life. Unfortunately, this has created an undesired trend in which individuals produce excessive range of motion while sacrificing stability and structural mechanics for the sake of gaining greater mobility.

Rather than focusing on increasing mobility, the goal should be to optimize mobility by finding the appropriate balance between increased range of motion and structural stability. Professionals in the field of sports science are beginning to understand this and I believe we're going to see a very different approach to the way we go about addressing mobility and improving movement mechanics. Let's hope it's not a trend that comes and goes, since it's one that actually deserves to stick around for the long haul.

Although the intent of this article is to inform and educate individuals as a means of preventing injuries, some may misinterpret the information as fear mongering. That being said, cautionary warnings could be considered fear mongering if these were unsubstantiated rumors being spread in the absence of any real threat.  If, in fact, significant threats such as orthopedic injuries, pain, and tissue trauma are not only possible but likely, then such cautionary statements should be considered thoughtful warnings and prudent admonitions.

The worst advice we can give an athlete or individual engaging in physically demanding activities is that body mechanics and technique aren't that important. The notion that we need to empower/encourage people to workout and train without fear of biomechanical-related injuries, instead of instructing them on how improve their body mechanics, is analogous to telling someone who chooses to snort cocaine that we support their decision to self-medicate and want to empower them to make their own choices, instead of warning them about the long term consequences of their illicit drug use. To label such warnings as fear mongering would be outlandish and irresponsible to say the least.

As professionals in this field it's our job and responsibility to educate people on proper mechanics as a means of minimizing the risk of chronic and acute injury. The worst thing we could do is to ignore potential risks, as it is the inevitable injuries that oftentimes accompany improper exercise protocols that ultimately instill fear of exercise in fitness enthusiasts. In fact, this represents a philosophy that sets individuals up for disaster and recurring injuries, with each injury oftentimes becoming worse and worse. That would be considered pure deception!!! 

Educating individuals on how to move correctly is essentially what “frees them up”, as they come to realize they can exercise and be more physically active without negative consequences, provided they keep their body mechanics in check. This is how we successfully empower individuals to reach their health, fitness, and performance goals.

• Any type of movement, be it yoga, weightlifting, gymnastics, Pilates, or mobility exercises has the potential to either be harmful or beneficial. The difference lies in the execution.

• Many movements are possible but not all movements are beneficial.

• The fact that the human body can do something doesn’t make it optimal or therapeutic.

• Just because something provides some benefit doesn’t mean it’s optimal. Good is the enemy of best.

• Just because a certain activity doesn’t cause immediate consequences and/or pain (i.e. acute pain/injury) doesn’t mean these won’t manifest at some later point in time (i.e. chronic pain/injury).

• There is in fact such a thing is too much ROM. Similarly, there is such a thing as improper or sub-optimal movement.

• Excessive range of motion, or even very extreme ROM, can take even the “healthiest” & most “therapeutic” physical movements and turn them into activities that produce a variety of contra-therapeutic physical issues and consequences.

• Extreme stretching over time can, unfortunately, teach the body to shut off proprioceptive and sensory feedback mechanisms such as muscle spindles and pain receptors, ultimately allowing it to stretch farther and farther without proper warning signs. As a result, many individuals eventually injure themselves due to the lack of sensory information and resulting inability to attend to the warning signals they would otherwise use to prevent physiological catastrophe.

• Remember, the goal should never be maximal ROM but rather optimal ROM. Rarely are they the same. So, stop trying to gain more & more mobility as it’s likely the very thing that, in the long run, will end up limiting your mobility due to inflammation, pain, & injuries. Simply put, when movements exceed the confines of how the human body is designed to move bad things happen. And no, most pain isn’t just a figment of one’s imagination, it can usually be traced back to faulty movement & muscle dysfunction. And remember, just because the human body can do something doesn’t mean it should.

• It’s not just a matter of tissue adaptation or gradual tissue loading.  Yoga instructors, gymnasts, ballet and other dancers represent the epitome of a population in which maximum adaptation should have, and likely did, occur as these individuals have been adapting for years.  However, injury prevention is only temporary at best.  Because tissues adapt to poor stimuli only so much, it’s just a matter of time before tissue damage and physiological breakdown exceed the positive tissue adaptation response. Simply, the concept of gradual & progressive tissue loading with extreme ROMs & mobility drills to promote tissue adaptation, only goes so far. If a movement is biomechanically & neurophysiologically unsound it will eventually have negative consequences.

• Just because an individual appears to have the optimal structural, anatomical, and anthropometric makeup to move into extreme positions doesn’t mean these positions are optimal. On the contrary, it appears that such individuals may be at greater risk of injury although the negative ramifications may take longer to appear. 

•  Consistently training with improper body mechanics and dysfunctional positions is analogous to smoking.  It may not have immediate repercussions.  However, like smoking, it’s only a matter of time before negative consequences are manifested. It could take weeks, months, years, or even decades but, eventually, they will show up.

•  The beauty of eccentric isometrics is that in contrast to many moves in yoga, Pilates, PAILs & RAILs, stretching, ass-to-grass squat techniques, extreme mobility drills, & other training methods which simply seek to maximize ROM with extreme contortionists positions, it teaches you to dial in the optimal ROM/stretch. Simply put, if you want to improve your mobility & quality of movement start doing eccentric isometrics on foundational movements with 90-degree joint angles. And yes, the science on muscle physiology, biomechanics, neurophysiology, motor learning, & functional anatomy confirm these statements. However, eccentric isometrics aren’t the only form of exercise that can provide such benefits. They’re one of many and the one I’m most familiar with.

•  Although additional research is needed, from the current literature and scientific investigation it appears that the 90 degree position not only maximize strength, hypertrophy, power, joint health, and muscle function but it also provides the most therapeutic stretch to the muscles.  It doesn’t over-stretch the muscles to the point where they come back tighter or cease to properly absorb force, yet it also provides ample lengthening to ensure the muscles receive a fully functional and therapeutic stretch. If you’re looking to optimize mobility and flexibility herein lies the key.

On Yoga:

• Yoga was not originally developed for the purpose of physical exercise and activity but rather for mental and spiritual enlightenment.

•  Yoga is no longer restricted to an exercise of the mind and spirit, it has evolved into a worldwide multibillion-dollar enterprise that includes classes, certification of teachers, clothing, books, videos, equipment, and holidays.

• The evolution of Modern Yoga over the last century is what turned yoga into an organized form of exercise and physical activity while simultaneously becoming a multibillion-dollar industry and money-making business. 

• People who are sedentary & inactive will benefit from almost any form of movement or training including most forms of yoga. However, gentle yoga poses that use more natural and functional positions such as planks, stride holds, bridges, & hinges with moderate ROM (not max ROM) will likely provide a greater benefit than other forms of yoga. 

• Most poses in yoga are not derived from original yoga practices, instead they are based on gymnastics and other forms of flexibility training and contortionist moves many of which aren’t themselves based on scientific models of movement such as biomechanics, structural physiology, and neurophysiology. Instead, most of the poses were conceived as aesthetically pleasing movements that fall under the “old school” flexibility training mindset of traditional stretching which we know has many flaws, not to mention potential risks.

• Do extreme positions in yoga as well as extreme mobility and flexibility drills provide any benefit? Of course!!! However, most of them also produce a variety of consequences & undesirable effects. Simply, most of these forms of training offer a mixed bag of positive & negative consequences. Proper training should not be mixed bag of results.

• Don’t feel obliged to stick with any particular pose(s) just because you think it’s tied to ancient methods that date back several millennia to yoga’s inception. Many, if not most, of the poses we currently see are based on modern fitness fads and trends, not ancient yoga methods. You won’t be disrespecting the origins of yoga, yoga traditions, or eastern spiritual practice by eliminating them. If anything, you’ll be helping to dissociate myth from ancient tradition.

•  Yoga is meant to be a therapeutic and healing activity not an injurious and aggressive athletic endeavor prone to injury.  To say that the rate of injury in yoga is similar to that of other sports and physical activities is not acceptable as yoga is meant to prevent injuries not simply reduce the rate of injuries.

•  That the injuries experienced by yoga teachers are a consequence of overuse associated with the many hours of practice and teaching is a poor excuse. As a trainer with a very demanding workload I’m on my feet training oftentimes 12-14 hours straight, demoing exercises every few minutes, and with no break other than a 1-hour workout. The more I demo and the more I perform the movements, the better I feel due to the movements’ therapeutic effect.  In contrast, the positions frequently performed by yoga instructors appear to have a contra-therapeutic effect, producing more negative ramifications the more they are performed. As shown in the study by Weiss et al. [16], the more time individuals spend performing yoga the greater the risk and number of injuries. For any therapeutic modality, including properly performed weight training or exercise, this should not be the case. If anything, the opposite should hold true if, in fact, the stimulus is therapeutic.

• If the incidence of injuries in my work and practice were similar to those observed in modern day yoga I would be out of business.  Even minor, infrequent injuries are unacceptable in my line of work.