What is Yoga?

The most prevalent form of yoga in the West is Hatha Yoga. Hatha, meaning literally "sun-moon" Yoga is thought of as a way of uniting opposite energies, such as "masculine and feminine" or "hot and cold." Traditional Hatha Yoga encompasses not only physical poses (asanas), but also breath-work (pranayama), mudras (energy locks), meditation, and contemplative practice. In the West, 90 percent of the Yoga practiced consists of asanas (poses), and it is more likely to be pursued for body toning and weight loss benefits than for spiritual transcendence.  What distinguishes Yoga from other types of exercise is the focus on "non-violence," not forcing or straining,  "non-competitiveness," focusing on improving oneself at one's own pace, achieving "balance and inner calm" and "listening to the body."  However, it would be virtually impossible to assess all the Yoga studios and gyms in the world to see if teachers actually follow these principles. Gyms may be unaware of these tenets when they make hiring decisions. Also, if you have an injury or chronic medical condition, it is not clear what percentage of teachers would be qualified to tailor the poses for you.  The Yoga Alliance certifies Yoga teachers who have undergone a fairly rigorous training curriculum, including instruction in anatomy, yet universal standards do not currently exist for therapeutic work (although I hear from good sources that they are in the works).

History of Yoga in the West

Hatha Yoga was brought to the West in the 1920's by three students of T. Krishnamacharya (a prominent Indian yogi) namely, B.K.S. Iyengar, T.K.V. Desikachar , and Sri Pattabhi Jois. These three gurus founded the schools of Iyengar Yoga, ViniYoga, and Ashtanga, respectively. Compared to the first two, Ashtanga is more vigorous, continuous. and aerobic and was originally designed to help adolescent boys calm their excess energy. In 1947, Indira Devi opened her Yoga studio in Hollywood, which led to a steady migration of celebrities to the discipline. Where celebrities go, the public eventually follows; today, there are thousands of yoga studios and millions of devotees throughout the Western world. In the last decade, the growth of Yoga has been exponential. The New York Times cites a 5-fold increase in Yoga practitioners from 4 million in 2001 to 20 million in 2011. 

Yoga gear has become a cottage indistry

Who Practices Yoga?

According to national surveys, the typical Yoga practitioner is an educated woman in her mid-30's with above-average income, living in an urban setting and perceiving herself as being in better physical shape than the average person (sounds like the Real Housewives!). Typical reasons for pursuing Yoga include stress and lifestyle factors, weight-management or pain.  Only a small minority of Yogis abandon traditional medicine; most continue to see regular doctors as well. Most practitioners believe that Yoga works for their physical or mental symptoms and also identify with the mind-body and self-care philosophy. With the typical doctor's appointment now only 14-18 minutes, they may need a bit more mind-body love (know what I'm saying?).

Benefits of Yoga

The last decade has also seen an increase in studies using Yoga to treat ailments such as cancer, pain, or diabetes.  Studies support the benefits of Yoga for a variety of health outcomes, including pain, functional ability, blood pressure, sleep, depression, anxiety, immune function, and cognitive function.  Most studies in medical samples have, however, used small samples of subjects, so participants may not be typical or representative of the average person in the real world. Also, many studies compared Yoga to being on a waiting list for treatment. As we all know, just about any treatment will make patients feel happier and better than being on a waiting list. Therefore, it's not clear if the results were due to something special about the Yoga, or because Yoga group participants were given more attention and therefore expected they would improve (the placebo effect). Also, if patients did improve, was this because they exercised and became stronger and more flexible, or because of the psychological and spiritual aspects?

Risks of Yoga

Practicing Yoga is not without risks, however.  As research results on Yoga's benefits reach the public via the internet, older and less healthy people are trying it out. At home Yoga tapes can be bought relatively cheaply and are widely available at discount stores and on a plethora of expert websites. Gyms and health clubs without a holistic focus are also meeting demands from consumers by offering Yoga classes.  Sites like Groupon offer discounts for a series of Yoga classes as well. Because there are many different styles of Yoga and participants may not be aware of the difference in style, they are likely to choose the most affordable. This may lead novices into vigorous classes, such as Ashtanga or Bikram (heated) Yoga, with increased injury potential unless you know what you are doing. Even classical Yoga poses, such as shoulder or headstands, may pose risks for neck compression injuries. Extreme backbends may lead to hyperflexion, and those with high blood pressure may have increased risk for stroke when doing inverted poses.  According to The New York Times, emergency room visits due to Yoga injuries increased from 13 in 2000 to 20 in 2001.  Considering that millions of people actually practice Yoga, this does not seem like a particularly troubling number. Any serious adverse effects, potentially resulting in potentially permanent disability, should not be taken lightly, however.

To evaluate the benefits versus costs of Yoga more systematically, I looked at a recent, groundbreaking study by Karen Sherman and colleagues at the Group Health Cooperative in Seattle, Washington in the Archives of Internal Medicine (December, 2011). This study used rigorous methods to assess the benefits of Yoga for participants with chronic low back pain.  This is the first study of Yoga for chronic pain that has included a large number of patients (228 to be exact), used a long-term (approximately 6-month) follow-up assessment, and compared Yoga not only to a minimal treatment (self-help book), but to another intervention (Stretching) that is widely used to treat back pain. Participants were therefore assigned, on a random basis, to either get the self-help book, attend 12 weekly Yoga classes taught by an experienced Yoga instructor, or attend 12 weekly classes of stretching exercises taught by an experienced physical therapist.  Everybody in the study was assessed before treatment and at 6, 12, and 26 weeks as to how impaired they were in doing their daily activities and how bothersome their pain was.