‘Pushing myself to the edge’
Susan Eaton, a 45-year-old physical therapist in San Francisco, has always been athletic. She runs, hikes and lifts weights, and started doing yoga in 2000. Even though she knew better than to push her body into an asana that didn't feel right, there was a part of her that wanted the challenge. “I was very competitive with myself,” she says. “I felt that if this is how the teacher presents a pose, then this is how I want to perform it.”
Eaton's spirited approach to yoga served her well for the two years she practiced two or three times a week. But toward the end of a class she took in December 2002, something went wrong.
The class was in Fish pose, a position that involves the student lying on her back, her spine arched, her chest up and open, the top of her head resting on her mat. In a modified version, the student supports herself with her elbows on the floor; in the advanced incarnation that Eaton did, more weight is borne by the head and neck. “It's a hyperextended neck pose that as a physical therapist I later questioned,” Eaton recalls. “I had done this pose before, but this time I was uneasy, as though I knew I might be pushing myself to the edge.”
Over the next three days, Eaton experienced intense head, neck and jaw pain. Then, on the fourth night, she woke up alone in the middle of the night to flashing lights and a popping sound in her head. She slipped out of bed and fell to the floor, the entire right side of her body limp — a symptom she recognized as a sign of a stroke. “I knew that if I let myself pass out, I'd probably die because no one would have found me until I didn't show up for work,” she says. She dragged her body to the phone to dial 911. It took five tries before she succeeded.
Rushed to a nearby emergency room, Eaton slipped between cognition and confusion, alert and focused one minute and unable to remember her daughter's name the next. She had torn her left carotid, one of the two arteries located in the front of the neck that supply the head with blood; a clot had then formed and traveled to her brain. And her doctors agreed that the likely cause of the tear was yoga.
Such a thing is unusual but not impossible. In 2001, The New England Journal of Medicine published an article that cites yoga as one of the many possible causes for arterial dissection in susceptible patients. “It's not likely, but if you extend your neck and look toward the sky, you can tear one of the carotid artery's layers,” says Eaton's neurologist, Wade S. Smith, M.D., director of the Neurovascular Service at the University of California at San Francisco. “These things can happen spontaneously, and you don't want to falsely accuse a form of exercise. But in this case, it makes sense that yoga was involved in the tear because they were so closely coupled in time.” Dr. Smith adds that Eaton tested negative for tissue disorders that might have predisposed her to the event.
Eaton was put on blood thinners to prevent clotting and remained in the hospital for three days. It was three months before she could return to work full time and ease into exercising again. Today, she is fully recovered, although she still sometimes has problems recalling words and numbers that should be familiar. “It was an accident,” Eaton says. But one she learned from. “I adore yoga, but you have to be mindful when doing these things.”
Not all teachers emphasize this mindfulness, the idea that students need to know their body's limits and heed the signals that it's time to cool it. The concept can be understandably hard to grasp for many women, who are rewarded for a can-do attitude in every aspect of their life. Dr. Fishman recently conducted a worldwide survey of more than 33,000 yoga teachers and therapists to investigate the most common injuries and their causes. He found that among the major reasons for injuries are inexperienced teachers and “egotistical,” competitive students who push themselves too hard.
“The ambitions of the yoga student have changed,” Dr. Fishman says. Many students come looking for a workout akin to aerobics or sports, with only ancillary meditative benefits. But, explains Terri Kennedy, founder of Ta Yoga House in New York City, “yoga is about intention, attention and breath.” In soccer, the mere intent to get the ball in the net won't score you points. In yoga, your movement toward, say, touching your toes is what matters, not whether you are able to wrench your body into that position. “If you keep the breath steady, then you can begin to steady the mind,” adds Kennedy, chairwoman of the board of Yoga Alliance, a national organization that sets standards for yoga teaching. “That's the essence of the practice. It's not about a perfect-looking posture.”
In the tradition set forth roughly 5,000 years ago in ancient India, yoga instruction was one-on-one and individually tailored, the passage of a sacred discipline from guru to student. Today, of course, classes are a group affair — and packed; 15.8 million Americans practice yoga, according to Yoga Journal. More than 2 million get instruction at the gym; many experts feel students who learn at a specialized yoga studio are more likely to be taught the subtleties that can head off injury. “Some of today's yoga teachers have been recruited from the vast army of the unemployed, the kind of people who used to become waiters and waitresses while figuring out what to do with the rest of their life,” says Dr. Fishman, who was once an expert witness in the lawsuit of a yogi who could no longer walk up stairs after she tore the cartilage in her knee doing a Hero pose. “That includes people who are eager to do the right thing but don't have the anatomical knowledge, physiological understanding, caring attitude and experience to be able to teach.”
No certification or specific training is required before a person is allowed to teach yoga. Yoga Alliance recommends teachers get a bare minimum of 200 hours of training and has built a registry of teachers and schools that meet its standards. But participation is voluntary; teachers can just as easily get certified in weekend or online courses. “If you are a Spinning teacher and you want to tack on yoga, then you can take a two-day training,” Kennedy says. “You may think you are qualified, but that has its challenges.”
These quickie courses teach poses but not necessarily the nuances of proper alignment nor the ideal, noncompetitive mind-set. And they likely won't train teachers how to suss out previous injuries and medical problems that yoga could worsen. A preexisting arterial tear, often signaled by dizziness and neck pain, puts you at risk for a stroke; leg pain could warn that a bulging disk in the back is putting pressure on your sciatic nerve. If you have undiagnosed glaucoma, you can go blind doing headstands or shoulder stands.
