yoga: the painful truth book review + q&a

The ideal spine (image via Kevin Khalili)

Many yoga practitioners and teachers believe that yoga is good for us on all levels: spiritually, emotionally and physically. However, lately there is increasing evidence that yoga can be harmful as well as healing. Recent articles in Time Magazine (“When Yoga Hurts,” from 2007) and The Globe & Mail (“Trouble on the Om Front,” from 2009) are exploring the reasons behind statistics indicating an increase in yoga-related injuries. Between 2004 and 2007, approximately 13,000 people were treated for yoga-related injuries, according to the Consumer Product Safety Commission.

Kevin Khalili, a chiropractor based in California, has added another voice to this growing (and essential) conversation, with his self-published book, X-Posed: The Painful Truth Behind Yoga & Pilates. Here, he claims that common motions and positions in daily life – which are actually stressful and unbalanced – are duplicated during certain yoga exercises. He singles out improper lying down, sitting and bending/lifting from the waist as the most dangerous motions.

In his chiro practice, Kevin noticed that yoga (and Pilates, but I’m only focusing on the yoga here) are the source of many needless, painful injuries, and he was compelled to research and study how this could be prevented. The information in X-Posed is supported by plenty of studies and academic reports (listed in a six-page bibliography at the end of the book), as well as observations in his office. According to his research, the most dangerous classes of poses are seated, forward bends and inversions. He includes a chapter on each class, detailing the aspects of the poses that are hazardous for most body types, and including alternatives. A chapter called “Lost Treasures” lists the “hidden gems” that are beneficial for most bodies.

I find it interesting that Kevin notes that North Americans have approached practicing yoga in a “dangerously uncritical way,” and that the positive effects of yoga (including the “sense of elation” that many of us feel after practice) have clouded our judgement. As well, yoga is marketed as something that is innocuous and beneficial, leading us to believe that it’s all good. “Motion is motion,” he writes, “and just because we are performing a wrong motion in a tranquil healing environment, it doesn’t make it a right motion for your body.”

Yet, X-Posed is not an attack on yoga, and Kevin repeatedly says that he is concerned about the safety and health of practitioners. The tone of the book is reasonable and balanced, and the information is well-researched. Since the book was self-published, the writing and editing isn’t as rigorous as the research, but the information is there and the intention is clear.

It takes a lot of courage to speak out consciously *against* yoga. Luckily, Kevin can explain his reasons for writing the book better than I can. He graciously agreed to answer some questions for me.

What is your intention with this book?

My intention is to help establish safer standards of practice for yoga via valid scientific principles. In a nutshell: reduce risks and boost benefits of yoga practice.

What kind of research process did you go through to come to the conclusion that some poses aren’t safe?  

I was compelled to write this book because I saw so many needless and preventable yoga injuries by both students and seasoned instructors. I spent nearly 5 years researching and writing this book. It’s primarily based in rigorous scientific medical literature because I knew my opinion and my 19 years of clinical experience would have little value on its own.

I understand that you aren’t “anti-yoga” and that you actually practice yoga yourself. Could you tell me a little about your personal practice? Why do you practice yoga? 

I practice yoga about 3 times a week as part of a 75-90 minute home workout routine that I custom developed to specifically suit my body.  I practice to achieve balance, strength, flexibility, and relaxation. Some of my favorite poses that best fit my body are mountain pose, upward salute pose, warrior 1 pose, bow pose, wheel pose, cobra, bridge pose, locust pose, pigeon pose, dolphin plank pose, corpse pose, reclining hero pose, reclining bound angle pose, and reclining big toe pose.

What is the purpose of yoga? What is the purpose of asana?

The purpose of yoga is open mindedness, balance, evolution, learning, harmony and the passionate pursuit of optimal health. Asana is a vehicle of yoga to help achieve balance, strength, flexibility and relaxation.

You imply that seated poses are among the most dangerous poses to practice. Yet, in the yoga world, seated poses are considered gentle and therapeutic for people who may not have the endurance for a class based in standing poses. For example, many classes for seniors incorporate seated poses (and often “chair yoga”). What do you think about this?

Unfortunately, the gentleness of seated poses has wrongly been assumed as being safe. Many seniors’ classes incorporate “chair yoga” because sitting in a chair is safer and better for you than sitting on the floor. Why do we understand that sitting all day at our desks is not best suited for our bodies but we don’t accept the scientific fact that sitting on a floor is a worse biomechanic ergonomic situation?

We assume it is okay just because it is “gentle” and labeled “yoga.”

I have seen many injuries to the lower back, hip, and knees from these sitting type poses, even from seasoned instructors. Most repetitive stress injuries are the result of repeatedly doing abnormal motions/positions that are “gentle.” I agree with you that we shouldn’t just do standing poses. In fact, the majority of poses that I recommend are not standing.

Another class of poses that you state is dangerous for spinal health are inversions (especially headstand, shoulderstand and plow pose). Should we not practice these poses at all? The yoga tradition tells us that these poses have many subtle benefits ~ do you think this is a viable reason to continue to practice these poses?

Due to the risk verses benefit ratio, I simply recommend avoiding these poses. My research suggests that there are approximately 1000 poses in yoga and by avoiding the inversion poses we can still have a very fulfilled yoga workout. Some of the worst injuries I have seen in my office are a result of these inversion type poses.

Some of your recommended “reformed yoga” poses don’t resemble anything that I’ve seen in a yoga class or yoga book. Do you think this comprises the integrity of the yoga tradition?

I believe the whole purpose of the yoga tradition is too be openminded and continually evolve oneself and the practice of yoga. Yoga deserves this and I believe it is our duty to apply this knowledge which only benefits the yogi for a enhanced practice with reduced risk. Knowledge is power and I am merely the presenter of scientific knowledge to help the yoga community. I recommend practitioners like myself worldwide have working relationships with yoga instructors in their community to offer them invaluable knowledge concerning practice optimization for their students.

I hope to never see a yoga injury in my office again. Prevention is my intention.

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19 Comments

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  1. I agree with him 150%. If more people truly understood that “yoga is all in the bones” — i.e, the ultimate limit of an asana is your BONE STRUCTURE AND HOW YOU’RE PUT TOGETHER — I believe there would be a lot less injuries. I just taught a workshop over the weekend where a woman actually believed her bone structure was exactly the same on each side of her body — she thought her skeleton really DID look like a plastic skeleton that you see in AP classes.

    That, and also getting your ego out of your yoga.

  2. The first time I tried practicing yoga on a daily basis, by myself, within a week I made myself so sore that, for the next month or so, I couldn’t do twists, or much of anything involving the knees or spine (which, needless to say, didn’t leave me much of an asana practice). Up until then, I, like most people, saw yoga as something that would make me stronger and more flexible and, thus, less likely to get hurt, so how could you possibly get hurt doing it?

    So, now, as a budding yoga teacher, in the handful of informal yoga classes I’ve taught, I’ve emphasized that yes, yoga has all kinds of physical benefits, including increased flexibility, but can also be dangerous, if not practiced with care–and this, I think, should be emphasized to every beginning yoga student (and, for that matter, isn’t bad to remind non-beginners on a regular basis).

    • hey dr jay ~ it’s cool that you’re taking that into consideration as a budding teacher. i do think, however, that it’s about more than “practicing with care.” i would like to see yoga teachers empower students to learn about their bodies, to really know what’s happening ~ rather than simply to “listen” or “honour” or “be careful.”

      in the book, kevin khalili encourages more collaboration between chiropractors and yoga teachers, so there is more information exchanged and shared, and teachers can refer students to practitioners (rather than try to help students themselves, which often does not work). i think this is a great idea.

  3. All physical activities come with risks. More people are coming down with yoga injuries because more people are doing yoga! It is plain and simple. Yes, there is a right and a wrong way to do yoga. But that is true for walking,running, swimming, playing basketball, weight training etc…. Outside of all of that…. Of course he will see a yoga injury in his office again…As long as humans exist on this planet, they will be pushing their limits..and to see how far we can go comes with risks. We would never have airplanes if someone hadn’t have risked falling out of the sky to make it happen…I just think the whole yoga and injury thing is just being blown way out of proportion…Though I am sure the book is a great tool to teach people to do it safely and is written with love and consideration…I’m just saying….

    • thanks for jumping in, shanna!

      i agree that all physical activities have risks, and that most other sports and activities have some potential for injury. people who run get injured, basketball players get injured, snowboarders get injured. but i also think that thinking people will just keep pushing their limits is simplistic.

      i think the difference here is that many people do yoga to alleviate pain, especially back pain. it’s perceived and marketed as harmless. and that while they are trying to heal themselves, they may actually be doing more damage.

      take, for example, an office worker with an achy lower back, and he starts going to yoga class because he heard it’s good for back pain. without knowing it, he may have a condition such as degenerative disc disease and have bone spurs along his spine. in yoga class, he’s doing sun salutations, forward bends, and it feels good, but is also totally contraindicated for his condition and possibly aggravating the bone spurs.

      i think the underlying message here is for practitioners to take their health into their own hands and learn their bodies, then do a practice that is beneficial and useful.

  4. painful postures for my lower back? seated forward folds. i put so much pressure on my lower back trying to keep myself bent that way that it’s often painful.

    I also agree with him 150% as LindaS says. As a health professional myself, I truly feel that regulation and further training can go far in protecting both the yoga practitioner and the instructor.

    I think this is the tricky part of pairing spirituality with a physical component. As opposed to other forms of physical activity (say running for example), each posture in yoga has an overlaying sense of reverence and divine reason. As soon as it is implied that this type of spiritual divine practice may have negative physical implications- many become defensive.

    Being open to critical and ultimately helpful feedback from professionals who know the body (chiropractors, physiotherapists etc) from years of study and clinical experience can be a good thing for the yoga world.

    • “I think this is the tricky part of pairing spirituality with a physical component… each posture in yoga has an overlaying sense of reverence and divine reason.” yes yes yes. i agree that this makes it complicated and differentiates yoga from running or swimming.

      however, i think we have to question the “sense of reverence and divine reason” and examine where that comes from. i feel that it might be superimposed on yoga by western teachers. i wonder how much of this is what we project on the postures.

      • ouuu- that is interesting! I wonder…

        • have you read yoga body, by mark singleton? basically, he puts forward the argument that yoga asanas grew out of early 20th century “physical culture” and are connected to Indian nationalism. it’s a very interesting argument…

          • no i haven’t! I’ll look into it- i’ve heard this perspective before (i think firstly in Enlighten Up! but can’t be sure- may have been blogs here and there). Thanks!

  5. YES!!! Tissues with “issues” are not always healed by poses. Applying the simple logic of “incongruous motion is ineffective motion in any environment” is a sane and compassionate approach to the body that loves to give itself some asana. Ordering book and reposting now! THANKS!

  6. I encourage yoga practitioners not to be afraid of asana practice. There is nothing inherently dangerous with asana; nothing if you are truly being a yogi and not merely doing gym exercising. It is in the execution of the pose where the troubles arise. Learning precise alignment and not allowing the ego to override the practice will determine the outcome. These requisites may take years to learn but that’s why its called a practice. Yoga, when practiced with alignment will be vitalizing and therapeutic. Yoga, without alignment will be dangerous and cause damage. There is very little middle ground.

  7. This is pretty much exactly what my thesis is on – I’m a grad student in Kinesiology. Since yoga exists in the context “it is good for you,” people look over the fact that it is still movement. As we know, movement always carries a risk of injury. Thank you for this!

  8. I practice Svaroopa yoga which focuses on opening up the spinal muscles, etc. It is very gentle and restorative…but I have had neck and back injuries and in any yoga class, I abstain from doing those poses that I know could cause me pain / harm. In Svaroopa, we are told, “Less is more.” If you stretch or force, your body will likely “retract” in response, causing you to be stiffer, more sore. I think that teachers should be more aware of individual limitations – and yogis should be more aware of their own bodies and limitations. Totally agree w/poster who said that we also need to take our egos out of it – yoga is not a competitive activity, one of the things that I love so much about it! This is a much needed commentary on the “dark side” of yoga! 🙂

    • thanks for your comment! i tried svaroopa yoga a couple of years ago and really enjoyed the practice. i’ve become more intrigued by it lately. as far as i know, there is only one svaroopa teacher here in montreal ~ i will have to try one of her classes again.

  9. While I haven’t had the chance to read Khalili’s book yet–but intend to do so–I think it’s important to consider, before making generalized statements about hypothetical detrimental effects of yoga, certain questions, questions I’ll be sure to keep in mind when I read his book.

    What kind of medical literature is he drawing upon? Is his research based on actual controlled critical studies of practitioners over a period of time? Does it consider the demographics of practitioners? Does it consider the type of yoga class? Hatha vs. Ashtanga? Does it consider the qualifications of the teacher? Does it consider specific, contextualized case studies of how injuries arose?

    Is his research and thesis founded upon the notion that properly executed and controlled asanas cause damage to the body? Or is it founded upon poor asana execution as a result of misalignment and incompetent yoga instruction wherein the fault lies with the instructor as opposed to the physical aspect of yoga itself.

    One of the articles linked (The Times) cites injuries as a result of poor yoga instruction from unqualified teachers; we can’t blame the yoga system for the inefficacy of poorly trained teachers. (It’s very scary that some instructors can get away with a weekend course of training.)

    And while Khalili’s book title might have a nice ring to it, it seems to neglect how physical asana practice is only one component of the eight limbs of the ashtanga yoga system.

    I commend Khalili for his work and really do believe it’s important to have this kind of dialogue, between health care professionals, instructors, and practitioners. Just because the yoga system is ancient, it doesn’t mean we have to be rooted in tradition — even the Buddha invited people to question and challenge him, and to make their practice their own.

  10. “he puts forward the argument that yoga asanas grew out of early 20th century “physical culture” and are connected to Indian nationalism. it’s a very interesting argument.”

    and one that I find specious considering the yoga taught at the Krishnamacharya Yoga Mandiram and by my teacher Srivatsa Ramaswami who studied with Krischnamacharya for over 30 years.

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