LAUSR

Yoga is widely practiced for its health benefits (Alter, 2004; Singleton, 2010), especially for chronic non-communicable diseases (Holte and Millis, 2013). The Consortium of Academic Health Centers for Integrative Medicine located at Michigan, U.S. teaches yoga in most of its branches (Holte and Millis, 2013; https://imconsortium.org/)1. Yoga is one of the top ten complementary health practices used by adults in the U.S. where 45 percent of this population have at least one chronic illness (Wu and Green, 2000). Two meta-analyses were carried out to examine yoga in the context of stroke (Lawrence et al., 2017; Thayabaranathan et al., 2017). The authors of the meta-analyses concluded that yoga is effective but did not report any adverse event associated with yoga practice (Lawrence et al., 2017; Thayabaranathan et al., 2017). Despite this, safety is important during stroke rehabilitation, especially for practices which involve maintaining balance. Similarly, we found that in meta-analyses of yoga used for multiple sclerosis or cardiac disease there was a lack of information related to the safety of yoga interventions as adverse events related to yoga practice were not usually mentioned (Cramer et al., 2014, 2015a). Apart from this, when safety related data were reported there were no adverse events (Cramer et al., 2014, 2015b). Safety issues in yoga practice apply to all chronic illnesses. The Need for Safety in Yoga Practice An ancient Hatha yoga text gives importance to the method of practice, stating “….by the proper practice of pranayama (voluntarily regulated yoga breathing), all diseases are eradicated, whereas through the improper practice all diseases can arise” (Hatha Yoga Pradipika, Circa 1500 A.D., Chapter II Verse 16; Muktibodhananda, 1998). William Broad (2012) attempted to highlight the adverse events which could occur with yoga practice in his book “The Science of Yoga: The Risks and Rewards” (Broad, 2012). This evoked a wide range of responses, especially from those who have benefitted from yoga practice. However the adverse events related to yoga cannot be discounted. Hence this opinion article has two aims. (i) The first aim is to cite published examples of adverse events occurring from yoga practice due to: (a) an unusually long duration of yoga practice, (b) practice of a yoga technique more frequently than is recommended, (c) excess strain on a specific joint during yoga practice, or (d) ignoring any health condition which would be a contraindication for yoga practice. (ii) The second aim is to suggest recommendations to improve safety and reduce adverse events related to yoga practice as therapy.