HYDERABAD:

has its side effects. However, the adverse effects need not be cause for concern so as not to practice it at all.

A study titled ' Adverse Events Associated with Yoga: A systematic review of published case reports and Case Series' published in the scientific journal Plos One has come up with the adverse events associated with yoga.

The research study conducted Holger Cramer, Gustav Dobos, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany and and Carol Krucoff, Duke Integrative Medicine,

, Durham, North Carolina, United States of America was published in the scientific journal on October 16, 2013.

The authors said while yoga is gaining popularity in

and Europe, its safety has been questioned in the lay press. The aim of this systematic review was to assess published case reports and case series on adverse events associated with yoga.

Medline/Pubmed, Scopus, CAMBase, IndMed and the Cases Database were screened through February 2013; and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha yoga, and

were the most common yoga practices; headstand, shoulder stand,

position, and forceful breathing were the most common yoga postures and breathing techniques cited.

In the study 27 adverse events (35.5%) affected the musculoskeletal system, 14 (18.4%) the nervous system; and 9 (11.8%) the eyes. Fifteen cases (19.7%) reached full recovery, nine cases (11.3%) partial recovery and in one case (1.3%) there was no recovery. In one case (1.3 %), the person had died.

It was pointed out that yoga was rooted in Indian philosophy and has been a part of traditional Indian spiritual practice for around 3000 years . While the goal of yoga has been described as uniting mind, body, and spirit, it has now become a popular means to promote physical and mental well-being.

While yoga traditionally also comprises advice for ethical lifestyle and spiritual practice, it is most often associated with physical postures (asanas), breathing techniques (pranayama), and meditation (dyana) in North America and Europe , the study pointed out . These more physically-oriented yoga forms are gaining more popularity as a therapeutic practice.

About 14 million Americans (6.1% of the population) reported that yoga was recommended to them by a physician or other therapist .

The systematic review by the authors included 76 unique cases of yoga-associated adverse events. Most adverse events affected the musculoskeletal, nervous, or visual system. More than half of the cases for which clinical outcomes were reported reached full recovery, one case did not recover at all, and one case died. Headstand was by far the most often cited yoga posture and Pranayama and Bikram yoga were the yoga practices that were most often associated with adverse events.

In a small survey in 110 Finnish Ashtanga Vinyasa Yoga practitioners, 62% of respondents reported at least one yoga-related musculoskeletal injury, mainly sprains and strains. About half of those reported full recovery, the other half partial recovery. Ashtanga Vinyasa Yoga is a physically demanding yoga style that uses standardized sequences of physical yoga postures with synchronized breathing , the report said . More recently, in a large national survey, 78.7% of about 2500 Australian yoga practitioners indicated that they had never been injured during yoga. A survey in more than 1300 mainly North American yoga teachers and therapists found that respondents considered injuries of the spine, shoulders, or joints the most common.

The report said while voluntary vomiting is a common Kriya or cleansing technique in traditional yoga, it is rarely practiced in North America or Europe. As a case of intermittent reflux symptoms and another one of dental erosion - both of which originated from India - can be assumed to be directly related to regular vomiting, and the postulated cleansing properties of the practice are not in accordance with biomedical science. "This practice should be discouraged in general," the report said.

A word of caution was also given. "Yoga should not be practiced as a competition and yoga teachers and practitioners should never push themselves (or their students) to their limits . Beginners should avoid advanced postures such as headstand or lotus position and advanced breathing techniques such as Kapalabathi. Practices like voluntary vomiting should perhaps be avoided completely," the report said.

As yoga has been shown to be beneficial for a variety of conditions , it can also be recommended to patients with physical or mental ailments, as long as it is appropriately adapted to their needs and abilities and performed under the guidance of an experienced and medically trained yoga teacher. Especially, patients with glaucoma should avoid inversions and patients with compromised bone and other musculoskeletal disorders should avoid forceful or competitive yoga forms. Yoga should not be practiced while under the influence of psychoactive drugs, the authors conclude