Monday, February 15, 2010

Injuries and women

Lately, I’ve been practicing next to a significant number of injured women… and seemingly uninjured men. This gender discrepancy could be for many obvious reasons -- maybe there are simply more women practicing yoga (making the odds higher), maybe the injured women have been practicing for a longer time-period (thus more prone to overuse injuries), maybe women are naturally more flexible (and thus push themselves too far), or perhaps some men are injured but are masking their injuries.

After some research, I found that female rowers are injured more frequently than their male counterparts. This study looked at 398 rowers (42% female, 58% male) competing in the Junior World Rowing Championships in 2007, finding overall 73.8% reported overuse injuries, and 26.2% reported injury from a single traumatic event. Females had more injuries than males (110.2 vs 90.5 injuries per 100 rowers). (I'm still wondering if there was a gender difference in traumatic versus overuse injuries).

This is leaving me wondering -- is there something that makes women more prone to injuries from intense physical practices such as Ashtanga or rowing?

I’ve been thinking about the hormone progesterone. During pregnancy, the high levels of progesterone help the woman’s body gain flexibility in preparation for labor and delivery. Progesterone levels also rise in the last two weeks of the menstrual cycle (the “luteal” phase). Could this make women more “open” during this part of the menstrual cycle, and thus more susceptible to injury? (It could be coincidence, but this was the time when I pulled my serratus anterior back in December).

I was glad to see that this question has begun to be studied. Though a very small sample size (n=8), this study showed no difference in flexibility over the menstrual cycle. They divided the cycle phases into menstrual (estradiol and progesterone levels low), ovulatory (estradiol high and progesterone low), and luteal (progesterone elevated), and measured maximal isometric voluntary contraction, muscle activation level, and tendon properties (using ultrasound). They found no significant changes during the three phases.

I would love to see a prospective study of hundreds of Ashtanga practitioners (or a similar daily physical practice), that tracks type of injury along with menstrual cycle phase/progesterone level. In the meantime, I’ll continue with self-observation on this question.


  1.'s so strange that you posted this. I was just thinking during practice this morning how many of the students are nursing injuries...

  2. I'm practically in a constant sate of injury. I think if you asked most of the ashtangis in the room (and they are honest with you) they would tell you that something is hurting. It might not be debilitating but I would bet you that everyone has some kind of pain issue. I had to modify my practice for 2.5 months due to back pain over the summer. It's just the nature of a practice like this.

  3. In the last few months alone, I've been working through shoulder pain and lower back pain. Both of these issues have migrated in and out of my practice for the last four or five years. It's a rare moment when I'm not working through pain of some kind, it moves around but never really seems to disappear. I broached this topic with one of my instructors, and he said something along the lines of "There's always pain, whether it's physical or mental."

    It also depends on how you define 'injury' since I don't necessarily consider muscular pain an injury (which is another long conversation), although that might just be my pro-Ashtanga bias. One of the common criticisms/ mantras from yogis who don't practice Ashtanga is that too many people are injured by the practice.

  4. Christina, if it makes you feel any better, my wrist has been hurting me since Christmas or so. It certainly feels better than it did at first, but I am still modifying a number of things. During the second half of the summer or so, including the entire month of August, I couldn't do Chatturanga due to shoulder pain which, like my current wrist pain, was of unknown provenance. However, I kept trying at every practice. I was skipping vinyasas, doing "high plank" without lowering down, trying all sorts of things. Eventually, I discovered that I could lower down consistently if I dropped my knees to the ground. I think that's a good example of how injuries can be made less apparent. When I was doing this modified Chatturanga, I was still doing the general motion of Chatturanga. I think you'd have to pay quite a bit of attention to notice that I was *never* jumping back and that my knees were on the ground. Presumably, if you're engrossed in your own practice, you will only notice the most obvious injury modifications (e.g., chairs, prop-forts, omitting all vinyasas) that others are making. More subtle modifications, I'm sure, abound.

  5. So interesting to hear about the injured female rower study. I rowed everyday for 8 years and had constant low back pain, I'm not sure I would have called it an injury (at the risk of being sidelined by my coach!), but it was just part of the package. Im finding that my back pain is begining to return as I have begun to practice Ashtanga with the same intensity which I rowed for so many years. Perhaps there aren't more injuries in Ashtanga because of the practice itself, but rather the intensity and focus of the practitionars drawn to it.

  6. Have a body and "there is always pain". Our bodies are prone to injure, age, breakdown. With ashtanga the practice is learn how to work compassionately with our injures, our aging, our suffering.