Power yoga induced acute para-spinal compartment syndrome: a case report and review of literature.

Abstract

Acute Paraspinal compartment syndrome (PCS) is a very rare clinical condition resulting from high pressures within the erector spinae muscle compartment due to intense edema of the erector spinae muscles and can be associated with rhabdomyolysis and renal injury. Though several causes have been identified, PCS caused by power yoga has not been reported. Power yoga is a form of fast and vigorous yoga, and involves intense flexion-extension of the spine and other parts of the body in a repetitive manner. We report the case of a 36-year-old male who presented with acute onset of intense low back pain following power yoga practice. His lower limb neurology was normal and MRI showed diffuse intramuscular oedema of the bilateral para-spinal erector spinae muscles around the lumbar region indicative of PCS. Laboratory values of elevated urine myoglobin and serum creatinine phosphate kinase (CPK) confirmed the presence of rhabdomyolysis. He was monitored closely for renal injury and treated by rest, analgesics, fluid management and supportive care. Serial CPK values indicated a decreasing trend and at sixth week, the value was normal. Follow-up MRI at 6 weeks showed complete resolution of muscle oedema. Patient had full recovery and returned to normal activities in 6 months. This report highlights the importance of vigilance and performing early MRI for diagnosing yoga-induced PCS, so that appropriate treatment can be initiated avoiding serious sequelae of rhabdomyolysis and paraspinal muscle loss. This report highlights the need for suspicion and early MRI for diagnosing yoga-induced PCS and appropriate care.