According to estimates, more than 30 million people now regularly practice yoga worldwide. And 14 million of those include Americans who received a prescription for yoga from a physician or other therapist. (1) People have practiced yoga for thousands of years. During that time, the practice has earned a strong reputation for promoting well-being in both body and mind.
However, something many practitioners may not realize is that a number of commonly taught yoga poses (or asanas, as they are often called in class) can also be risky. Particularly yoga injuries are a real threat. So are the healing benefits of yoga worth the risk?
Yoga injuries — including back pains, popped ribs and strained necks — are not necessarily a rare occurrence, especially among those brand new to yoga who push themselves too hard or too quickly. Yoga poses such as handstands, inversions and back-bends might quality yoga as moderate exercise, but these tougher poses also can be cause for concern if you’re not ready for them.
An article published in The New York Times investigating the prevalence of yoga-related injuries found that several factors seem to be related to the rising number of pulls, tears and sprains prevalent among yogis. (2) A major contributing factor is a shift in both those who teach and practice yoga. More than ever before, adults who are mostly otherwise sedentary and unfamiliar with the practice are turning to yoga to improve flexibility and strength. While this can be helpful in many instances when students are properly guided, a tight, inactive or aging body mixed with a vigorous practice or an experienced teacher can also sometimes serve as a recipe for disaster.
Given all of the proven benefits of yoga, but also the potential risks, what’s a yogi to do? The solution to avoiding yoga injuries seems to be a combination of taking your time to ease into the practice, listening to your body, never pushing yourself past the point of comfort when stretching, and also mixing yoga with other exercises to strengthen weak areas and reduce compensations. It’s also wise to find an instructor who is well-qualified.
How Common Are Yoga Injuries?
A 2012 study conducted in Australia and printed in the International Journal of Yoga found evidence that around 20 percent of all yoga practitioners claim to have experienced a yoga-related injury at some point during their practice. (3) On the other hand, an exclusive survey of Ashtanga Vinyasa (considered a more vigorous style), 62 percent of practitioners reported having had at least one injury lasting longer than 1 month.
A 2013 review published in the journal PLOSone investigated the prevalence of case reports and case series on adverse events associated with yoga, plus the most common types of yoga injuries reported and treated. They found that among reported yoga injuries, about 35 percent affected the musculoskeletal system; 18 percent the nervous system; and 9 percent vision/the eyes. Around 20 percent of those who were injured doing yoga reached full recovery, while 11 percent reached partial recovery. Only around 1 percent reported lasting injury, and sadly even one death was found to be associated with yoga practice. (4)
Of the 76 case studies included in the yoga-injury review, 66 injured students were found to have had no preconditions that were associated with the adverse events, while 9 case reports described an aggravation of existing preconditions. Women experienced double the yoga injury rate as men (not surprising considering women tend to practice more often), while the mean age of injury due to yoga was about 44 years old.
On the other hand, in 2013 after examining how a national sample of yoga practitioners were affected by injuries (including how many have had to stop their practice and which injuries were most common) researchers who published a study in the International Journal of Yoga found that only about 1 percent of all yogis (only 13 people out of 2,230 people included in the study) reported experiencing a side-effect from their practice that led to discontinued use of yoga. (5)
Of those who were injured, back pains and joint pains (affecting the hips, wrist, and ankles) were the most common complaints. Less than one-third of those injured reported seeking medical attention. The researchers stated that “These findings suggest that injury due to use of yoga is an infrequent barrier to continued yoga practice, and severe injury due to the use of yoga is rare.”
Types of Yoga Injuries: What Are The Causes & Riskiest Poses?
As with any other form of physical practice, yoga should be practiced carefully under the guidance of a qualified instructor in order to reduce risk. If you’ve been injured in the past, or have been mostly sedentary, consider skipping some of the riskiest poses all together.
A high percentage of yoga-related injuries seem to be caused from the following more advanced poses:
- Shoulder Stand (Salamba Sarvangasana) or Plow Pose (Halasana): Shoulder stand and plow pose are performed while propping up the body onto the shoulders with the legs straight up in the air (or behind the head in the case of plow). According to an article published by Yoga Journal, this applies a lot of pressure to the cervical vertebrae in the neck, causing the neck to flex forward uncomfortably. (6)
- As the entire body applies pressure to the spine, injuries are possible that can radiate downward or out to the shoulders. Neck pain can result, or worse a serious vertebrae or spinal disc problem.
- It’s debatable whether shoulder stands should be performed at all, but for those who do teach the posture because it can be beneficial for things like decreasing the heart rate, they advise using a blanket under the shoulders/neck for support and extra lift.
- Other tips for reducing strains in the neck and shoulders include not pushing the neck too far forward and remaining very still in the posture without turning the head.
- Headstand (Sirsasana): Headstands can be risky because they apply lots of strain to the neck, shoulders or hands, plus there’s always the chance of falling and in the process throwing-out the back.
- First determine whether you are ready to safely try inversions by testing that you can hold down-dog, forearm plank and dolphin pose for at least 1 to 2 minutes, since these build needed strength in the upper body.
- Experts warn that patients with glaucoma should avoid inversions due to blood rushing to the head/eyes.
- If you are going to try inversions (bringing your feet above your head) or difficult balancing poses, one of the safest ways is to use a wall for support. A wall can help catch your legs or heels, keeping you from falling backward. Many teachers advise students to use a wall while they learn for at least the first 5 to 10 attempts.
- Another option is to use blocks under your shoulders for extra support, or to have a teacher assist you and hold up your feet.
- You can also skip head stand and shoulder stand all together, simply elevating your feet up a wall to relax while you lay flat on your back. This is virtually a no-risk posture but still helps cool down the body and slow the heart rate.
- Back-bends (including Updog, Lotus, Bridge, Wheel, Cobra or Camel): Back-bends involve pushing the chest or hips forward and curving the back and chest so that the head extends backwards.
- If you have any existing neck injury or chronic back pains, avoid back bends (unless you are practicing under the supervision of an experienced teacher). Beginners should also move into backbends with caution.
- Try to guide yourself into any backbend very carefully and slowly, allowing the lower spine be the last part of your spine to move. Never push the hips forward or the neck/head back too abruptly.
- Keep your knees, thighs and feet parallel as much as possible when bending back. This will help keep hips facing forward and prevent twists in the spine.
- Feel free to use a block or bolster under your sacrum for a supported back bend, where you the rest the pelvis.
- Poses that pull the sciatic nerve (such as sitting on the heels in Vajrasana):
- It’s been found that some practitioners who spend too much time sitting back on their heels (perhaps when teaching yoga for several hours daily) can cut off blood supply to the nerves branching from the sciatic nerve into the heels or feet.
- There have been recorded instances of this causing difficulty walking, running and climbing. Too much pressure or strain applied to the sciatic nerve, which runs from the lower spine through the buttocks and down the back of the legs, is a common cause of recurrent radiating low back pain in adults.
- To prevent sciatic pain, stretch the legs and low back gently, give yourself enough rest between workouts, and consider treatments for lasting injuries like massage therapy or active release technique.
6 Ways to Avoid Yoga Injuries
1. Gently Stretch Tight Areas (Avoid Temptation To Push Too Hard!)
Stretching (and similar dynamic movements like calisthenics) should always be done mindfully, gently and slowing. Take your time loosening tight areas — such as the hips, calves or hamstring — being careful not to move too quickly into any poses. Try to warm the body up before any vigorous practice with some dynamic stretching, since this helps to loosen muscles that might be prone to pulls. It’s okay to feel mild to moderate resistance while stretching or bending, but be careful not to push past your limits (some teachers call this habit “being led by the ego”). Over-stretching ultimately only sets you back, since it can worsen existing injuries and lead to tears, pulls and other pains.
2. Reduce Muscular Compensations Through Regular Strength-Training
In addition to doing yoga, resistance-training and “functional exercise” can help reduce compensations by building strength in weak areas. Aerobic exercise is also an important component of overall health, so keep in mind that attending slow-paced yoga classes might be doing more for your brain than your body.
Focus on regularly doing cardiovascular and full-body resistance exercises several times per week based on your physical abilities. If you are weak on one side of the body, or in one particular area like your knees or hamstrings for example, try to build strength there gradually in order to reduce placing too much pressure on other compensating body parts. Just remember slow and steady is the safest way to go when beginning any new type of exercise.
3. Practice Yoga Cautiously (Especially If You’re A Beginner)
You should always practice yoga with a trained and qualified teacher, but still be careful to listen to your body during practice. Don’t assume that any teacher knows exactly how to modify postures to suit your specific needs, and don’t assume that you should be able to bend or move in ways that other students can. Every body is truly different, and therefore “perfect postural alignment” might not be possible for you in some yoga positions. If a teacher ever pushes on you, pulls, or applies pressure to get you further into a posture than feels comfortable, make sure to ask them to back off.
4. Consider Sticking to Gentler Styles
If you’re susceptible to dizziness, muscle cramps or the effects of heat and dehydration, keep in mind that hot yoga (Bikram) might not be the best match for you. Try to ease your way into any yoga practice by attending basic/beginner classes or workshops, or even trying restorative/yin yoga at first which move at a slower pace. Learn the foundations of yoga poses from an experienced teacher so that you can build your practice safely from the ground up.
5. Use Props for Support
Props including yoga blocks, straps, blankets or even a wall or chair can really come in handy. These are especially useful for yoga newbies, the elderly or those recovering from injuries. Use a rolled up blanket under the hips to help you in postures like pigeon or other hip flexor openers. If your hands don’t reach the floor in any forward bend, side bend or twist, use blocks on the floor to “bring the mat closer” and take pressure on the legs as you bend down. Straps are useful when laying on your back and stretching the legs, just don’t pull too tightly or quickly. Always feel free to ask your teacher for recommendations using props if you have limitations.
6. Get Your Doctor’s Advice If You Have Any Injuries
Work with a physical therapist or personal trainer for guidance at first if you have any existing injuries prior to beginning a yoga practice. Ask for referrals or teacher recommendations, get clearance to start a particular style if it tends to be vigorous (such as Ashtanga or Bikram), and discuss whether there are styles you should avoid. You can also get advice from your orthopedic or chiropractor if you’re ever unsure of which postures and movements might be risky based on your limitations.
Healthiest Yoga Poses
All of this being said, yoga has been still shown time and time again in clinical studies to offer various benefits: reduced stress or anxiety, improved range of motion, protection against falls, healthier image body, less trouble sleeping, and much more. A 2007 review published in Evidence Based Complimentary & Alternative Medicine including 32 articles found that yoga interventions are generally effective in reducing body weight, blood pressure, glucose level and high cholesterol. (7) This is probably why yoga remains one of the most popular complimentary/alternative practices used worldwide. (8)
To take advantage of all that yoga has to offer in a safe way, focus on practicing poses that seem to pose a low risk for injury:
- Lunges: great for building strength in the legs, plus stretching the hamstrings, which can prevent falls.
- Squats (or “Chair Pose”): as long as you take things slow, squats can be a great leg and lower-body exercise for thighs, butt, back and core. Keep the tail bone tucked and try to straighten the back to prevent straining.
- Forward bends: these help to stretch the hamstrings and back, just move slowly into straightening the legs.
- Gentle side bends: like forward bends, move into side stretches slowly. Try not to yank the neck or twist abruptly from the spine.
- Breathing exercises: breathing practices (also called Pranayama) are an important part of most classes that help to warm the body, lower the “fight or flight” stress response, and calm anxiety. They can even be used outside of class to help you fall asleep, wake up or handle stressful moments.
- Seated positions: for those with injuries, trying yoga postures while sitting on the floor or a chair can be helpful. This allows the student to have more control and move slowly. Sitting or laying can allow you to bring the arms out side to stretch the shoulders, to twist and stretch the waist, raise the feet in the air, open the hips (such as in “happy baby” pose) or bring the knees towards the chest to stretch the quadriceps.
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