Shoulder injuries in yoga: Our survey project explores chaturanga injury and more!
In this article, we continue our series of posts that focus on the most common types of injuries reported in our survey project. We explore some potential reasons for why we might see the types of shoulder injuries in yoga that we are. But, keep in mind that our survey also indicates that the injury rate of yoga practitioners is NOT especially high compared to many other activities. Refer back to our post summarizing the negative experiences of practitioners for those details.
However, it is still important to examine the injuries that happen and especially the specific contexts in which they happen.
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Below are a few reminders about the statistics we calculated to help you understand what we report below from our survey project. Remember that statistical analysis, in the most general sense, is a method of calculating the likelihood of one particular outcome in a situation given a specific set of circumstances. We include the information: n=some number, to tell you how many people answered the question we’re reporting on. Survey participants were not required to answer every question, so the sample size for each question varies.
Remember also that you’ll see within the text, this symbol: p=some number. This value, referred to as the “p-value”, is the probability that variables in the survey are unrelated. If the p-value is less than 0.05, then there is a less than 5% probability that the variables are unrelated. Or, you could say there is a more than 95% probability that the variables are related. We would then say there is a statistically significant relationship between the two variables.
We also report the “effect size” of the relationship between the two variables. Effect size describes the strength of the association between two related variables. For example, we might say that two related variables have a weak, moderate, or strong relationship to one another. This is noted as Cramer’s V=some number. We say there is a small association when Cramer’s V is between 0.1 and 0.2. There is a moderate association when Cramer’s V is between 0.3 and 0.4. And there is a strong association when Cramer’s V is equal to 0.5 or greater.
Remember that, in order to get more specific about where injuries occurred in the body, we did some consolidation of our data. The question we asked respondents about where in the body their injury occurred allowed them to select multiple areas in the body. We consolidated this data so that we could make direct comparisons by putting the responses of those respondents who marked more than one body area into their own category “multiple areas”. We similarly consolidated data about what style of yoga respondents reported that they were practicing at the time of their injury. Those who marked more than one style were grouped in their own category “multiple styles”.
When we analyzed the data, shoulders were the third most likely area of the body to be reported as injured by our survey respondents. Of those respondents who experienced one or more injuries during the lifetime of their practice, 19% reported that they had injured their shoulder(s). (Remember, this is NOT 19% of all respondents; this is 19% of those respondents who reported an injury.)
Relationship of all shoulder injuries in yoga to chaturanga injury
We found a moderate relationship between shoulder injuries in yoga in general and specifically reporting a chaturanga injury (or an injury in a transition including chaturanga) (n=1422; p<.0001; Cramer’s V=0.44). Notice in the table of poses where respondents reported a shoulder injury, that 95 people reported a shoulder injury in chaturanga. That’s 95 out of 217, or 35% of total respondents who reported shoulder injuries in yoga and reported which pose it occurred. Of those who reported a chaturanga injury (or an injury in a transition including chaturanga), 82% reported that it was their shoulder(s) that they injured.
Since we found a relationship between shoulder injuries in yoga in general and chaturanga injury, we report on our survey results related to both.
Poses in which shoulder injuries in yoga were reported
(Number at the end of the bar is the number of respondents who reported a shoulder injury in the pose listed; n=285)
Anatomy: Why might our shoulders be sites of injury?
The shoulder complex is definitely complex! It includes three bones:
There are also three separate joints that make up the shoulder complex.
- The glenohumeral joint is where the humerus meets the scapula.
- The sternoclavicular joint is where the clavicle meets the sternum.
- The acromioclavicular joint is where the clavicle meets the scapula at a bony point called the acromion.
These three joints work together to allow for the wide range of very versatile movement that we need from the shoulder complex. The downside of the mobility that’s available from our shoulder complex is that it can be more difficult to stabilize than other areas in the body. Lack of sufficient strength or tightness of any of the muscles that contribute to stabilization at the shoulder girdle, impact the other muscles around the shoulder area. This is because muscles around a joint work in relationship to one another.
Why might we experience a chaturanga injury?
When we think specifically of the mechanics of chaturanga, we’re not only looking at the muscles and joints of the shoulder complex. We also need to be aware of the relationship of those three joints to the elbow joint and the wrist. Additionally, remember that chaturanga doesn’t live in a vacuum. What we experience in chaturanga is often affected by the way we transition into and out of the posture.
If you do a vinyasa style practice, this might include landing in chaturanga from a jump back. And that requires that you “catch” yourself in chaturanga with some amount of momentum propelling you into the posture. In a vinyasa style practice, it’s also very common for the transition out of chaturanga to be an upward facing dog. Either of these situations can put strain on the shoulder girdle depending on how they’re done and what strength is available to stabilize the shoulder girdle.
Practice context: When are shoulder injuries in yoga occurring?
So, now we have some context for the complexity of both the shoulder girdle generally and chaturanga specifically. So, let’s take a look at what we learned from our survey respondents about shoulder injuries in yoga and chaturanga injury. We found a small association between shoulder injuries in yoga and when they were likely to happen. Among all injuries reported, shoulder injuries in yoga were more likely to build up over time than to happen all at once with no warning. (n=1418; p<.0001; Cramer’s V=0.15)
Shoulder injuries in chaturanga were often overuse type injuries
Similarly, we found a small association between chaturanga injuries and when they were likely to happen. Among all injuries reported, chaturanga injury or injuries that occurred in vinyasas including chaturanga, were more likely to have built up over time than to have happened all at once with no warning. (n=1424; p<.0001; Cramer’s V=0.18)
We found a small association between chaturanga injuries and adjustments. Among all injuries reported, chaturanga injury or injuries that occurred in vinyasas including chaturanga, were less likely to have occurred during a physical adjustment, than injuries in general. (n=1420; p<.0001; Cramer’s V=0.13)
We also found a small association between shoulder injuries in yoga, chaturanga injury, and when practitioners became aware of these injuries. Among all injuries reported, respondents were more likely to have become aware of shoulder injuries in yoga later, rather than immediately, in the moment. (n=1395; p=.0001; Cramer’s V=0.15)
Similarly, respondents were were more likely to have become aware of a chaturanga injury later, rather than immediately, in the moment. (n=1404; p<.0001; Cramer’s V=0.11)
It was very common for respondents to report their shoulder and/or chaturanga injury as an “overuse” type injury. That is, one which built up over time and that they were not aware of until some time after it happened. (See the comments from practitioners at the bottom of the post for examples.) Related to that is the result that more than a third of respondents didn’t remember what stage of the pose they were doing when they experienced a shoulder and/or chaturanga injury.
Style of practice when a shoulder injury occurred or when injured in chaturanga
Shoulder injuries were very common among many styles of yoga asana that practitioners reported. The highest percentages of shoulder injuries in yoga per total injuries experienced for a particular style of practice were among those who reported practicing Vinyasa/Flow yoga and Baptiste yoga. The highest percentage of chaturanga injuries per total injuries experienced for a particular style of practice was among those who reported practicing Vinyasa/Flow yoga.
There was no relationship between shoulder injuries in yoga or chaturanga injury and the following:
- Whether respondents saw a doctor about the injury
- Length of recovery time to heal the injury
- Likelihood of reporting a re-injury
- Self-reported consistency of practice
- Level of asana experience at time of injury
- Pressure from a teacher to do the pose or to do it in a certain way
- Temperature of the room when injured
- Time of year of practice when the injury occurred
Here’s how some of our respondents described their shoulder injuries in yoga practice:
“Overuse of my shoulder before my body had become adjusted to the type of movements in Ashtanga”
“Doing chaturanga incorrectly repeatedly caused lots of pain in my shoulders, so I backed off a bit and re-worked the movements around chaturanga.”
“I believe it was the result of years of bad alignment while doing chaturanga dandasana. It resulted in very limited mobility of my left shoulder and displacement of the joint.”
“Shoulder inflammation from doing 108 sun salutations ”
“jump through. Probably supraspinatus.”
“I was slightly new to Ashtanga and I did not really understand my body or bandha well. I pulled my right shoulder somehow. Couldn’t do chaturanga for awhile. Had to reduce my practice.”
“Impingement of left supraspinatus in left rotator cuff; repetitive motion injury”
“Weak Chaturanga – incorrectly doing the pose for a period of time lead to shoulder pain.”
“Suddenly I just had shoulder pain, and I’d never had any trouble with this part of the body. Yoga seemed to help heal other injuries (knees from running and back). But I’d never had anything w/ shoulders. My hunch is some of the adjustments for kapotasana were not helpful, but I can’t be sure they were the cause.”
“AC ligament injury in left shoulder”
“I injured my shoulders due to practicing on wrong alignment /method under unauthorized ashtanga teacher(but she has YTT). However it could be my age related known as hormonal change could cause frozen shoulder symptom. It seemed to me it was the combination.”
“Poor alignment while ‘flipping my dog’. I felt pain in the medial area of my right scapula. To heal that injury and any subsequent one to that area, I avoid chattaranga to updog transition. Instead, I moved from high plank to dolphin pose to high plank to downdog. It seems to strengthen the midback.”
“Introductory class, being asked to hold posture [chaturanga dandasana] for too long”
“While taking part in the teacher training, right at the beginning, I wanted to keep on with others in the class and put pressure on me because I thought, that as a prospective yoga teacher I had to do “all-stuff” otherwise I would not be a good teacher. I did to much of “flowing” from caturanga dandasana to urdhva mukha svanasana without using the right technique, but just “stemming” my whole body into the pose by using the “strength” of my arms.”
“A deep and forceful adjustment in supta kurmasana”
“Tendonitis from repetitive chaturangas with poor form – relied too much on the shoulders/biceps to hold and push up from the pushup.”
“When lifting the left arm out to the side suddenly had a pinch in the front shoulder area”
“Bad alignment during chaturanga”
“shoulder pain due to too much focus on down dogs and chaturanga to updog.”
“Dislocated shoulder in parivrtta parsvakonasanana. But shoulder had been previously dislocated as well several times”
“I had bursitis in the shoulders after doing too many handstand vinyasas”
“I think overextended while trying to bind… it was a long time ago, but my shoulder started to hurt, and over time, it got very painful to bear any weight on it. (Should have backed off of it when it first started to get uncomfortable, but didn’t, and eventually it started to hurt too much to practice. Lesson learned.)”
“There was never an injure moment. Just started to feel pain in my shoulder blade in the first 3-9 months of practice.”
“Using a belt around the upper arms in Pincha Mayurasana, the right shoulder popped out of joint and tore the Supraspinatus tendon.”
“I injured my shoulder while performing a poorly aligned chaturanga on a day when I was very tired and unfocused.”
“Marichiasana poses twisting and being guided into a too tight wrap” “Supraspinatus injury from overzealous marichyasana c work.”
“I was in a fast pace led class during lunch time called ‘Spiritual Warrior’. I was still a beginner and we were advised to practice handstand against the wall in a right angle feet pressing into the wall. My angle was not perfectly 90 degrees, the teacher told me to make it 90, I did immediately what the teacher said and overstretched my left shoulder joint, that was not very stable, by moving too much weight over it. At first I did not notice the injury, only later realized a ligament was torn.”
“I hurt my rotator cuff doing too many chaturanga (low push up)”
“During an adjustment the teacher pushed too far and injured my shoulder. It took 18 months to heal.”
“over adjustment of a teacher to my shoulder. my main ashtanga teacher was left the city. i started to different shala. new teacher tried too much to open my shoulders. at that moment i was practicing 4 years. shoulder capsule tear, inflamtion, tendinitis”
“No instruction or first year in all-levels flow class at local studio. Hideous plank-chaturanga-upward dog alignment. Shredded rotator cuff tendon and it tore off the bone.”
“Years of Bad Lady technique in chaturanga. My own doing!”
“Repetitive use injury. I have had a total shoulder replacement.”
“Non-mindful transition to Chataranga”
“We were working with blocks on jumping back and through from downdog to seated.”
“repetitive stress to shoulders, exacerbated by adjustment”
“too much Chaturanga resulting in shoulder pain”
“Improper chataranga form, overuse — led to rotator cuff inury”
“Shoulder-impingement due to overdoing it probably the wrong way”
“Don’t remember. During teacher training. Lots of Chaturangas.”
“dumping into the shoulders in chaturanga caused pain in the bicipital groove.”
“To many improperly perform chaturangas.”
“I had a collar bone injury while getting into supta kurmasana. There was a loud popping sound and pain around my collar bone, neck and shoulder for several months.” “Compression of the shoulder/collar bone leading to a nerve pinching. Coming out of kurmasana to bakasana in ashtanga primary series.”
“too many chaturangas in one short time”
“overuse of shoulders with poor alignment doing repetitive sun salutations (large number)”
“Repeated movement from chaturanga to up dog nearly shredded my shoulders.”
“The repetitiveness of the poses and the ‘guidance’ from the teachers to “push”, “go harder”, “pain is your friend” etc. eventually caused bursitis in both shoulders.”
- Healthy muscles making up the shoulder complex with strength in the right places to provide stabilization
- Patience to acquire strength in the right places. Overdoing it with the muscles around the shoulder girdle can lead to excessive fatigue, inflammation, and potentially injury.
- Good technique in chaturanga to develop patterns that support doing this posture over the long-term
Our survey results point to a lack in any of these three areas as potentially contributing to shoulder injuries in yoga, and chaturanga injury in particular. In the direct quotes from survey respondents that you can read at the end of this post, practitioners repeatedly mention doing too much, too soon and doing chaturanga with technique inappropriate for their body as contributing to their injury. Is there a magically “right/correct” way to do chaturanga that prevents all injuries? The short answer is no. Like every other posture, the “right” way for anyone to do chaturanga is going to depend on the person. I do think there are some general concepts that you can work with to find a chaturanga that works for you. I go over these in more detail in my post: Just Blame Chaturanga.