How common are injuries in yoga adjustments?
Hands-on adjustments or assists are common in many Western yoga asana classes. And, injuries in yoga adjustments are a common topic of discussion in the yoga community. Yoga adjustments or assists depend on the particular style of yoga and the background of the teacher. They might look something like spotting in gymnastics. Or, they might more closely approximate a form of bodywork. They might also just be a light touch. The intention of adjustments is to help practitioners find their way kinesthetically toward the expression of a posture that they might not initially be able to find on their own. This might mean nudging someone farther forward in a forward-bending posture. Or it might mean helping someone balance in headstand. That support could eventually give them the strength and confidence to come up on their own.
There are very vocal advocates for the benefits of receiving adjustments in practice. And there are also those who feel strongly that adjustments have no place in the yoga room. There is essentially no published research to provide a defense for either position.
In this post, we share the results of our yoga survey regarding what practitioners experience related to hands-on adjustments and assists. We now have data that we hope will further the conversation about injuries in yoga adjustments.
Methods: A quick lesson on statistics
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. There are lots of different formulas for making statistical calculations. Different formulas are appropriate in different situations. The specifics are well beyond the scope of a blog post. What’s important is that we explain enough of the methodology that you understand what we mean when we describe the results of our survey. 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 we say that the two variables are related.
Context and practice experience
Again let’s note the context in which practitioners reported these experiences with hands-on adjustments. Remember from our survey summary post that the greatest majority of our respondents were long-term practitioners (4+ years of consistent practice). Respondents were primarily female and between the ages of 31 and 55 at the time of the survey. Most respondents practiced for 60-90 minutes in a single session. They practiced either at a studio or at home.
Experience in hands-on adjustments
What do practitioners report regarding the impacts of physical adjustments/assists on their yoga practice? Nearly all respondents (97% ) said they had received hands-on physical adjustments in class. That left only 2.9% who had not (n=2610). Most respondents (n=2530) found hands-on physical adjustments to be “very helpful” (71.9%). Another 19.5% said they were “somewhat helpful”. Only 3.3% found them to be either somewhat or very unhelpful. About half (53.9%) of respondents who reported that yoga had been part of healing from a pain or injury, reported that hands-on physical adjustments from a teacher contributed to their healing process (n=2076).
Of the 2620 total practitioners who responded to our question about an injury during yoga practice, 284 (11%) reported injuries in yoga adjustments. Among the 1422 people who were injured at least once during the time that they had been practicing yoga, 972 people (68.4%) said they were not receiving a physical adjustment when they were injured. But, 316 (22.2)% reported injuries in yoga adjustments (n=1422). An additional 4.6% said they were being verbally adjusted when they got injured. The remaining 4.8% didn’t remember the circumstances of the injury.
Another way to look at the same question is this: 2534 respondents received a hands-on adjustment in a yoga practice. And 316 of those people reported injuries in yoga adjustments. 284/2534 gives us 11% of those who have ever received a hands-on adjustment who have also been injured.
When were injuries in yoga adjustments more common?
Those who received hands-on yoga adjustments during their lifetime of practice (n=2610) were also more likely to report at least one injury from yoga. However, this relationship was only moderately significant (p = .0209). Those who practiced Ashtanga yoga were more likely to report injuries in yoga adjustments than those who didn’t. However, consider that statistic in the context that Ashtanga teachers likely use hands-on adjustments more consistently than in other styles, since they are part of the teaching tradition.
We could not directly compare the percentage of respondents injured in an adjustment in each specific style of yoga. This is because we allowed multiple answers to the question on practice style. Many respondents marked more than one practice style. So percentages did not represent discrete groups. Additionally, it is important to remember from our negative experiences summary post, that the overall rate of injury, that is, the total number of injuries experienced over the total number of years that someone practiced, was low compared to a number of other activities. (Average overall injury rate of respondents was 1.6 injuries over the total number of years of practice.)
We did find a relationship between those who reported injuring their lower back (p=.0229) or their upper back (p=.0124) and also reported injuries in yoga adjustments. However, this relationship was only moderately significant. There was no relationship between a knee, shoulder, foot, ankle, or hip injury and experiencing an injury while receiving a yoga adjustment.
Poses and injuries in yoga adjustments
Respondents reported injuries while receiving physical adjustments in many different poses. You can peruse an abbreviated table above for the number of respondents who reported an injury during an adjustment in a specific pose. But, a better question is what does this mean? Are adjustments “good”? Are they “bad”? Or, are they “good” some of the time and “bad” some of the time? And if so, how do we know the difference?
What you might notice in the table below is that we could lump the poses listed there into groups. One group is poses that take the body to the end of range of motion for a joint. A second group includes poses that have the potential to put pressure into a joint or muscle attachment that is anatomically more tenuous in the body. The third group includes poses that incorporate balance and/or momentum so we have the potential to fall. Of course, many poses fall into more than one of these categories.
Poses that take the body toward ends of range of motion
In the first category, we have a pose like supta kurmasana. That pose takes the body to the end of range of motion for forward bending. That happens by bringing the torso, not just to the legs, but all the way through the legs in the full expression of the pose. A second example of a pose that falls into the first category is kapotasana as done in the Ashtanga Vinyasa Yoga system. This backbend takes the body nearly to the end of range of motion of back bending. It asks the practitioner to lengthen tissues along the whole front of the body allowing them to reach the hands behind them to their feet.
Postures with potential to put pressure into anatomically tenuous areas
In the second category, we have all of the forward-bending postures. Notice there are many variations of forward bending postures at the top of this list! In this case, respondents most commonly reported the tendinous attachment at the sit bone as the specific site injured during a forward bend. This kind of injury is not at all unique to yoga. In fact, there is a growing amount of research in the area of sports research on why this attachment is tenuous. It is potentially prone to injury in all kinds of sports and activities! We discuss forward bending and sit bone pain more specifically in this post (Forward Bends and Hamstring Injury).
We also have postures in this second category that have potential to direct pressure into one or both knees. I’ve already written quite a bit about why the knee joint is tenuous in its position in the middle of the kinematic chain of the leg. The knee is vulnerable because other joints can impact it from either direction or both. (You can check out my new Online Lotus Workshop.) What do you think might happen in a posture where we prevent one end of the kinematic chain of the leg from moving and put pressure into the chain from the other end? For example, if you sit on the foot, as in Janu sirsasana B, and put pressure into the chain from the hip end, there is potential for that to travel into the knee since we prevented the foot from moving to allow the knee joint to adjust.
The third category perhaps requires the least anatomical explanation. In this category, we have poses like headstand or visvamitrasana (a version of side-arm balance). Whenever we learn to balance in new ways, there exists the potential to fall. With that, is the potential for the teacher who is spotting the pose not to catch the person who fell. This was the least common type of injury reported related to yoga adjustments and assists.
That was a quick look anatomically at what has the potential to cause injury in hands-on adjustments. The other piece of this that we should consider is what happens in the nervous system.
Adjustments and the nervous system
The relationship between the nervous system and muscular system becomes particularly important when we talk about movements at the ends of range of motion or movements that potentially put pressure into anatomically tenuous areas of the body. When we put any type of stimulus into a person’s body, we put that information into their nervous system. They then process, react, or respond to that information. Depending on the joint and the tissues around it, adding to range of motion may be very small distances (say, the shoulder), or potentially larger (hip). In other words, speed and force need to adapt according to the joint, its position, and the tissues surrounding it.
Doing any type of hands-on yoga adjustments requires sensitivity on multiple levels. From the teaching or adjusting perspective, there is listening or observation. That includes an assessment of the totality of information observed. And it includes an appropriate response to that observation and information.
What we as teachers are often unaware of are our biases. We all have a preconceived idea about how we are supposed to do the pose. This is based on prior experience and the system of yoga asana we teach. It’s often our observation of a student doing something that is not in line with our own story which initiates our desire to do or say something to them. If we are reactive, then we may drop into the simplified version of teaching, which is trying to “fix” something. However, a response would be to process the context in which this person is doing the pose. For instance, what level is their practice? How well do we know them? What type of class is it? What type of body do they have?
Checking for your bias
Remember, if you are not responding to all of it, you are often just reacting to your own bias. At these moments of doing the adjustment, the student picks up on this. This is critical because if the student resists a more physical adjustment, the chance of injury goes up significantly. (This observation is based on my experience, not on the survey results.)
As I discuss in my adjustments video, when you offer an adjustment, ultimately, you are trying to tune into the information that the student’s body is giving you on a moment-by-moment basis. And, you are responding to that on a moment-by-moment basis. What needs to get out of the way is your story. That is, your story that you are fixing them or making it right, which may be based on something other than what is happening in that moment.
When resisting, students engage their muscles in a way that makes it harder to deepen or realign the posture. There are some arguments for engaging tissue at the end of range of motion. But that is very different from trying to adjust someone when they are actively resisting. In this case, you are fighting the tissue and the tension created from engaging as a reaction. This seems to be the most common place for injury to happen.
Finding the therapeutic edge
The “therapeutic edge” is itself a bit of a catch-22 in my experience. Forget adjustments for a moment. The edge of sensation (often the end of range of motion or end of pressure placed on tissue) of the student is often a place where we see change or response in the tissue. That is, we see positive change.
It is at this same edge that the potential for injury increases. Going too far beyond that edge is an injury. When you take someone beyond that therapeutic edge you are at the ends of range of motion. If you keep moving past it, you can easily cause injury or add pain to the system. And then, it will react or respond.
In the case of adjustments, the body typically responds with contraction as a protection mechanism. If you continue to put pressure on the tissues, you essentially fight rather than work with the system.
For example, one student shared this description of their injury: “Pulled muscle/tendon when pushed just a bit too far and I tensed – which probably partially incurred the injury”
An adjustment might work well for us in the context of working with a teacher with whom we have an established relationship of trust. But, it might backfire if it is applied by someone who is unfamiliar to us, even if they are a skilled teacher. Our availability in a particular situational context to “accept” an adjustment affects how our nervous system receives it. This affects the number of injuries in yoga adjustments reported.
Sharing the experiences of practitioners when injured in an adjustment
Below we share a range of students’ experiences with injuries in adjustments. Several themes emerged from respondents’ open-answer descriptions of their injury circumstances. The first group of quotes reflects the importance of student-teacher relationship when giving and receiving adjustments. The second group reflects the importance of experience when giving adjustments. The third group reflects the wide use of hands-on adjustments in multiple styles of yoga. Adjustments are part of the traditional teaching method in the Ashtanga vinyasa system. However, other styles of yoga use them as well.
These experiences reflect the importance of student-teacher relationship when giving adjustments!
“Pulled hamstring – was practicing with a cover teacher and she pushed me a bit too far in utthita hasta padangusthasana pulled the hamstring attachment at the top of my left leg/buttock.”
“an assistant in a workshop gave me a too-strong adjustment using a strap, and tipped my left femur slightly out of the socket.”
“Adjustment from a teacher covering who didn’t know my body. Paschimottanasa – too strong on my lower back.”
“I was attending a workshop of a senior, internationally known teacher. During asana he came came over to “assist” me to go deeper into a deep seated twist pose (Bharadvajasana ). without asking permission. I immediately heard a loud pop in my knee. This adjustment resulted in a major tear in my meniscus.”
“an adjustment in ardha baddha padma paschimottanasana that was too deep for my capabilities at the time, from a teacher that didn’t know me during a week long workshop.”
“Trying half lotus with not enough hip opening. Teacher was not my main teacher, it was at beginning of my ashtanga practice.”
“It was a misunderstanding about an adjustment: A teacher (not my main teacher) helped me drop back with a belt around my hip and I did not feel particularly safe doing this, but I did not want to discuss.”
“Started as a hamstring tendon injury when adjusted in standing forward fold by guest teacher”
“Hamstring injury as I was being helped on a standing pose by a substitute teacher”
“An adjustment that was brutal in kapotasana by a certified teacher! It was the first time i had practised with this teacher and he did not watch me do kapo first nor ask me how far I usually went.”
“Hamstring injury as a result of an adjustment that went too far. This adjustment was done by another teacher while I was traveling, not my regular mysore teacher”
“Non experienced stand in teacher adjusted me in Marichiasana D”
“Adjusted at a workshop and she cranked my shoulder”
“I was practising with an unfamiliar but reputable, experienced teacher. I had informed them of my chronic neck injury. At the start of the practice I was told I could “let go of my neck injury now.” I was given a very deep adjustment in Pasasana at the end of the practice I was lying down in savasana; went to roll onto my right side; felt my neck injury ‘unzip’ down the back of my neck. I was encouraged to continue practicing on subsequent days, pain just hit worse ended up in casualty”
These quotes reflect the importance of experience when giving adjustments and the need to use caution when first learning to share adjustments
“Tore calf muscle in leg during adjustment by fellow yoga teacher trainee”
“Students did adjustments to each other the way teacher said in My Case, I was in baddha konasana and fellow student put her weight to My back and pushed My legs toward floor. Stretch was too powerful.”
“I had an assist in urdhva dhanurasana that injured my lower back at a workshop that had people assisting other classmates. One person pulled on my hips the other pulled on my upper back/shoulders.”
“In supta kurmasana I was adjusted by a fellow practitioner and my collarbone popped”
“I was in an ashtanga class in India, and I didn’t realized that in this class people doing the TTC with this teacher were about to adjust. In paschimottanasana I was almost reaching my head to knees but it wasn’t my aim in this class, so this girl pushed my without being careful. I didn’t feel anything till I cool down when the class finished and as soon as I took some steps it hurt so much! And I know it was that adjustment. My pain continued for 8 months on and off”
“Overdoing it on the first day of teacher training, in particular doing poses intentionally wrong in order to allow a partner to correct you.”
“Many years ago I attended workshop for learning hand’s on postural adjustments and was paired with a beginning yoga student who was taller and stronger than I, and I was moved into a misaligned adjustment and held there.”
“Was being adjusted in half lotus in teacher training workshop”
These quotes reflect the wide use of hands-on physical adjustments in many styles of yoga practice
“I was over adjusted in a Yin class, and at the time was very new to Yin, the teacher kept going on about yoga being pain, so I ignored the pain and tried to breath through it. My knee swelled up afterwards and then 3 months later was diagnosed with a torn meniscus and had it operated on. Never been back to that teacher !”
“I was the demo for a Iyengar teacher in a module during my 500-hour teacher training. I was asked to demo triangle pose, and the way I was asked to do it aggravated a long-standing injury that, until then, I’d managed pretty well with my own practice. (Not an Iyengar practice.)”
“I was in a Bikram class (that I was not a regular student of ) . The teacher came over and lifted my leg to my face in Uttitha Hasta Padangustasana without even speaking to me or knowing my history/practice.”
“Decided to try an anusara class with a well known teacher. She had asked us to do chaturanga in a way I had never been instructed and she had a student demo it. Then she came around to the rest of the students to help us do it ‘correctly’. She was trying to move my body in a way that it did not want to go. I am not sure it was her inexperience or the method, but I hobbled out of the studio w/tremendous back pain. I’ve always had a sensitive lower back and this method just aggravated it more.”
“I broke my left ring finger by incorrectly landing on it while trying to jump into bhujapidasana in a Rocket Yoga class. The teacher, who was trying to teach me this entry into bhuja, said she was going to catch me and not let me land on my face. Not only did I land on my face, my finger crumpled unnaturally and it broke”
“Working on Maltese Cross position with assistance of teacher, Adductor muscle/tendon of Right inner thigh “Popped” very painful and took many months to heal, still feel twinges 4 – 5years later”
“I practiced the head stand with my Iyengar teacher but my physical strength was not ready for it. So I got two slipped disks in my cervical spine which had to be operated on.”
“The teacher came to adjust me in standing compass pose and when he lifted me there was a loud pop noise (followed by my scream). I couldn’t walk after class and an MRI revealed my left ischial tendon was torn”
“I was in halasana, in an Ashtanga workshop. The assistant who was NOT an Ashtanga teacher but an Iyengar teacher came up behind me during the posture and shifted my hips quite violently “straight” with her hands. I was not aware she was going to do this as I was inverted and looking down my nose. It was shocking and abrupt. I experienced an immediate dislocation of the sacrum on one side, and lots of pain for months/years!”
“A 40-year Iyengar teacher asked for volunteers to do an assisted full backbend to standing sequence. I was the backbender. When the two assisters pulled me up at the instruction of the Iyengar teacher they snapped my spine in the upper thoracic region. We all heard it snap then I became dizzy. Then it passed. Two hours later I began to have trouble moving.”
I teach adjustment workshops and I have produced a four-hour DVD on this subject. At the time, I did have reservations about producing that video. I considered whether or not it was appropriate to teach such a subject through this medium. In the end, I realized that I would rather be a positive part of the conversation because I believe I have something valuable to add. As I ask in workshops, and on the DVD: What is your intention as you approach someone to do a hands-on adjustment? This may be the single most important factor in determining the success or failure of the adjustment.