What’s the risk of injury in yoga?
In this post we’ll wrap up a series of articles on our findings from our yoga survey project related to injury in yoga. Although our results indicate that yoga is not a high-risk physical activity compared to many other physical activities, yoga is not risk-free. So, if there is any possibility that we might get hurt, why do we practice yoga?
Why do we practice yoga?
We should recognize and acknowledge that yoga is a tool and we can use it in different ways. We might use yoga as a recreational fitness activity like aerobics, dance, or gymnastics. Or we might consider it to be a complementary wellness therapy like physical therapy, massage, or chiropractic. We could also use yoga as a practice to work with our own evolution of mindfulness or awareness. And certainly, you could use the tools of yoga in more than one way. What’s important is to note that the expectations for different uses of yoga are exactly that: different. The expectations of teachers change as well, with the way yoga is being used. This invites a conversation about our assumed and implicit biases regarding the purpose and methods of yoga practice.
Our yoga bias
At some point, as the practices of yoga increased in popularity around the world, yoga assumed a particular bias. Yoga practice is often spoken about as if we have an expectation that yoga asana should be able to heal all things and be simultaneously 100% risk-free. We don’t assign this kind of expectation to any other recreational activity or any type of complementary or Western medical therapy. For example, we recognize that gymnastics and dance have potential benefits and risks. Similarly, we recognize that medical practices, whether it be surgery or physical therapies, have potential benefits and risks. So, why do we assign this particular suite of expectations to yoga asana?
If we are practicing or teaching a particular style of yoga, then we assume there is a value to the aspects of practice unique to that style. Those aspects might be a specific method of breathing, a sequence of postures, or an approach to how one moves through postures (with or without connecting vinyasa, for example). We practice, then, with the idea that the various aspects of the style come together in a method that is designed to “do” something or “take us somewhere”. It’s within our own biases about the hows and whys of practice that our actions as teachers and practitioners emerge.
Yoga is a tool
How we use the tools of yoga may increase or decrease our particular chances of having a specific kind of pain or injury in yoga. If we think an aspect of a yoga practice or style is effective at creating a change we’re seeking, then we might be willing to accept some amount of increased risk of injury.
For example, learning many types of inversions carries a risk of falling. Let’s say we want to learn headstand. We might reduce the risk of falling by working with a teacher to spot us, or working on a wall. But the risk of falling still exists. If learning headstand is important to us, then we need to accept the risk of falling. But, if this isn’t a risk that we want to take on, then we need to look for other options. Perhaps that means practicing a different posture.
Yoga asana is not inherently healing or injurious. It’s not inherently safe or dangerous. It is a tool. Yoga is neutral. It can be applied in any number of ways and in any number of situations. A shovel is also a tool. I can use it to dig a hole and plant a tree or I can hit someone with it. The qualities of these two actions are very different. And neither of those qualities exist inherently in the shovel itself. The shovel is neutral.
Asking more informative questions
I think it is important for us as a yoga community to start asking better questions about what we intend to use yoga asana for and how much risk we are willing to accept in that process. Yoga asana is physical movement. There is inherent risk in physical movement. The risk can increase or decrease depending on our specific situation as a practitioner and the specific yoga tools we are using.
In our survey project, we began to delve into questions such as:
- Are there contexts of practice in which risk of injury in yoga is greater or lesser?
- Where is there more or less risk for specific types of injury in yoga?
The answers to these kinds of questions empower us as asana practitioners to make more informed choices about what kind of asana practice suits what we want to use it for. It gives us information about ways and contexts in which we could potentially reduce the risk of injury in yoga, while still doing the practices that we find most beneficial.
Our first responsibility as a yoga community is to acknowledge openly and honestly that yoga asana is a physical activity. It is not risk-free. From there we can look at the places where teachers can reduce the risk to yoga participants as well as the ways that yoga students can take responsibility for their own experience in yoga practice and yoga classes.
As yoga teachers, we need to be clearer about what we specifically are offering to students and the kinds of risk that may be involved. We also need to be more specific and direct about expectations for practice experience, for example, stating clearly:
- Stop if you feel pain
- If you are unclear or confused about the instructions, stop
- Stop if you feel fatigued and/or unfocused
As teachers we need to teach in a way that reigns in new students from over-enthusiastically doing too much practice too soon, thereby increasing the risk for repetitive motion injuries. We should consider how important it is to “fix” things in our students’ practices. Changing too much too soon can also be a problem, as students’ bodies need time to absorb and adapt to corrections. We also need to check our own over-enthusiasm for “taking students deeper” and injuring them via adjustments and assists.
The answer to the question: Are people getting hurt in yoga? is: Yes, they are. A better question than: Can we make yoga risk-free? is: Where are the contexts in which there is greater risk in yoga? With that information, we can both acknowledge and modify that risk as appropriate for each student that comes to the practice. Yoga is not risk-free. I’ll wrap this post up with some direct quotes from survey respondents describing the many, often unexpected situations, in which they experienced an injury in yoga.
Quotes from respondents: Injuries happen for all kinds of reasons…
“Doing Upavistha Konasana when my child came into the room to speak with me. In my distraction, I pulled my piriformis, I believe. It took a long time to heal with a modified practice.”
“Slipped on my mat.”
“I think it was more related to work as I am on a computer 8-10 hours per day.”
“Pain in shoulders during vinyasa, lowering to chaturanga. But also have 2-year-old who I pick up several times a day which likely contributed. Background of trying to change alignment from yoga teacher training definitely contributed but probably improved the alignment long term and shoulder injury (rotator cuff) now resolved.”
“I was at home doing my own practice. The injury occurred as a result of shoveling snow. I didn’t know it was a spinal injury at the time – I thought it was a muscle pull. [Then], I used yoga to stretch it out [and] I used rest to rest it out. It didn’t get better, and slowly got worse.”
“Not only asana, but life, moving home and teaching may have contributed to this injury which manifested when doing asana.”
“I have had knee problems as a result of a ski injury 20+ years ago. All variations of lotus have always been difficult/impossible for me (yet I love ashtanga and continue to work at it). The more I practice, the better it tends to feel. Unfortunately, when it feels better I am likely to push it and try things too quickly. I was attempting marichyasana b and d, and allowed a teacher I didn’t know well to help me and it aggravated my knee. I do not hold the teacher responsible at all.”
“Broke my toe jumping through.”
“Pike to adho mukha vrksasana in the sand.”
“I sleep funny on my neck and went to an asana class that made it worse rather than helping.”
“It was not during yoga practice and stemmed from trying to swing a very heavy gate uphill from the back of a horse.”
“I’ve practiced twists after an insignificant back injury (not caused by yoga) which turned out to be a wrong decision. The injury worsened very much.”
“The injury occurred in my groin (not an option in your list of above so I picked closest body area). I was in parighasana and I overstretched the left groin because I became distracted. Took a year to recover and heal.”
“Pulled my leg into padmasana rather than glide it in finishing sequence of shoulder stand variation – knee popped and got a bucket handle méniscal year but it was accumulative with playing tennis and tight hips.”
“I stupidly did a headstand when I was tired and pulled a muscle, I did this at home on my own.”
“In Vashistasana my shoulder just gave out. Likely caused by repetitive use from throwing a baseball for my dog.”
“When moving my foot forward to come into a lunge, I stubbed my toe and broke it. It was towards the end of a 90 min session and I was tired and did not lift up to move my foot forward.”
“I was not warmed up practicing headstand at home.”
“Jumped on my toe and it broke.”
“I entered carelessly into a Prasarita Padottanasana and hurt my hamstring. Music that I liked was playing outside the shala.”
“I injured my back muscle when having both legs behind my neck. It was self practice with little kid crawling around me and I was not very present and the weight of my legs put me in the collapsed position in middle back.”
“I felt something tear on my lower right back. While pulling on my toes. Also not focused and was distractedly chatting.”
“I was modifying my practice to avoid inflaming an injury from outside practice but I was causing repeated stress by not engaging the surrounding muscles. Ore fly. In hindsight I would have shifted away completely.”
“Illness exacerbated by yoga practice.”
“Did setu bandhasana after having a neck fusion.”
“I broke my toe doing a vinyasa / jump through.”
“Fell down hiking and tore medial meniscus on right knee and high grade sprain on popliteal ligament and MCL. I believe they were yoga related although final injury was not while practicing yoga.”
“Post-partum practice – going back into second series too quickly.”
“Pulled my pectineus while modeling a hard pose for 20+ hours for a bronze sculptor.”
“Ok it was a crazy posture. Straddle headstand with one arm extended out to the side, resting on fingertips, and aiming to lift the fingertips one by one until balancing on just the head and the other forearm. The balance point is very small in this pose, and I fell over backwards twice. I got away with it the first time, but not the second. I knew I’d yanked my neck but initially it didn’t seem too much of a problem. However it got worse from there.”
“Recurring shoulder issues NOT from yoga.”
“Had just started doing dropbacks (which in all honesty I really was not ready to do). I got so intoxicated and exhilarated by the feeling that one day after Mysore I came home and did a few more in my garden and injured my right wrist.”
“I fell out of a toe stand and rolled back on my right hip injuring my SI joint, it was very painful.”
“A very old injury resurfaced. Although it is not a direct injury from my practice it did reoccur because of it. Teaching level 1 requires showing the poses and being on my knees so many times a day brought the injury to the surface.”
“Hypermobile joints and over stretched lower back and therefore weak lower back muscles, dropped sacrum. All of this contributing to sacrum sprain outside the studio during a dance performance.”
“As I started teaching, I started to feel pain in my right wrist possibly as a result of repetitive stress.”
“I did my full practice, up until Kapotasana, after a long break from full practice, on a day when I felt a bit stiff. In retrospect I realize it was a bad idea to do my full practice after such a long break, but I didn’t realize until after that I’d injured myself. It then improved – the pain disappeared – but after a few weeks I woke up unable to move my neck after a bad night’s sleep, lying in funny positions while trying to get my son to sleep. It has flared up twice since.”
“I was teaching a led ashtanga class for beginners. I demonstrated parsvottanasana and immediately felt something ‘ping’ in my wrist.”