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Problems and injuries in yoga.  




Understanding and Preventing Yoga Injuries

Loren M. Fishman, MD, 1 Ellen Saltonstall, RYT, 2

Susan Genis, RYT, Esq.2

1.Columbia College of Physicians and Surgeons 2. New York, New York





Summary :

To get an initial estimate of the nature and causes of yoga-related injuries (to hatha-yoga/PA practice), we invited 33,000 yoga teachers, yoga therapists, and other clinicians to participate in a 22-year survey. issues. The survey was conducted in collaboration with the International Association of Yoga Therapists (IAYT), Yoga Alliance and Yoga Spirit. 

Between May and October 2007, 1,336 responses came from 34 countries. A majority of participants believed that the most common and severe injuries occurred in the neck, lower back, shoulders and wrists, and knee. Poor technique or alignment, previous injury, overexertion, and inadequate instruction were the most commonly cited causes of yoga-related injuries. 

For example, neck injuries have been attributed to Sirsasana (headstand) and sarvangasana (stand-up); lower back injuries were associated with twisting and forward bending; shoulder and wrist injuries were related to adho mukha svanasana (downward facing dog) and plank pose variations (eg, chaturanga dandasana, vasisthasana); and the knee was most frequently injured in virabhadrasana (warrior pose) I and II, virasana (hero pose,) eka pada rajakapotasana (one-legged pigeon pose), and padmasana (lotus pose).



Most authorities seem to agree with the American Association of Orthopedic Surgeons that “the rewards of yoga outweigh the potential physical risks, as long as you take precautions and do the exercises in moderation, according to your individual level of flexibility” . The increase in injuries has been noted alongside the growing popularity of yoga, and a variety of factors are commonly, but not empirically, listed as the causes. 

If yoga is to be welcomed into medicine's healing repertoire, then in addition to demonstrating its benefits, it behooves the yoga community to estimate its responsibilities and determine, where possible, how "to do no harm". to his health.

Understanding the causes and frequency of yoga-related injuries is important for several reasons: 1) It will allow the Yoga and health communities to responsibly assess the benefits and risks of yoga. 2) will help protect practitioners and prevent injuries. This will therefore enable the entire health care community to accept yoga in an intelligent and informed way.


The Yoga Journal published an excellent article on this subject in June 2003, titled “Injury Insight…”  Author Carol Krucoff highlights the attitude issue right away, saying that she “learned the hard way that yoga isn't a no-brainer. Krucoff cites numerous teachers and experts in the field, who note that injuries in yoga are most often caused by overzealousness and unrealistic student expectations, inadequate teacher training, poor technique, and large class sizes. Krucoff notes that the market-driven aspect of yoga has “begun a rush for instructors, leading to the hiring of some teachers with inadequate training.”


Pamela Paul's article "When Yoga Hurts", which appeared in Time magazine in October 2007  echoes these issues. Paul argues that increasing yoga class attendance will logically lead to an increase in the total number of yoga-related injuries. Paul also mentions that new yoga students may be out of shape and expect yoga to be easy, leading to overexertion injuries. Here, the teacher's experience and advice are crucial. Paul points to the lack of adequate teacher training as a factor in the increase in injuries.


The Time article cites 13,000 documented yoga injuries over a three-year period. With approximately 14 million people practicing yoga, this is only one injury in every thousand practitioners. If this statistic is accurate, it makes yoga safer than many other types of exercise. However, this figure was reported by the medical community (emergency rooms and doctors), not by the yoga community. Therefore, it is unclear whether the figure fully reflects the experience of yoga practitioners who cannot seek medical care for yoga-related injuries.


The attempt to investigate Yoga injuries is made difficult by many factors:  

  • the lack of any formal reporting protocol within the yoga community

  • the wide range of injuries 

  • and the challenge of identifying the specific causes of any injury.

    Yet there is little doubt that such injuries do occur.



The poll

To initiate the self-examination process, we created an anonymous online questionnaire of 22 multiple-choice questions. We designed the survey over a period of four months, getting opinions and advice from many yoga teachers and therapists in the international community, as well as design advice from statisticians and researchers.

With the cooperation of three international organizations (IAYT, Yoga Alliance and Yoga Spirit) and various other sources of email addresses of yoga teachers and therapists, we sent the URL of an online survey to more than 33 000 yoga teachers and therapists.


We asked respondents to share their opinions based on their actual experience (not what they had read or heard) with their students, clients and themselves. Respondents were asked to report injuries only if they were reasonably certain that practicing yoga caused them, whether they occurred during their sessions, at home, or in the presence of another practitioner. The order of multiple-choice question answer choices was randomized in each individual presentation, to minimize response bias. Respondents were not compensated in any way for participation





There were 1,336 responses to the survey, a response rate of 4%, from a total of 34 countries. The majority of responses came from the United States (81.4%), Canada (11.7%), Australia (1.3%) and the United Kingdom (1%).


The non-exclusive professional status of the responders was: yoga teacher (91%), 

massage therapist (8%), personal trainer (7%), doctor (2%) and others (41%). 

The number of years respondents have been teaching yoga/using it in their practice fits a reasonably well-centered normal distribution curve at ages 5-10: 0-2 (9%), 2-5 (20%) ), 5-10 (27%), 10-20 (20%), 20-30 (11%), >30 (7%) and others (6%). 

The “other” category included both teachers in training and retired teachers and therapists. Most respondents saw either 11-30 (35%) or 31-75 (35%) clients/patients per week. About 18% saw 1-10 customers, 10% saw 75-150, and 2% saw more than 151.


Respondents listed a variety of yoga styles or traditions, as follows:  

  • Hatha (16%)

  • Vinyasa (10%)

  • Iyengar (7%)

  • Anusara (6%)

  • Ashtanga (5%)

  • Kripalu (5%)


The authors believe that the designation "Hatha" generally denotes teachers and therapists who consider themselves eclectic, having no firm and/or exclusive connection to any particular school of yoga.



Are there more yoga injuries today than before?  

  1. 39% of respondents answered yes

  2. 36% answered no

  3. and 25% said they didn't know.



Why are there more injuries now than in the past? Only those who answered “yes” above received this question. Respondents could choose more than one reason, and the following percentages of participants agreed with each reason:

  1. Excessive student effort 81.4%

  2. Inadequate teacher training 68.2%

  3. More people do yoga overall 65.4%

  4. Unknown pre-existing conditions 59.5%

  5. Large classes 47.0%

Preventing injuries in yoga when injuries or preconditions exist :  


Regarding prior injuries or conditions as a cause of new injuries, teachers and studios should ask, and students should inform their teachers, of any pre-existing conditions. Nevertheless, these conditions may not be disclosed. Therefore, teachers should be proactive in mentioning the contraindications of a pose. Teachers must have the body knowledge required to know how to adjust a student's practice to avoid the risks of prerequisites. In each section below, we have noted when special care is recommended.



Prevent neck injuries


The cervical spine is the most vulnerable part of the spine because it is the most mobile. The two types of poses in which great care is needed to protect the neck are backbends and inversions.

In backbending, spinal compression and nerve impingement occurs when a yoga student is overly aggressive, pushing the head and neck into bhujangasana (cobra pose), urdhva mukha svanasana (upward facing dog), or ustrasana (upward facing dog pose). camel). This is especially true in poses such as the ustrasana where gravity will play a part in taking the head back. The key instruction (and awareness) that will protect the neck is to arch the head back only after reaching the maximum possible arch in the thoracic spine. It is also helpful to maintain muscle tone in the front of the neck. With these protective actions, the arching motion is evenly distributed through the spine.



Prevent lower back injuries

forward tilts: 

Considerations of the anatomy of the spine, pelvis, and legs are relevant here. The risk in most forward bends, such as uttanasana (standing forward tilt) or pascimottanasana (seated forward tilt), is that the tightness of the hamstrings will prevent the pelvis from tilting, causing flexion excessive lumbar spine rather than hip flexion. This excessive lumbar flexion could lead to sprains of the spinal ligaments or muscles, such as the thoracic and lumbar musculature and the quadratus lumborum, and could also cause a herniated disc, or an osteoporotic wedge fracture. Here, a previous injury, overexertion, inadequate instruction, and poor technique are an unfair combination.



Prevent lower back injuries in twists

Excessive flexion of the lumbar spine is also a risk in seated twists, such as ardha matsyendrasana (half fish), and flexion combined with rotation exerts particular force on the spinal discs. Sitting with the hips on a folded blanket can help the pelvis tilt forward, maintaining the natural arch and length of the lumbar spine, even if one leg bends toward the chest. Props such as blocks or pillows can be used to prevent overstrain injuries in reclining twists and to support the student when the shoulders, arms, or legs cannot rest easily on the floor.


Prevent lower back injuries in backbends

In back-bends such as ustrasana (camel pose) or ûrdhva mukha svanasana (upturned dog pose), damage to the lumbar region often occurs because the thoracic spine does not bend, forcing the lumbar spine to overextend. Here, an overzealous student may contract the lower back, taking on the outward form of the pose without regard to technique or awareness. In many cases, it is up to the teacher to educate the students.



Prevent shoulder and wrist injuries

Adho mukha svanasana (downward-facing dog pose), chaturanga dandasana (four-limbed pose), and vasisthasana (side plank pose), all poses that require bearing weight on the arms and hands, shoulders, and wrists. Many students will diligently try to complete the full pose even without the technical instructions or strength required to do it safely. Again, a teacher's watchful eye for overexertion and misalignment can be the difference between learning and injury. When there is a difference in ability between students in a class, the teacher should accommodate and not ignore those who cannot yet practice these poses safely, and provide alternatives in flowing sequences like surya namaskar (greeting under the sun).



Preventing Knee Injuries in Standing Poses

The knee is located between the long bones of the upper and lower leg, and shares muscles with the hip joints and the ankle joints. This makes the knee dependent on the alignment and mobility of the hips and ankles for its safety. Wide-legged standing poses like the virabhadrasana (warrior pose) series place such a demand on stretching the hip muscles that safety of the knees can be compromised.

A basic safety cue for students is to line up the center of the knee with the center of the foot, whether the knee is to the side, in front, or behind the heel.

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