Yoga-related injuries is a hot topic in the yoga world these days. With a seemingly growing number of yogis reporting aches and pains as a result of their practice, many in the yoga community have turned their attention toward the question of what causes injuries in yoga and, by extension, what injury prevention on the mat should look like.
My colleague Travis Pollen and I have been following this trend for quite some time now. (As a Rehabilitation Science PhD Candidate whose research focuses on injuries, Travis takes as natural an interest in this topic as I do.) Rather than attempt to provide answers to these complex questions ourselves, we thought it would be an informative undertaking to ask a selection of prominent yoga teachers to share their personal beliefs about yoga-related injuries. Our hope is to shed some light on what the current spectrum of approaches toward this important topic looks like by sharing a variety of responses side-by-side.
We are grateful to the 7 incredible yoga teachers who shared their perspectives with us for this project: Annie Carpenter, Jason Crandell, Donna Farhi, Lara Heimann, Jill Miller, Jules Mitchell, and Carrie Owerko.
These teachers come from varying backgrounds, but they share one characteristic in common: they are all respected senior teachers in the yoga community who train and have a strong influence on other yoga teachers. We felt that their opinions would be particularly insightful in gaining a sense for how the yoga world in general is currently treating the topic of injury prevention.
Please note: the opinions expressed here do not necessarily reflect Travis’ or my own; they are simply our best attempt at showcasing a selection of current attitudes toward yoga-related injuries from some important figures in today’s yoga world. We hope you find these answers insightful and revealing!
QUESTION 1: HOW COMMON ARE YOGA-RELATED INJURIES, AND WHAT IS THE MOST COMMON CAUSE?
Donna Farhi: Given the relative absence of definitive research on causation, what I can say through teaching for over three decades is that the students who come to me already injured almost always correlate the practice of end-range movements such as deep back bends, deep forward bends, and repetitive movements such as Sun Salutations with the onset of lower back, sacroiliac discomfort, and other conditions such as carpal tunnel syndrome and shoulder injuries. The other very common and disturbing trend is students who arrive with serious injuries with lifelong consequences such as ruptured discs, torn knee ligaments and torn hip labrums who were injured through a teacher giving forceful, and often non-consented “adjustments”.
Jill Miller: It’s challenging to know whether practicing yoga created an injury, or if a student had an underlying issue and the practice of yoga was the final “straw to break the yoga camel’s back.” From my own personal experience as a teacher, I see over-stretching and muscle weakness as a main factor contributing to injury and persistent pain… At this point in movement culture, I think there is general agreement that no single yoga “practice” covers all the bases for long-term health of tissue despite its claims to be a panacea. I think the common cause for injury is repetitive stresses and lack of variability in soft-tissue conditioning.
Jason Crandell: Yoga-related injuries occur. They don’t occur frequently, but they certainly occur. The more answerable question relates to the mechanism of injury. The 2 most common mechanisms of injury in yoga are repetitive stress and overstretch. The repetitive stress injuries are often in the anterior shoulder, medial knee, and sacro-lumbar areas.
Lara Heimann: I don’t know any hard statistics but I can speak from my own experience of teaching yoga for over 20 years and seeing that yoga-related injuries are certainly not uncommon. I often say that yoga doesn’t necessarily cause the injury but certain yoga practices can very much exacerbate the underlying factors that contribute to an injury… There are many paths that can lead to injury but if I had to point to one common cause, it would be the lack of adequate movement education that is fairly prevalent in the yoga world of teaching.
Jules Mitchell: Yoga injuries are less common than we hear about anecdotally and in the mainstream media. While it is difficult to ascertain the actual likelihood of injuries occurring as a result of yoga practice without high quality controlled longitudinal studies, there are several recent papers that have used other techniques including surveys and retrospective data collection from treatment centers. When compared with other activities, yoga-related injuries are relatively low, with the chances increasing the longer you practice. People reported the most common causes being pushing themselves too far and too much repetition. Overall, yoga is considered a low-risk practice and most of the reports of major injuries come in the form of case studies examining either single person situations or small sample sizes.
Carrie Owerko: I don’t think yoga-related injuries are any more common than the injuries one might encounter in other physical activity like sports, dance or martial arts. And as with these other types of physical activities there are many reasons people might injure themselves like a previous history of injury, physical unpreparedness, and/or doing just too much too soon just to name a few… If we do not progressively stress our tissues they will not adapt and we might be more prone to injuring ourselves. And very often it is a simple case of doing too much too soon, or too much of the same thing without variety or allowing enough time for recovery.
QUESTION 2: How important is alignment in yoga in terms of injury risk?
Annie Carpenter: Alignment not only helps to prevent injury on and off the mat, it is an essential element in teaching being awake to each moment. The “presencing” is at least as important as the cuing we give, teaching each student to remain mindful to what she is doing, and awake to her edge. Teaching alignment empowers the student, if taught well.
Jill Miller: Alignment gives us a sense of “home base” from which we can safely navigate and explore our range of motion… Alignment CAN mitigate injury risk especially as practitioners frequently veer into exaggerated end ranges of motion where it is difficult to maintain strength integrity. But ultimately the challenge is helping each practitioner to improve their ability to sense themselves in stillness or motion to optimize their alignment awareness for any given task.
Donna Farhi: You can have all the technical knowledge in the world, but if you have no sensitivity to the feedback your body is offering you, no one can save you from yourself… As a teacher I used to think that teaching alignment was very important. Now I believe that helping people heighten their perceptual process and increase their kinesthetic and interoceptive literacy is the key to a student’s safety.
Jules Mitchell: Interestingly, of those reporting injuries, some cited trying to fit into the expected alignment of the pose as the cause. Of course, others cited not knowing the correct alignment as the cause. Herein lies the problem with self-reporting in research like this – we are asking the participant what they believe is the cause. Without any high-quality research to support my statement, I must proceed with a warning that this is my professional opinion based on years of education and familiarity with the overall body of literature on injuries and rehab. I believe yoga is a relatively low load activity where alignment is not as important for safety as is commonly promoted. For example, one may choose a certain form or alignment to lift a heavy object, but not to pick up a pencil off the floor. Where on that spectrum does yoga fall?
Carrie Owerko: I think [alignment] is probably less important than many of us have been led to believe. My general emphasis is on helping students increase their capacity to respond and absorb stress. All kinds of stress and to learn to have fun doing that… That means progressively exposing ourselves to a diversity of movements and a variety of loads so that we are a little better prepared to handle not only yoga poses–but what living a full life might throw at us.
QUESTION 3: Are there poses that should be eliminated from yoga classes because they are too risky? If so, which ones & why?
Donna Farhi: Personally I’ve stopped teaching Headstand and Shoulderstand because I generally work with very large groups of 50-60 people, many of whom I do not know. If people do want to practice these postures, they should work closely with an experienced teacher and build the necessary skills to practice them safely. I’m appalled when I see teachers at yoga conferences and festivals teaching Headstand in a group of 150 people. When I look around, at least 50% of these people have no business practicing Headstand: they have insufficient strength to carry the weight of the body through the shoulders and arms and insufficient technical ability to come up and down safely. Not to mention that the teacher has absolutely no idea who may have pre-existing conditions such as high blood pressure, glaucoma, detached retina, or fragile capillaries. With Headstand in particular there is growing research to suggest that placing the entirety of one’s body weight through the fragile cervical vertebrae may not be a good idea.
Annie Carpenter: Yes. Which poses depends on the age, experience, fitness and ability of each student. I am cautious with all deeply asymmetrical poses; some, if taught well can be managed by some students, others are probably best retired for most students.
Lara Heimann: I would love to eliminate headstands and shoulderstands, because of the potential compression on the cervical spine and surrounding structures. Genuinely, in the cost/benefit analysis, I think the costs are just too high. You can get benefits in other ways without possibly compromising the joints of your neck, the surrounding connective tissue, and the blood supply in this area. I also think any pose that takes you into less functional/more extreme ranges of motion should be scrutinized. Personally I don’t teach Parsvakonasana/extended side angle or Hanumanasana/front splits because I just don’t see the value they add for the general population. Most people cannot “get into” these poses without some form of compensation that is problematic for the joints and surrounding tissues. Plus these poses unintentionally both reward and punish the hypermobile people since they’re capable of performing the poses short-term but may pay the price long-term for the potential stress placed on the joints.
Jason Crandell: There are many postures that contain some degree of mechanical risk. But, the practicing population needs to also be considered. Certainly, there are postures that should be done under greater supervision and by a limited student-base. There are many, many postures that I choose not to teach because I think they have an increased risk in a large group of students. Examples of these postures include headstand and shoulderstand. But, this doesn’t mean that I think these postures are dangerous for everyone. But, in the context of a large, all-levels class without pre-requisites, I limit Headstand and Shoulderstand. There are countless more esoteric and incredibly difficult postures that I don’t teach because they aren’t reasonable for my student-base. But, Headstand and shoulderstand are the most common postures that I’ve chosen to take out of my curriculum.
Carrie Owerko: I prefer to increase options, rather than remove them. That might mean that certain poses will be regressed significantly in terms of ROM or strength requirements, etc. with options provided for the various people in attendance. I don’t tend towards thinking that there are “bad poses” but rather bodies that are not prepared or bodies that might not have the requisite bony structure that would make certain more extreme yoga poses possible. I think what one teaches in a general level class is probably going to be very different than what one might teach in a class very experienced long time practitioners.
QUESTION 4: Does injury prevention play a role in the verbal cues you use in your teaching? If so, how? Specific examples are appreciated.
Jason Crandell: Yes. I do not teach passive stretching in any of my classes. Rather, I give cues that teach students to engage their muscles when they are nearing their end range of motion. My focus is to use cues that help people prevent overstretch injuries by converting passive ROM to active ROM. These verbal cues help students create more eccentric strength—especially in regions of the body that are typically overstretched.
Annie Carpenter: Absolutely. My primary concern with most populations is making sure the sacrum is stabilized to support the spine. For example in a backbending pose when one leg is in flexion (bridge with one leg up, or ekapada viparita dandasana) I would limit the range of the lifted leg to where the student can keep the pelvis neutral in all 3 planes.
Donna Farhi: More than giving specific cues I try to uncover people’s higher allegiance to false belief systems such as the “no pain, no gain” myth, or “pain is weakness leaving the body” and some of the more alarming trends towards spiritualizing pain. I suggest that pain is the “body’s way of asking us to make a different choice.” Distinct, localized and sharp sensations that cause the body to flinch are warning signals designed to get our attention. These sensations may be asking us to better prepare for a movement practice (perhaps there has been insufficient warming, conditioning, or intelligent sequencing), to alter the vector of the movement (e.g change the angle of the arms or the arc of the movement of the arms through space), decrease the size of the movement, or to simply desist from that movement at this time.
Jill Miller: Yes, I feel this is very important. Both of my formats, Yoga Tune Up® and The Roll Model® Method, are geared towards rehab/prehab prepare/repair. One of the fundamentals of our “cue-ing” is to educate people about their anatomy, help them discover their body parts, felt sense, and improve awareness of how all systems interconnect. A large part of our teacher trainings focus on terms of anatomy and clinical nomenclature rather than mystical anatomy. This helps future teachers to better translate their teaching to a wide variety of humans, not just “yogis.”
I feel strongly that teachers should be able to easily converse with movement and clinical professionals about the poses and positions they teach, and the only way to do this is to bring on Latin as a primary language and let them maintain “Sanskrit as a second language.” We then help our teachers to find ways of using their Latin and “anatomy speak” to relate to the contexts and communities they instruct. They talk like humans speaking to other humans, not reciting a script, imitating their teacher’s lineage, or talking in a robotic manner. Ultimately we don’t focus on proper cues in our trainings, we teach our trainees to articulate their felt experience and to provide clues to their students on how they might discover new ways to embody and experience their body.
Jules Mitchell: Not anymore. I have adopted an optimistic dialogue and I am continually supporting teachers in how to achieve this. For example, instead of saying “in order to protect the knee, keep the knee over the ankle in Warrior 2,” one might say, “in Warrior 2, we generally stack the knee over the ankle.” This allows teachers to teach the pose without suggesting the knee is at risk. It also allows for the teacher to offer alternatives without being contradictory when the student might not favor the standard alignment.
QUESTION 5: Does yoga need to change in order to become safer & more sustainable? If so, how?
Jason Crandell: Yes. In addition to including a greater emphasis on all forms of strength, especially eccentric strength, manual adjustments and sequencing need to continue to evolve. Manual adjustments should not add additional tensile load on a student. Our job should no longer be to help students go passively further into their postures by adding leverage. Instead, manual adjustments should shift so that they provide the students with greater feedback so that they can use their body in a more balanced and comprehensive way. Finally, sequencing needs to be much, much more balanced. Currently, most sequencing is disproportionate for every joint of the body, especially the shoulders and hips. Certain stresses are repeated an exceptional amount, while other stresses are completely ignored. Examples include an extreme amount of shoulder and hip flexion compared to minimal extension. Another example is the amount of stretching of the thoraco-lumbar fascia, including the muscles that feed into this fascia, compared to the amount of strengthening.
Donna Farhi: While teachers becoming more knowledgeable about anatomy, kinesiology and sound biomechanics would go a long way towards making yoga classes safer, ultimately I think the problem lies in the archaic pedagogic model that has ruled lineage-based yoga systems for the last 100 years. The guru or teacher-knows-best model for teaching is fundamentally flawed. Scientifically speaking there is no person who is connected to the proprioceptive matrix of your body. No one, no matter how experienced, is capable of knowing how far you should go or how long you should stay. When these thresholds are externally referenced or interfered with (in the case of forceful adjustments), people will get injured. My focus now is on educating teachers about making a shift from “Simon Says” pedagogy to “Self-Sovereignty” pedagogy where we guide people to inquire into their somatic experience and to make their own deductions and adaptations.
Lara Heimann: My podcast is called “Redefining Yoga“ and this title was selected as it is an appropriate verb to help direct the yoga community toward a more sustainable and joy-filled movement practice. It’s hard to feel joy in your body when you move in ways that create an unhealthy ecosystem. Yoga is not often the culprit for injuries but it is a place and a practice that can help us move better and more consciously. I think that yoga itself doesn’t have to change as much as our interpretation of it needs to be refined and redefined in terms of our own practice and teaching.
Jill Miller: I like the way it’s changing. I think new teachers today have many more options than I had when I took my first “formal” yoga training 24 years ago. When I first started teaching my work more than 18 years ago, I pushed functional movement concepts and self-massage into the yoga space. It was embraced by few, and I was called a heretic by many. But as I persisted to teach what I thought was right, I found other like-minded movement and clinical professionals who saw that their own tribe was caught in a box and that we needed to break through our walls, cross-train and celebrate interdisciplinary movement. I truly see that there is a massive shift happening in the yoga community as they embrace concepts from far and wide and incorporate best practices into classes and formats. I think the diversification is AWESOME and I’m proud of the moment we’re having in the yoga community.
Annie Carpenter: Finding balance between honoring our traditions and being smart and safe is — in my view — a yogic point of view. Some of my concerns right now:
Moving into advanced level asana before the body and mind are able to attend to all of the necessary elements.
Moving too quickly to be able to sustain mindfulness and alignment
Commit to stability over flexibility
We need as much emphasis on rest and integration as we have on movement, flexibility and strength building.
We need to give the practice to our students. As we encourage and empower them to know and honor who they are, and the karmic results of their own actions, on and off the mat, the promise of yoga — freedom — rather than our egos, can be fulfilled.
Jules Mitchell: I don’t think yoga was ever unsafe or unsustainable, at least not less safe or less sustainable than any other leisure activity. There was just a big anecdotal dialogue among the community that it was. I think we are all learning a bit more about load management, pain science, and biomechanics which just makes for better educated teachers. Will this ultimately make yoga safer and more sustainable than before? That’s impossible to predict and even harder to quantify without adequate research.
WHAT CAN WE LEARN FROM THESE RESPONSES?
Surveying a variety of experienced yoga teachers can give us great insight into how the topic of injury prevention is currently being approached in the yoga community. Clearly we can see that there are a spectrum of viewpoints on this topic. This might help explain why we tend to see quite a bit of debate and confusion in the yoga world regarding how best to keep students safe.
With more time and intelligent discourse, our hope is that the community will eventually coalesce around one effective, evidence-based approach to the important issue of yoga-related injuries.
If you’re interested in exploring the perspectives and work of any one of the renowned yoga teachers featured here further, you can learn more from each of them here:
Travis Pollen, co-author: Travis Pollen is an author, personal trainer, and PhD candidate in Rehabilitation Sciences at Drexel University. His research focuses on core stability, movement screening, and injury risk appraisal in athletes. He also holds a master’s degree in Biomechanics and Movement Science along with an American record in Paralympic swimming. He’s been a yoga student for 15 years. Website | Instagram | Facebook