Yoga Injuries
Rates, Risks, and Reduction Strategies for Yoga Teachers
In this week’s Group Coaching discussion we talk about yoga injuries.
If you prefer to read, or want to check out some particular notes or resources, scroll down to the discussion notes. Or, watch the video below:
Yoga Injuries: Rates, Risks, and Reduction Strategies for Yoga Teachers
We cover a lot of ground in this subject, including how common injuries are in yoga and how they commonly occur (although it’s hard to get accurate numbers.)
As well, we talk about how we might reduce the risk of injuries in our yoga classes by encouraging, educating, and creating a space for enthusiastic and safe exploration on and off the mat.
Key to our discussion is an understanding that all activities have a risk of injury, just as no or little activity (sedentary life) also carries a risk of injury or illness. However, of course we want to reduce the risk of injuries as much as possible in our yoga classes.
Our aim is to foster an environment where all practitioners can deepen their understanding of safe, sustainable yoga practices, for our students, our yoga community, and of course for us as yoga teachers.
This discussion is aimed at yoga-teachers-in-training and yoga teachers, but I hope that yoga participants find it useful as well.
Overview
We are going to touch on a few topics that I think are important to the injury discussion, including:
- Injury Rates
- Bio-Psycho-Social Factors in Injury Risk Management
- Culture and Mindset
- Educating Students
- Invitational Teaching Strategies
- Retiring Some Old Yoga Models
- How to manage an injury in your yoga class
Injury Rates in Yoga
Before we dig in, it’s important to note that I’m not an academic, so my ability to interpret research is limited. I’ve done my best but will also include some links to research and resources so you can have a read yourself. The topic of yoga injuries is heated, and there are strong views on both sides of the spectrum, both in the ‘yoga is the safest activity you could ever do’ camp, and the ‘yoga injuries are rampant this is an emergency’ camp. I tend to sit in the middle, understanding that all movement has risks, and hope that we can learn together how to reduce that risk so people can move as safely, mindfully, and joyfully as possible.
Injury Rates – The Obstacles
I want to mention the obstacles to clear data on yoga injuries – including the usual issues with yoga research – which form of yoga, which teacher, which students, which environment? These are just some of the factors which challenge our ability to study yoga. A few other obstacles are:
- There is no standardized system of reporting.
- Many yoga injuries go unreported either because there is no clear pathway to reporting, students may feel that they are to blame for their injury, or they see no purpose in reporting.
- Yoga varies wildly between different styes and forms of yoga, so it’s hard to draw conclusions from one stye of yoga and apply it to another.
- Injuries can often have multiple causes or causative factors, including previous injuries, anatomical or structural factors, psychological factors, skill level, and more. While we might pinpoint a certain activity as ‘causing’ an injury, it’s often far more complex.
Injury Rates – the Research
The first study I’ll mention is a cross-sectional survey done in Germany in 2016 with 1,700 participants
“Yoga has found to be as safe or safer when compared to other movement types”
1 in 5 adult yoga participants reported as least one acute adverse effect in their yoga practice, and 1 in 10 reported at least one chronic adverse effect, mainly musculoskeletal effects. (20% will experience acute injury, 10% will experience chronic injury)
“The most commonly reported yoga practices that were associated with acute adverse effects were hand-, shoulder- and head stands”
“The risk of chronic adverse effects was higher in participants with chronic illnesses and those practicing only by self-study without supervision. Most reported adverse effects concerned the musculoskeletal system. 76.9% of acute cases, and 51.6% of chronic cases reached full recovery. On average 0.60 injuries per 1000 h of practice were reported, with Power yoga users reporting the highest rate.”
You can find that study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664709/
The second study I want to mention is a systemic review of about 7,500 participants was published in 2018 on injury rates. One study found overall injury incidence is 1.18 injuries per 1000 yoga hours. Overall, this study found that the rate of injuries in yoga was about 7%.
In this review 4 of the 5 studies didn’t specify what type of yoga, but one focused solely on Ashtanga Yoga. This study found the majority of yoga injuries to be lower extremity injuries.
Regardless of the specific school of yoga, poses that exceed ‘normal’ joint motion may cause musculoskeletal damage and subsequent pain.
You can read that study here: https://www.sciencedirect.com/science/article/pii/S2059775421002972
Overall, from a sampling of studies, there are a few conclusions to consider:
- How often and how intensely you practice is a strong factor.
- The lifetime prevalence of acute injuries is a wide range, 21 to 62%. The higher number being associated with more frequent and more intense practice.
- The most common adverse events reported were sprains and strains. Poses associated with adverse events were Headstand, Shoulderstand, Handstand, Lotus, forward folds and back bends.
So, this is an area to continue to pay attention as yoga research becomes more refined, and we learn more about injury rates and risks.
For now, let’s talk about what’s happening in our classes.
Should I be worried about injuries?
Short answer, no. Don’t be worried but do employ safe teaching strategies.
Keep in mind that in general, people don’t want to hurt themselves, and they generally won’t hurt themselves unless they think that the pain is normal, expected, or just an obstacle to the goal. If we insist on a goal, instead focus on the journey, this may reduce the risk of injury.
In my own teaching practice, there are three factors that I see could potentially increase injury risk:
1. Repetition
2. Ignoring the body in favour of the teacher/style/ideas of ‘good yoga’
3. Not understanding individual differences
1. Repetition
The risk of repetitive strain injuries can rise when people are doing too much of one type of movement and as well not balancing it with other movement forms. This includes:
- types of movement (i.e. too much stretching, not enough strengthening)
- specific movements (i.e. too much hip flexion, not enough hip extension)
- and specific activities (all yoga, or all one type of yoga, with no variety)
An example of this repetitive risk can be found in athletics, where studies show that multi-sport athletes have less injuries than single sport athletes. If we are to infer the same in activities like yoga, we would be wise to add activities to our movement practice to reduce that repetitive risk and improve overall health.
What might that look like? Have your beloved yoga practice, but also consider adding:
- lifting heavy things (resistance training with weights, machines, tubing, kettlebells, bodyweight, etc.)
- getting your heartrate up (walk, run, roll, cycle, swim, dance, skate, etc.)
- moving at different paces, in different directions, on different terrain (hiking, tennis, basketball, ping pong, plyometrics, martial arts, etc.)
This is important for your students to understand, but who does the most yoga? You do! So, be sure to weave some complimentary movements into your life.
2. Listen to me, not your body.
Our risk of injury is increased when students feel they should listen to our guidance exclusively, rather than tuning into their own bodies. Understand that students may have been taught, either overtly or covertly, to over-ride their own body in favour of the alignment ideas of the teacher or their perceived notions of what ‘good’ yoga looks like.
Our risk of injury is also increased when students feel they ‘should’ try new or fancy movements because the teacher is excited about it. Offer options, versions, and varying intensity and complexity of movement in your class without putting a higher value on fancier or trickier movements.
3. Individual Difference
Many students will come to class thinking that all bodies should do the same things and look the same when they are doing yoga. It’s important for us as educators to teach students about differences in body design and structure, the difference between tension and compression, and that bodies come in all shapes, sizes, and abilities. You might have hypermobile students in class who can tuck their legs behind their head, and hypomobile students who will never touch their toes. They should be encouraged to practice their own yoga, without thinking that one is better or more valued, spiritual, or moral than the other.
If flexibility was a measure of your spirituality, all gymnasts and circus artists would be enlightened.
How can you help to reduce the risk of injury?
Culture and Mindset:
Participants will come to class with their own history of movement, ideas about their bodies, and paradigms like ‘all or nothing’ or ‘no pain, no gain’, or what it means to ‘be good at yoga’. Do your best to counter that with messaging that encourages a culture of exploration rather than perfection, experience rather than achievement.
Be aware of the Nocebo effect (protect, you could damage, this is a risky movement). You’ve heard of the placebo effect; the nocebo effect is the opposite. The nocebo effect can occur when we have a negative outcome because we believe we will. In other words, we are more likely to experience an adverse effect if we are worried about an adverse effect. Be aware of the impact of using language like ‘to protect your (back, knees)’, ‘if you do this/don’t do this you could damage…’, and ‘this is a risky movement’. Aim to provide safety cues and guidance without creating a sense of danger or harm.
Change the paradigm – Have pain? No gain.
Create a culture of free communication – do students feel able to speak up about discomfort or injuries? Can they ask about options, versions, or alternative poses without feeling like they aren’t ‘yogic’ enough? Do they feel safe to approach you with safety concerns? How can you create that culture in your classes?
Educating Students:
Talk about yoga philosophy and ethics as it relates to safe practice – that includes Ahimsa/non-harming, Satya/truthfulness, Brahmacharya/energy management, Santosha/contentment,
Teach students about the ‘edge’ – the space between comfort and discomfort. Challenging your body with movement or rest without moving into discomfort. You might posit this as a practice of Tapas – disciplined intensity.
Talk about feeling a stretch in the belly of the muscle rather than the joints. (a general guideline)
Discuss with your students how you sequence a class to balance strengthening and stretching and stretching all sides of a joint.
Teach students about movement principles like progressive overload, and how our systems respond to our efforts, including the musculoskeletal system, and the nervous system. In my own teaching I might talk about this in terms of ‘how do we get stronger or more flexible? By asking for just a little bit more’. And ‘your nervous system is a key player in giving you more of the flexibility you already have. Your nervous system needs to feel safe and stable to explore a deeper stretch or larger range of motion than usual. Approach your stretches with curiosity rather than force.’
Explore the Goldilocks method – not too much, not too little, just right.
Teach students about different body designs, and how and why some bodies don’t do the same thing as others. It’s not always about flexibility or strength-building.
Invitational teaching strategies
People may be coming to class with preexisting injuries, medical conditions, unique body designs or structures, or a history with movement that makes them vulnerable or feel vulnerable in led movement. Make space for these students to safely experiment with movement in their own way.
Invite people to get to know their bodies through the practice of yoga. Let them be curious, try new things, play, and explore versions and alignments to find their flow.
Make your teaching a conversation or collaboration. Be clear ‘I don’t know your body better than you do.’ Can we try a few things to find a right fit?
Remind students that yoga not about being a yoga robot, it’s all about getting to know YOU better.
Take care to not impose your yoga goals or values on your students. Do they really want to perfect poses and ‘advance’ their practice, or are they here to move, breath, and relax?
Retiring old yoga models
Retire rigid alignment rules. They are made up, often based on how it looks (aesthetics), and most have nothing to do with safety. If you want to talk about alignment, be clear on what is safety alignment or safe practice, and what is yoga alignment or aesthetics. Encourage students to find their own alignment that allows them to experience the essence of the pose in their unique body. For example, is this a pose of deep hip flexion in a seated position? How can your students find that movement in a way that works for them?
If a student is choosing an alignment or version that you aren’t familiar with or that you can’t do, but they are feeling safe and happy and not putting anyone else at risk, let them move in their own way.
Let’s maybe stop having the most flexible person in the room demonstrate a pose for everyone else to observe. This puts the demonstrating student in a vulnerable position and encourages the idea that everyone should look like they do.
Offer guidance, refinements, and workshop versions, but let go of right/wrong pose management. We don’t need to highlight ‘errors’ or micromanage alignment. Let students do it wrong (safely) in the journey to finding their right pose.
Retire phrases like ‘practice, practice, all is coming’ and ‘you need to move through the pain (break your knees) to express the full pose’. These loaded little cliches are popular in practices like Ashtanga Yoga and promote a dangerous and outdated culture of injury or pain as a part of the physical or spiritual journey. Be clear, you don’t need to suffer for your yoga.
If an injury happens – what do you do?
Begin with risk management – that includes your physical space, student guidance on safe practice, and planning for practices that suit the class in front of you.
We can all get excited about sharing cool yoga tricks or a fancy new sequence, but before you do, ask yourself:
- Is this movement or sequence suitable for this class? Do they have the skill level and experience for the movement or sequence you have planned?
- Is there enough space, props, walls for this yoga movement or sequence?
- Do students have all the information and support they need to practice safely?
- Am I able to support students verbally, visually, and physically for this movement?
- Can I provide guidance or safety tips for students who will take this movement home to their practice?
If an injury happens in class:
What is your emergency protocol? You can’t plan for everything, but you have to have at least a sketch.
The show must not go on. This is a mindset you must be ready to adopt. Don’t let a student limp out of your class without checking in with them. Do not keep the class flowing while a student is injured or otherwise experiencing discomfort.
If a serious injury occurs, do you have a clear process for getting emergency services to your location? A piece of paper that you can hand to a student with the emergency services number, location, what door to enter etc. is useful. You have to assist the injured student, so you need a helper to make the call.
Plan for action. If an injury happens:
- Ensure the injured student is safe and has a support person. Ideally a friend, or someone with first aid training to keep them calm.
- Calmly clear the room of extra people.
- Have someone call paramedics.
- Send someone outside to direct paramedics to the space.
- Have helpers quietly get mats and bags out of the way.
- Follow the guidance of emergency services.
- Stay to talk to any students who might have concerns, strong reactions to the injury
- Report the injury to your insurance company, employer, venue, or organization.
Put these steps into place now so you’ll be prepared.
- Do you have an emergency plan?
- Do you have a sample injury reporting form?
- Do you have an emergency sheet?
- Do you have a clear grievance process?
- Do you have an aftercare process? A simple text to check in with a student can be enough to ensure that they are recovering, getting the support they need, and have some space to talk, ask questions, share concerns, and explore a return to practice.
Better to move with risk than to never move at all
Now, I’ve said all that and it’s a downer. So, let me tell you that in my almost 30 years and at least 30,000 hours of teaching, I have only had two really serious issues in my class. I drove a student to hospital with chest pains once. And I called an ambulance once, and rather belatedly because I didn’t realize he was ‘really’ injured. He was minimizing his pain, and I was focused on flowing on. We both kind of failed that day.
I have had other quite worrisome injuries in class, and learned from them about putting safeguards in place, improving my teaching strategies and communication skills, and not letting myself or participants get carried away when it’s not the right time or place.
Serious acute injuries are rare in yoga and can be somewhat mitigated with safe practice guidelines. And, in my opinion, it’s better to move knowing there is some risk, rather than live a life without the highly beneficial movements like we find in yoga. The consequences of a sedentary life aren’t the kinds of risks I want to take.
In Closing – Yoga Injuries: Rates, Risks, and Reduction Strategies
As you can see this is a complex discussion. Understanding and mitigating yoga injuries is complex and dynamic. While precise injury rates may be hard to identify now, it’s crucial to recognize that the risk exists in any physical activity, including yoga. However, by taking a holistic approach that encompasses physical, psychological, and social factors, we can cultivate safer yoga spaces.
Key to our efforts in providing safe yoga practice is education. By equipping ourselves and our students with knowledge about injury risks and safe practices, we empower everyone to make informed choices on and off the mat. By fostering a culture of inclusivity and encouragement practitioners can explore their boundaries safely and with enthusiasm.
As yoga teachers, we can reevaluate and retire outdated models that may perpetuate injury. Embracing invitational teaching strategies allows for a more mindful and responsive approach to practice, honouring each participant’s unique needs and limitations.
Ultimately, our goal is to create an environment where all practitioners can thrive and deepen their understanding of yoga. Through ongoing education, open dialogue, and a commitment to risk management practices, we can pave the way for a safer and more sustainable yoga journey—for ourselves, our students, and our community as a whole.
Thanks for reading or watching this far – this was a big discussion!
I look forward to hearing your ideas, strategies, experiences, and insights into your own teaching practice!
Heather Agnew, ERYT-500, lead trainer
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