Updates on Bali, Yoga & Meditation
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The physical practice of yoga is low-impact and therefore relatively low-risk. With conscientious and ability-appropriate practice, the risk can remain small. However, like any other form of exercise, injury is possible and in fact, too frequent. So it’s important to be aware of common yoga injuries and prevention, as students and teachers.
First, some statistics. It is estimated that 79% of regular yogis have never experienced a yoga-related injury, 20% have encountered a mild injury, and 1% have suffered an injury that caused them to stop practicing. Another study calculated a risk of one new injury per 1000 hours of practice. Strains and sprains are the most commonly-reported yoga injury. Interestingly, only about 43% of yoga injuries seem to be due to performing an actual physical posture. The remaining 57% of injuries are related to yoga but caused by myriad other factors such as stumbling into another participant, slipping on the floor, or tripping over a prop. The lesson here: simply being more aware of your surroundings can help keep you safe in class!
The asanas most commonly associated with musculoskeletal injury (strains, sprains, and fractures) fit into one of two categories: (1) relatively higher risk of falling out of the pose, or (2) involving extreme range of motion. The most damage-inducing postures are headstand, handstand, shoulder stand, lotus pose, back bends, and forward folds. Below we’ll look at various joints of the body, how they are susceptible to injury, and how to avoid damage to our musculoskeletal systems.
The cervical spine consists of seven vertebrae that link the base of the skull to the rest of the spine. The c-spine is incredibly important because it houses the upper portion of the spinal cord, which connects to the brain. It also sends out nerve roots that provide movement and sensation to the arms, and serves as an anchor for countless muscles that stabilize the neck, shoulders, and upper back.
The cervical vertebrae are small and pretty delicate, because they don’t need to support much weight (just the weight of the head). But they do need to be able to rotate, flex and extend in all different directions so that we can move our heads. The lumbar vertebrae, in contrast, are chunky, so they can handle the huge loads we place on our low backs from above and below.
Knowing how important the cervical spine is helps us appreciate the need to support it in postures where is may get compressed, most notably sirsasana (headstand). Repeated weight on the c-spine has the potential to cause micro-fractures of the vertebrae. Over time this damage can cause pain, change in shape, and decreased range of motion of the neck. Compression can also lead to disc herniation and nerve pinching, which has various downstream effects such as loss of sensation or decreased muscle strength of the arm and hand.
Another notorious pose is sarvangasana, or shoulderstand. The excessive neck flexion in this pose can over-stretch and damage the ligaments in the neck, as well as compress discs.
That all sounds terrible. So how do we avoid it?!
The rotator cuff is a group of four muscles and their ligaments that keep the arm bone anchored at the shoulder. Damage to the rotator cuff is usually from overuse or impingement. Repeated weight-bearing movements or frequent small stresses can eventually lead to weakening or tearing of the tendon’s attachment site. Chaturanga dandasana is a pose that requires a high level of shoulder strength to perform sustainably.
Impingement (pinching) of any of the structures in the shoulder may occur when the joint is pushed beyond its healthy range of motion or the humerus (upper arm bone) is not stabilized into the shoulder socket. Impingement can, in turn, lead to tendinitis or tearing. Rotator cuff injuries most often occur at the supraspinatus tendon, but any of the muscles or tendons may be involved.
Here’s how to help keep your shoulders safe in practice:
Yes, arm balances are cool. We all want to be able to float up effortlessly into bakasana or fly funkily into eka pada koundinyasana. But there’s a reason we walk on our feet and not on our hands: our little wrists are not engineered to support our entire body weight! The anatomy of the hands is such that when we put pressure on them, the bones don’t stack nicely to give strong, structural support like the feet and ankles do when we stand. This makes the soft tissues of the wrists (muscles, tendons, ligaments, and fascia) vulnerable to damage.
Arm balances aren’t the only culprit, either. Downward-facing dog, planks, and cobra can also hurt the wrists. Now this doesn’t mean these poses (and eventually more advanced arm balances) are completely off the table. It just means we need to know how to prepare for and practice them safely. Also, in our daily lives we spend a lot of times with our writsts in extension: think of your wrist position while typing and driving.
Here are some tips to protect your wrists:
Oh, low back pain. The plague of our time. One of the most common reasons for visiting a doctor, and a major complaint by yogis, too. Countless postures we perform put stress on the lumbar spine, so even if you’re one of the lucky few who does not experience low back pain, it’s important to be aware of how to keep the low back safe. In yoga, low back stress usually stems from backbending. Classic backbends like dhanurasana (bow pose) and urdvha dhanurasana (upward-facing bow pose or wheel) and obvious culprits.
However, other back-neutral poses can sneakily turn into lumbar spine extensors if not performed properly. These are often the source of lumbar spine injury that causes pain. Examples of these are crescent pose, low lunge, and even tadasana. We tend to “deepen” lunging poses by anteriorly tilting the pelvis (pushing the seat back and low ribs forward), which compresses the low back and can damage lumbar discs. In standing poses like tadasana, the same thing happens – we get lazy in these seemingly simple postures, and sink our weight into our low backs.
Here are some low-back-friendly suggestions:
In our busy, fast-paced lives, we all crave the grounding and calming that forward folds provide. Since they feel so good, though, it’s easy to over-do it, putting our hamstrings at risk. The hamstring tendons attach to the pelvic bone, and it’s not uncommon for micro-tears to appear at this attachment point. This type of injury would likely manifest as deep pain in the bum or upper thigh region, or an uncomfortable pulling sensation down the back of the thigh, especially in forward folds. Micro-tears can accumulate and lead to macro-tears, which are much more debilitating and can require long-term physiotherapy, rehabilitation, or even surgery.
Preventing over-stretching and damaging the hamstrings is pretty simple:
Knees move in relatively few directions, compared to other joints. They flex (bend), extend (straighten), and when flexed between 30° and 90°, they rotate medially and laterally too. A multitude of ligaments support and stabilize the knees. You’ve heard of the notorious ones like the anterior cruciate (ACL), posterior cruciate (PCL), medial collateral (MCL), lateral collateral (LCL). There are so many other ligaments in the neighbourhood, though: transverse, arcuate popliteal, meniscofemoral, anterolateral, fibulocollateral, etc. etc. All of them keep the knees moving safely.
An example of a knee-straining pose is lotus. Full lotus places small but firm torsional strain on the knee, so there is a chance of damage to the ligaments and meniscuses. For this reason, lotus should never be forced, and should only be practiced by yogis with deep hip and groin flexibility, which enable full expression of the pose while keeping the knees in their neutral position.
Here are some ways you can protect your knees during practice:
When it comes down to it, the health benefits of yoga far outweigh the potential risks of harm. The small chance of injury should not discourage healthy people from practicing! Of course, accidents happen. But being aware of your own body’s limitations and paying attention to signs of damage should be enough to keep you safe. If you do get injured, yoga can help with rehabilitation, too! But that’s a discussion for another day.
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Cramer H, Ostermann T, Dobos G. Injuries and other adverse events associated with yoga practice: A systematic review of epidemiological studies. Journal of Science and Medicine in Sport. 2018; 21:147-154. DOI 10.1016/j.jsams.201708.026
Ferreira M, Galvez-Jimenez N. Sirsasana (Headstand) Pose Causing Compressive Myelopathy with Myelomalacia. Images in Neurology. 2013; 70(2): 268. DOI 10.1001/jamaneurol.2013.589.
Russel K, Gushue S, Richmond S, McFaull S. Epidemiology of yoga-related injuries in Canada from 1991 to 2010: a case series study. International Journal of Injury Control and Safety Promotion. 2016; 23(3): 284-290. DOI 10.1080/17457300.2015.1032981
Sfeir J, Drake M, Sonawane V, Sinaki M. Vertebral compression fractures associated with yoga: a case series. European Journal of Physical and Rehabilitation Medicine. 2018: 54(6): 947-951. DOI 10.23736/S1973-9087.18.05034-7.
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