Yoga Injuries

Sumeet Samant
Case Studies explaining Yoga
Injuries.
1. Yoga-Related Injuries in the United
States From 2001 to 2014.

2. Injuries/Harms Resulting from Incorrect

Adjustments/Alignments Performed by
Yoga Asana Practitioners.
3. Is the notion of Yoga Injury tenable?
Case Study No.1
Yoga-Related Injuries in the United States From 2001 to
2014.
Method: Data from the National Electronic Injury Surveillance System (NEISS) from 2001 to 2014
were used to estimate the incidence and type of yoga-associated injuries.

Result: There were 29,590 yoga-related injuries seen in hospital emergency departments
from 2001 to 2014. The trunk (46.6%) was the most frequent region injured, and sprain/strain
(45.0%) accounted for the majority of diagnoses.

Conclusion: Participants aged 65 years and older have a greater rate of injury from practicing
yoga when compared with other age groups. Most injuries sustained were to the trunk and
involved a sprain/strain.

While there are many health benefits to practicing yoga, participants and those wishing to
become participants should confer with a physician prior to engaging in physical activity and
practice only under the guidance of certified instructors.
Conclusion: Yoga is a safe form of exercise with positive impacts on various
aspects of a person’s health; however, those wishing to practice yoga should
be cautious and recognize personal limitations, particularly individuals 65
years and older. National standards for yoga instructor certification should be
created and should more aggressively teach information about safety and
injury prevention.

Courtesy : Thomas A. Swain, MPH*†‡ and Gerald McGwin, MS, PhD†‡

Case study no. 2
Injuries/Harms Resulting from Incorrect
Adjustments/Alignments Performed by Yoga Asana
Practitioners.

Misalignment during some Yoga poses and injuries:

Practitioners need to listen to their bodies instead of their mind; they
should not put themselves to the point of strain. However, there is no
need to give up any pose entirely, care should be given to the
particular pose, and it should be done under the supervision of some
experts.
This posture is performed by moving legs in
1. Shoulder Stand
an upward direction in the air with the (Salamba Sarvangasana)
support of the shoulders. Shoulder Stand is
useful for better thyroid and metabolism
regulation, reducing heart rate.
Misalignment responsible for injuries: The
practitioner may fall on the floor leading to
injuries in hips and legs. Since there is a lot
of pressures on the neck during the pose,
there is a possibility of neck injury due to
misalignment.
nerve flow passing through the upper
region of the spinal column to the brain,
over-contraction, and bending of the neck
can lead to internal bruising and trauma.
This pose is a compact arm balance in which
practitioners move their full weight to their
hands by folding their legs, and the final shape
looks similar to the sitting crow. It is useful for
strengthening of upper arms as well as the 2. Crow Pose (Kakasana)
forearms and wrists.
Misalignment responsible for injuries: Some
practitioners move their hips too high,
approximately vertical to the head, leading to
a non-uniform distribution of weight.
Practitioners may fall leading to injuries.
Elbows bending by the practitioner to the sides
may lead to joint pain. This is because of
stress in the joints and increased weight gain
of the wrists.
In this pose, practitioners stretch their legs and
spine sitting on the floor. The end of some poses
is done so that the body stays warm and ready
in this pose. It is useful for stretching the pelvis,
5. Double Leg Forward Stretch Pose
hamstrings, calves, groins, and spine. (Paschimottanasana)

Practitioners force themselves to bend forward,

especially when sitting on the floor, which may
result in pain in the back.
This is also termed as Low Plank, in which
practitioners straighten their body parallel to
the ground, and are supported by the palms,
and toes, along with elbows placed at 90
degree angles. This pose helps to strengthen
and provide flexibility for the arms, wrists,
forearm muscles, abdomen, and tones.

Some practitioners dump their full weight on

their shoulders, which leads to strained
shoulders. Practitioners should stay in pose
with not more than the right angle to avoid it. 4. Four-limbed staff posture
(Chaturanga Dandasana)
Some practitioners collapse belly first, pressing
on the lower back, and the upper body falling
to the floor, causing injury.
The practitioner performs this by bending their
bodies and touching the ground with the
palms, and the hips remain at the top. This
3. Down Facing Dog
yoga is performed by a practitioner for deep (Adho Mukha Svanasana)
stretching of the hands, back, shoulders, chest,
hamstrings, and spine.
Resting on the balls of their feet with their heels
lifted upwards. A very wide or very narrow
stance between the feet. The elbows are Bent
and/or collapsing between the shoulders.
Rounded spine and/or torso very far forward.
Improper weight placement in the hands.

.
This pose is useful for strengthening blood circulation in
the lower abdomen and helps to improve digestion and
strengthen the thigh and legs nerves .

Some practitioners apply extreme pressure on the sciatic

nerve, which causes low back pain in adults. This may be Thunderbolt Pose (Vajrasana)
responsible for the difficulty in walking, running, and
climbing. Practitioners should stretch their legs while
exercising.

Some practitioners sit on their heels for a longer time.

This can lead to cut off the blood supply in the nerve
branches. This may be harmful to the practitioner.

Sitting back on heels for a long time is harmful because it

reduces the blood in the heel causes pain.
BASIC FACTS TO AVOID
INJURIES DUE TO
MISALIGNMENT
1. Supervision of an expert
2. Warm-up
3. Strength by functional exercise
4. Start with basic yoga
5. Using Props
DISCUSSION
In this article, the various positive aspects of yoga are briefly discussed. However, all
of these aspects can be achieved by a practitioner who follows the proper
alignment during yoga practice. If there is any yoga demonstration during practice,
there is more risk of injuries. This negative turn of yoga can’t be underestimated.
Beginners should not blindly follow other experienced practitioners to perform some
hard poses. As definitely there will be misalignment during the practice of that pose.
The body will give the acknowledgment for it in the form of fractures, strains, sprains,
dislocations of joints, bone spurs, sciatic nerve damage, and stroke.
The basic solution to avoid all these injuries by misalignment includes expert
supervision, warming up, adding exercise to schedule to strengthen weak body
parts, starting with simple poses, estimating an individual’s body capacity.
Courtesy: Ghazaleh Shamaei Irani.
Ph.D. student in Yoga Therapy, Department of Yoga and Naturopathy.
Case study no 3.
 IS THE NOTION OF 'YOGA INJURY' TENABLE?

Abstract: In modern days, the reported incidences of so called yoga injury,

allegedly resulting from Hathayogic practices, are ostensibly due to violation
of basic principles of Yoga.

These are some of the issues dealt-with in this article which strongly holds
that yoga should not be misrepresented through unwarranted reports, often
published in magazines, news papers or web pages, as they amount to
defaming yoga, the timeless heritage of the entire humanity.
Yoga has become popular as a specific physical exercise regimen. This has
led us more towards the physical aspect of yoga, ignoring its psychological
and spiritual aspects, in the process.
This has resulted into only a partial advantage being accrued from yoga. With
such an approach, of course, we can maintain, predominantly, the bodily
health or even manage certain pathological conditions. But availing these
benefits alone does not lead us to the desired goal of yoga.
Principles of practicing Asana:
Sthira Sukham asanam – PYS: II : 46
prayatnasaithilyanantasamapattibhyam – PYS: II : 47
1. Effortlessness (prayatna saathiya)
2. Attending the infinite (ananta samapatti) expanse with a total mindfulness.
While practicing Asana, one must not over exert and try to surpass one's own capacity. The final
position of Asana should be maintained effortlessly. Effortlessness is applied not only for final posture
but actually the entire process of practicing Asana should be effortless. If one starts encountering
certain limitations during the practice he/she should stop there forthrightly and continue to maintain
the body position effortlessly. This will gradually increase the capacity of the body to maintain the
final position effortlessly with a sense of inward well being.

The practice of Asana brings about a felt sense of stability of mind and body and also gives a feeling
of well being. However, ‘sthira’ and ‘sukha’ are also implicated with the technique aspect of the
practice of Asana. We must be careful that our body is steadily stable during the final posture and we
are so comfortable that we feel an inward well being in it.

We are, usually, under the impression that the final position of the body, as described in the texts,
must be achieved at all costs. It is true that we must try to achieve the ideal position but along with
that we, also, must not violate the fundamental principles of practicing Asana viz. ‘sthirata’, ‘sukha’
and ‘prayatna aithiya’ as mentioned above. Every person, practicing Asana, has his own bodily
limitations and so also the body is not prepared, initially, to attain the ideal final position smoothly.
Therefore, whatever position body can adopt and maintain, in consonance with the concepts of
sthirata, sukha and prayatna saathiya, should be considered as the final position of the Asana. We
also have misconception that unless we acquire the ideal final position, asana will not give its due
benefits. It should be noted by every practitioner of asana that it is not the final position that gives the
benefit but it is the right technique of performing Asana, within the parameters laid down by Patanjali
that is vital even if the body is not able to attain the so called ‘ideal’ final position. If we violate the
principles of performing / practicing Asana, we are likely to encounter problems for which we
ourselves are responsible and not yoga.
Principles of Practicing Pranayama: It is to be practiced with an utmost care
as even slight carelessness may result into hazardous results,

Tasmin sati svasaprasvasayorgativicchedah Pranayama / PYS : Sadhana

Pada :51

Bahyabhyantarastambhavrittirdesakalasakhyabhirparidrusto dirghasukhmah
/ PYS: Sadhana Pada: 52

They mean – ‘While being in that (asana) the break in the regular rhythmic
movement of inhalation and / or exhalation (both) constitute Pranayama’
(PYS: II: 51).
Hatha yoga is another school of Yoga that has given maximum importance to
the practice of Kumbhakas. A representative book on Hatha yoga viz.
Hathapradipika has preferred to use the word Kumbhaka rather than
Pranayama.
Any person, violating these cautionary instructions, is likely to get adverse
effects of the practice.
Just as wild animals like lion, elephant or a tiger can be brought under control
slowly and gradually, similarly the respiration should be brought one’s
conscious control gradually with practice. Otherwise, it can ‘kill’ the
practitioner (himself) (HP: II: 15).
By the proper practice of pranayamas, all diseases get attenuated (whereas)
due to improper practice (of pranayama) all the diseases get generated (HP:
II: 16).
Various diseases like hiccup, respiratory disorders, cough and also pain in
head, ear and eyes get generated due to the malfunctioning of air.
1) hikka - Hiccup- indicates diaphragmatic irritation.

2) svasa – dyspnoea- breathlessness

3) kasa - cough.

4) sirah vedana -Head-ache

5) karna vedana - Ear-ache

6) akshi vedana - Pain in the eyeball (HP: II:17).

Exhale air properly, also inhale it in a methodical manner and it (air) should be
retained also in a methodical manner. In this way accomplishment and
perfection (in yoga) should be obtained. (HP II/18).
Why Injury
Unfortunately, while practicing yoga, people have accepted only the practical
aspect of yoga and that too, not in accordance with the right technique, as
shown by Patanjali or Hatha yoga authors.
In many Western countries yoga is considered as a specific exercise or has
got amalgamated with other exercise methods. Violation of yogic principles,
while practicing asana, may make the practitioner prone to the onset of some
problems.
Reports of such problems, arising out of a gross violation of the yogic
principles, have appeared in some standard medical journals, in a manner
that create a wrong impression that yoga itself leads to problems and
therefore is ‘not safe’! The headings often read something like, “the injury
through so called yoga practices.”
(Interestingly, the title suggests rightly that these yoga practices are so called
and not actual)
Before coming to any conclusion on the reports regarding such adverse
effects of yogic practices, we must know some of the facts about different
types of so called yogic practices which are actually innovations of modern
Indian, as well as, Western fertile minds, who have ‘molded’ yogic practices in
some vigorous exercises or superimposed their own understanding upon the
techniques of their performance in such a way that it has become more an
exercise and less of a practice of yoga.
Yoga Institute, established in the year 1924, is continuously engaged in treating
and giving training in yogic exercises. It has not recorded even a single
contraindication complaint about ‘Yoga Injury’. Thus, even after around 90
Years of Kaivalyadhama existence, the notion of Yoga Injury is quite an alien
term in its premises. This is high time that so called yoga experts and
promoters, of so called ‘innovative’ yoga practices, introspected and
pondered on the question, “Are we really promoting yoga in its true sense in
such a manner”? We are sure the answer will be crystal clear to these ‘experts’
of yoga.
1. A case of rectus sheath hematoma due to non contact strenuous exercise,
yoga, in 45 year old woman, admitted as an emergency in hospital (Ref.
American journal of Emergency medicine 2009).

2. . A case of hamstring tear, due to utthita padangusthasana which

recovered after 6 months with medical treatment and physiotherapy. By Carol
Krucoff--www.Yoga journal.com/life style/908.

3. A case about headstand injury in sirsasana-50 years old osteoporotic

patient who developed neck spine injury after sirsasana (Ref-
www.yogajournal.com/1620).

4. A case study by Dr. Jonson DB, Dept of Surgery, Berkshire Medical Center,
USA - Case of 29 years old woman who suffered from spontaneous
pneumothorax after the vigorous practice of Kapalabhati.
This is high time that so called yoga experts and
promoters, of so called ‘innovative’ yoga
practices, introspected and pondered on the
question, “Are we really promoting yoga in its
true sense in such a manner”? We are sure the
answer will be crystal clear to these ‘experts’ of
yoga..
Hathapradipika has explained the specific therapy in 5th chapter for such
problems:

The person, committing mistakes in practicing yoga, develops diseases

related to vata etc.

Thus, considering both traditional and modern references and also increasing
popularity and adaptation of yoga practices in masses, it is warranted to
apply, diligently, important scientific principles that may help us avoid the
incidences of complications, in case of the recipients of yoga training and
treatment.

The following are some of such principles for the use of yoga professionals.
1. Scientific base: During the performance of a particular Asana, one should be mindful as to
what muscles undergo contraction, what get stretched and also to what extent, where the
pressure of gravity acts most (specific joints, bones, organs, muscles etc), where is more
strain, what about the breathing pattern during the final state and so on. All these must be
well explained so that one can understand properly as to what is actually happening in the
body during the very procedure. Every asana, variety of pranayamas, kriyas, mudras etc.
should be explained within the parameters of anatomy and physiology.
2. Understanding difference between Physical Exercises and Yoga practices: In physical
exercises, the metabolic rate gets increased with increased energy expenditure. During
yogic practices, however, we have to keep our metabolic rate almost at rest, resulting into
the least energy expenditure. Obviously, after an hour of practice of physical exercises, one
often gets fatigued and needs a sufficient amount of recuperative rest, whereas after an
hour of correctly performed yoga practices, there is no sign of fatigue or exhaustion,
whatsoever. Yoga itself is a rest with its principle of ‘prayatna saathiya’.
Yoga makes us parasympathetically oriented, inwardly sensitive, introspective and intuitive
during its practices. Yoga, if performed like exercises would deprive one from the
abovementioned yogic benefits. Asanas should be performed with a slow and gentle
movement with gravity being allowed to operate gently and naturally, as well as, the
maintenance time of asanas being operational as per one’s individual
psycho-physiological limitations and capacities. There should be a proper rest in between
any two asanas performed sequentially.
3. Medical case reports: Most of the times, some people may get injured
initially due to some other forms of exercises. But unfortunately, it is
conveniently attributed to yoga and the same goes under the heading of
‘yoga injury’.

4. Yoga teacher training: Trainees for a yoga teacher course should have
authentic information and knowledge about anatomy, physiology and
psychology. They should learn yoga techniques properly and also take into
account all possible errors and limitations which become evident during their
practice. Also, they should have appropriate solutions to overcome those
limitations. One of the important suggestions to them would be that they
should teach the techniques according to psychophysiological conditions of
the learner.
5. The Stretching skill: For the beginners, there should be a gradual increase
in stretch. Simple rule is that during any movement, while practicing an asana,
if one feels unbearable uneasiness and pain, he/she should come back and
release the asana forthrightly. Then day by day one may increase the degree
of stretch. Yoga teachers should not force them to adopt the final posture in
an inordinate manner. During the practice, all movements should be slow.
Jerky movements may cause an acute spasm of muscles (stretch reflex) or
may injure muscle fibers.

6. Age and ageing mechanism: Though some people may be following some
advanced asanas during their youth, they should restrict overstretching and
difficult asanas. It is better to check one’s bone density after 45 years of age
and accordingly a proper yoga practice plan should be decided. We have
seen so many people becoming over-enthusiastic about yoga in their old age
(rather than in their young years!). They often exert themselves, rather
unreasonably, in performing difficult asanas.
7. Pathological conditions: If you are teaching yoga to healthy people you can
choose proper yoga practices rather easily. But when the person, having a
specific problem comes in front of you, there are certain limitations often
encountered. In such a case, it is better to take a medical advice. This is a joint
responsibility of a doctor and a yoga teacher. In these cases, modifications in
original asanas and also to use props and other such things may become
necessary. Therefore, a yoga teacher would do well in designing a personal
yoga practice plan for his patient/trainee.
8. Personal safety measures: Every ‘body’ has its specific properties. Some
people are born with a good flexibility. So, firstly, one should keep in mind that
it is never advisable to compare oneself with other persons. In group practice
often our ego gets hurt when someone is performing easily. We often tend to
compete, in such a situation, disregarding our innate limitations. So a yoga
teacher should see to it that any kind of such a competition with others is
discouraged. Challenge your maturity and wisdom in choosing the yoga
practices most suitable to your needs and your innate limitations. Therefore,
learn from a competent teacher, not from books or CDs or TV shows, for you
need a close supervision in the initial learning phases of your yoga practice.
Conclusion:
1. We must know the basic principles, as laid down by our ancient yoga sages like Patanjali or
Svatmarama and others, pertaining to the practice of asanas, pranayamas and other yoga
practices.

2. Asana, Pranayama, or other yoga practices, if practiced according to scientific principles, will never
result into any adverse effects, whatsoever.

3. Adverse effects of a wrong practice of yoga have been clearly indicated in the yogic texts.

4. ‘Innovative’ yoga practices, as well as, innovative techniques of performing the same are often not
safe to be practiced.

5. Asanas must be learnt from a competent teacher only.

6. A teacher must be earnest and diligent in following basic yogic principles, as well as, anatomic and
physiological principles pertaining to yoga practices.

7. Individual himself is thus, responsible for any adverse effect due to the wrong practice of yoga and
not the science of yoga.

Courtesy: Bhalekar, S.* Sahay, G. S. ** & Bhogal, R. S.***

Thankyou…