Common Yoga Injuries and How to Avoid Them

The essence of the 5,000-year-old yoga tradition is tranquility, mindfulness, and spiritual transcendence. But ironically, more and more people are leaving yoga class mindful of nothing more than a searing pain in their knee, shoulder, or wrist.

For a variety of reasons, including yoga's increased popularity, its transformation into a fitness activity taught in health clubs, overaggressive teachers and competitive students, an increasing number of yoga enthusiasts, are hurting themselves during class.

Yoga's explosive popularity, driven by the influence of celebrities such as Madonna and Sting, a greater public awareness of yoga's benefits, greater scientific acceptance of yoga and a greater integration of mind-body modalities within the medical profession, have multiplied the number of practitioners. Also, many people with sports injuries have sought relief in yoga therapy. So although yoga is generally considered safe, especially when compared to other fitness regimes such as running, the sheer number of new yoga students has led to a rise in injuries. (There are no official statistics available on the number of yoga-related injuries.)

Why So Many Injuries?
There are many reasons why people get injured while performing yoga.

"For starters, yoga today is taught out of its traditional context," says my friend and yoga instructor Mary Jones. "The intention of the ancient science of traditional hatha yoga was to prepare the student for meditation, using the body as a vehicle for mental and spiritual development."

Mary adds that because the fitness-oriented styles of yoga taught in health clubs are more popular, "the emphasis is on getting a workout, so you're likely to get more biomechanical stresses and strains."

In addition, new styles of yoga such as Iyengar, Vinyasa, and Bikram, are more active and free-flowing. While they induce the student to sweat a lot and develop a lot of strength and flexibility, they also increase the risk of injury. For example, Bikram, held in a hot, unventilated room, facilitates flexibility, but also can induce the student to take his/her pose beyond a safe range of motion. And, Mary says, "The eclectic fusion of yoga and fitness activities in classes such as Yoga Booty Burnout and Yogilates means that when it comes to safety, all bets are off."

Moreover, this dizzying array of hybrid yoga classes are often taught by inexperienced and poorly trained instructors. "Yoga injuries are common in those circles where ill-trained teachers do aggressive, hands-on adjustments or create an environment of competition, ego, and expectation," Mary says. "There are certain styles of yoga that encourage the instructors to be verbally derogatory to students."

A major conundrum for the beginning yoga student is that there is neither an overarching governing body nor a standardized, scientifically validated teaching methodology.

Crowded classes also may lead instructors to overlook a student's risky misalignment. Kathy Lee Kappmeier, director of Yoga Well, a school that certifies yoga teachers in San Diego and author of Instructing Hatha Yoga, says that "Large classes often are comprised of students with a wide range of fitness levels and needs, and the teacher may not be knowledgeable enough to help them all."

In addition, students may bring an existing physical problem into the yoga classroom and worsen it by pushing beyond their capabilities.

Mary says that, ironically, yoga is more dangerous to the flexible than the inflexible. "Very flexible people can overdo their range of motion, and some teachers get excited when they find such a student. A stiff person tries to work through obstructions, while a flexible person has to know where to stop and create kinesthenic boundaries, because they're not getting biofeedback from the instructor on when to stop. Both may be consumed by the unbridled pursuit of unlimited flexibility."

While some poses are more dangerous than others--the "plow," "shoulder stand," and "headstand," for example, can put undue pressure on the neck (individuals with cardiovascular problems, hypertension, diabetes, or glaucoma also should refrain from these poses)--Mary adds that, "It's not so much the pose, but the way it's being done or taught. For example, a teacher may show you the proper way to do a headstand, but if you do it on your own and have tight neck and shoulder muscles, you could injure yourself." She adds that the safest postures are the standing ones, which are less likely to exacerbate preexisting conditions.

How to Avoid the Most Common Injuries
Most yoga injuries are caused by repetitive strain or over-stretching. The most common acute injuries are:

Shoulder girdle/rotator cuff injuries. Often caused by unsupported (knees off the floor) plank and crocodile poses as well as teachers' maladjustments, shoulder girdle and rotator cuff injuries may be avoided by dropping the knees and bringing the hands together during those poses.

Hamstring tears, lower-back strains. Forward and backward bends, and twists, if done incorrectly, can result in back problems. For prevention, Shaw advises bending the knees during all forward flexion.

Damaged knee joints. Don't force your knees into a lotus or other vulnerable positions. Without adequate hip-joint flexibility, you could tear a meniscus (cartilage) or stretch or tear one of the knee ligaments. To protect the knee, do gentle hip-opening poses, such as pigeon pose or baddha konasana (sitting with the soles of the feet together and knees out to the side).

Many yoga-related injuries are chronic, the result of microscopic trauma happening over time due to ongoing repetition of poor technique. The most frequently injured body parts in this category are:

Wrists. Mary says you can develop tendonitis in your wrist from doing Vinyasa yoga, which emphasizes salutation movements such as the down and up dogs.

Soft tissue inflammation of the pelvis and gluteus muscles. What some refer to as "yoga butt" is the result of destabilizing the pelvic joints by too much seated practice.

Neck. To prevent neck injuries, don't hold poses that don't support your head.

Finally, here are some general tips for preventing yoga injuries:

• Find a qualified instructor who can give you individual attention, especially one who teaches poses step by step. Be wary of a class where all the poses are taught inflexibly (no pun intended). To find a class near you, contact the Yoga Alliance, www.yogaalliance.org.
• If you're new to yoga, start slowly and learn the basics. Take a beginner class, learn what to expect and move through the poses cautiously for the first couple weeks. If you feel that your instructor is pushing you too far or isn't focused on your safety, find a new class.

While some people support the use of instructional DVDs, Mary demurs: "The only true way to learn nuances is to be coached. You need feedback." Another tip is to start with a yoga therapy class, a relatively small class that focuses on your preexisting conditions or injuries. That way, if you move on to a larger class you'll know how to avoid stressful positions and use props such as a blanket, straps or blocks for support.

• If you have a preexisting injury, ask the teacher if he/she is equipped to support and protect your body. For example: "Have you ever worked with a student who has had a shoulder injury?"
• Don't compete. Many yoga students get hurt trying to keep up with the instructor or other students. It's better to practice a partial pose with good form than a full pose with poor form. Try to focus more on your breathing rather than how far you stretch.
• Listen to your body. If something hurts, back off.
  
• Ask questions. If you're unsure of a position or movement, stop and ask your instructor for more explanation. You should also check with your doctor about any movements or poses you should avoid.
  

Who's Minding the Ashram? How to Vet Your Yoga Instructor
Yoga, like any other exercise class, is safe if performed properly and taught by experienced instructors. The concern is that not all teachers are qualified, and some certifications aren't very rigorous.

The closest thing to regulation in the yoga "industry" is provided by the Yoga Alliance, a nonprofit, voluntary registry of yoga teachers and schools. To be registered in their database, teachers must demonstrate that they have met Yoga Alliance standards for 200 or 500 hours of training.

Mary Jones says that, "There's such a demand for teachers that some yoga training programs are more than happy to provide under-qualified teachers. [The Yoga Alliance] has a 200-hour program which provides students with a template, which is enough to teach people how not to hurt anybody. But that's just a minimum standard, and it doesn't guarantee anything."

Another pitfall of yoga instruction is a tendency for the instructor to pander to students seeking a nice-looking butt or a vigorous workout. "Some teachers think it's a reflection of their self-worth if they push students beyond their limits."

Mary feels that the key to maximizing safety is for the student to find the style of yoga that's right for them, a task made easier as the level of teaching improves and the importance of higher levels of training is embraced by more instructors and those responsible for hiring them.