From Om to Ouch

Is your yoga practice causing more harm than good?
By Linda Sparrowe

I should have known better than to let the teacher’s assistant adjust me in Shoulderstand Pose, but he seemed so sure of himself. He wanted to help me get the most benefit out of the pose, and he said he knew just what to do. I protested (not very convincingly) that I had some problems with my shoulders and neck and wasn’t too keen on Shoulderstand in the first place. But he insisted, and I relented. Unfortunately, as he lifted me up off the ground, someone else caught his attention. He seemed to forget what he was doing and fumbled, dropping me onto my neck and left shoulder.

This assistant violated the first law of yoga: Do no harm (ahimsa in Sanskrit). But I had also breached the rules. I had ignored my body’s limitations, and as a result, I got hurt. The irony of this? I am a yoga teacher. If I couldn’t muster the courage to say, “Please don’t,” how could a beginning yoga student?

We know yoga is a good thing. It brings us peace of mind and relief from a host of physical and stress-related complaints. But the truth is, it can also injure us. Luckily, yoga injuries don’t top the charts of physical fitness-related problems. While some 580,000 cyclists visit the emergency room each year, the US Consumer Product Safety Commission reports that only 5,500 yoga-related injuries were serious enough to require treatment in doctors’ offices, emergency rooms, and urgent-care clinics in 2007. But statistics on yoga injuries don’t include unreported accidents like mine, which anecdotal evidence from the yoga community suggests are more common.

Whose fault is it anyway?
Richard Rosen, director of Piedmont Yoga in Oakland, California, and an Iyengar-trained teacher, says if yoga injuries are indeed on the rise, he suspects that the “growing number of inexperienced teachers may be partially to blame.” But he’s careful not to hold the teacher completely responsible. Students, after all, need to be reminded to stay within their limits and learn to speak up.

Yoga, Rosen says, demands conscious awareness from teachers and students alike. A teacher’s job is to keep each student safe and to guide the class through a practice that is appropriate for each individual’s skill level. A student’s job is to choose a class that meshes with her abilities—beginners do not belong in an advanced class—and will allow her to listen to her body and work within its capabilities and limitations.

The practice of yoga includes what the ancients called svadhyaya, or self-reflection. So while it’s tempting to blame your injuries on the teacher, take a look inward first. Elizabeth Larkam, Pilates and yoga director of the Mind & Body Center at The San Francisco Bay Club, where she works with injured yoga students and teachers, says injuries can occur when a student is “unaware of the sensations that are the warning signs of impending injury, she isn’t paying attention to those sensations, or because she’s paying more attention to her neighbor’s ability than her own.”

When are adjustments OK?
Most yoga-teacher-training courses instruct the art of mindful adjustments—how to give verbal cues to students, when to do hands-on corrections, and when to leave well enough alone. Not all adjustments are bad, by any means. Without skillful corrections, students could actually develop overuse injuries by repeatedly doing the poses incorrectly, according to Larkam.

But how do you know if your teacher is adjusting you correctly? Skillful adjustments, says Jill Edwards Minyé, are “suggestions for movement in a particular direction,” a means to help you learn proper alignment—proper, that is, for your own body’s quirks and limitations. Minyé, a yoga teacher in Santa Rosa, California, says a teacher’s responsibility is to offer support and guidance, not to impose his or her will on the class. Her advice: Don’t assume that your teacher knows your body any better than you do. Speak up. If you don’t wish to be adjusted or if a hands-on correction does not feel right to you, say so. Never allow a teacher to push you deeper into a pose. If you feel your body resist during an adjustment, ask the teacher to stop. Yoga should never hurt.

The most common injuries
Some types of yoga are riskier than others, depending on your flexibility, strength, and experience. For example, many athletes gravitate toward a fast-paced, heated form of yoga, like a power vinyasa or an Ashtanga practice, but it may not be the right choice. Why? Because moving quickly through the poses (vinyasa links one pose to another, using the breath) doesn’t allow for attention to alignment or time to modify for tight hamstrings or a strained lower back. If you’re one of these athletic “stiffs,” you’d do better in a slower, stretchy class, like Iyengar or Kripalu, that blends slower vinyasa with alignment principles. Bikram yoga, another form that can lead to injury, sometimes causes more harm than good. The heat of Bikram classes makes it possible to reach greater ranges of motion than you normally might, resulting in soft-tissue injuries, such as ligament and hamstring tears, and groin pulls.

But even if you choose the most appropriate class, injuries can happen. The most common injuries Larkam sees in her practice include shoulder instability, lower back dysfunctions, and problems with the sacroiliac (SI) joints, which connect the spine and pelvis. Jeanie Manchester, a certified Anusara yoga teacher and Rolfer in Boulder, Colorado, agrees and adds hamstring pulls and meniscus (knee) injuries to the list of common traumas. If you find yourself nodding knowingly at the mere mention of any of these body parts, read on for ways to practice injury-free.

Shoulder issues. If you cannot straighten your arms over your head, says Manchester, you probably have tight chest muscles (pectoralis) and weak upper back muscles (rhomboids), which cause your shoulders to round forward. A vinyasa practice, with yoga push-ups, arm balances, and inversions, may irritate the tendons in already restricted or overly flexible shoulder joints and result in rotator-cuff tears.
Prevention: When practicing the Sun Salutation vinyasa, common in power and Ashtanga classes, good alignment makes a big difference. Focus on strengthening your shoulder muscles and opening your chest. Keep your arms slightly externally rotated when moving into Plank Pose or Downward-Facing Dog Pose (your inner elbows will open out slightly). Practice Chaturanga Dandasana (the yoga push-up) on your knees, keeping your clavicles wide, your shoulders gently rolled back away from your ears, and your elbows in toward your body. Then move slowly from Downward-Facing Dog into Plank and back again several times, concentrating on moving the shoulders down, keeping your chest open and back broad.

Hamstring problems. A pull or tear in the hamstring (any of three muscles in the back of the thigh) can take a long time to heal. This type of injury occurs most frequently when you stretch too quickly or push beyond the limits of too-tight hamstrings. You’ll know you’ve hurt your hamstrings if you feel a dull or sharp pain around your sit bone (in the middle of your buttocks) when you bend forward with straight legs. According to Manchester, hamstring injuries occur because people typically have not engaged their quadriceps (the front of the thighs) enough, causing muscle strain. Whatever the reason for a hamstring pull or tear, it’s a serious injury: Never try to move through the pain.
Prevention: Gentle stretching of the hamstrings while strengthening and engaging the quadriceps can help. Never push beyond your comfort level in forward bends, and always begin with gentle stretching, like Downward-Facing Dog, before moving on to more intense hamstring stretches. Practice standing poses, like Warrior III and Triangle, making sure you ground through the four corners of your feet and lift up through your knees and the front of your thighs, so the muscles hug the bones, says Manchester. If you feel any pain near your sit bone, back off and bend your knees.

Hip and knee injuries. Most knee problems happen when you don’t have enough flexibility in your hips to do deep knee-folding or hip-opening poses, like Lotus Pose, says Manchester, or when you don’t align your knee properly in lunges, like Warrior Pose. If your knees don’t touch the floor when you bring the soles of your feet together in Butterfly Pose, then you should not be pushed forward into Lotus. Never let a teacher press down hard on your knees in any hip openers like Butterfly or even Pigeon Pose—doing so can be harmful.
Prevention: Find a teacher who can help you with proper alignment—Iyengar and Anusara teachers are the most therapeutically savvy. Don’t strain or push beyond your limits, and never lock your knees in standing forward bends. Manchester says that when doing Warrior I and II, your front foot needs to be anatomically neutral; that is, the second or third toe should line up with the center of your ankle, and the center of your knee should align with your second toe. If you feel any pain in your knee or hip, stop the pose and rest. Use props if necessary: In Pigeon, use padding under your hip if it doesn’t touch the floor, and under both thighs in Butterfly. For healthy knees and hips, move slowly and deliberately until you are comfortable with the mechanics of your poses.

Lower back/SI pain. Yoga that focuses on forward bends or deep twists should be practiced with appropriate support to avoid tearing the annular fibers that protect the lower back and to prevent placing too much stress on the SI joints, says Larkam. De West, a therapeutic yoga teacher in Boulder, says she rarely does a forward-bending practice in her beginner classes and tends to shy away from asymmetrical poses, such as Head-to-Knee Pose, that put added stress on the SI joints. Backbends, such as Cobra or Bow Pose, are actually easier on your back and, when done correctly, can help stabilize the SI joints.
Prevention: Elongate your spine and sides of your waist before moving into a forward bend so that you increase the space between the vertebrae. Never push deeper into a twist than you can comfortably hold. To strengthen your core, try not to use your arms as leverage. Instead, inhale to elongate your spine, and exhale and engage your core to gently twist. Always take your sacrum with you in a twist; that is, don’t try to hold your lower body still as you twist. Never go beyond your comfort zone when performing twists—or any other yoga pose, for that matter. If you have back problems, always bend your knees in forward bends, avoid wide-legged poses like Butterfly, and don’t bend forward with your legs spread apart.

Linda Sparrowe is a writer, yoga instructor, and the former editor-in-chief of Natural Solutions. She lives in Boulder, Colorado.

Pull your shoulder blades in toward your spine and down to activate your upper back and lats. Rotate your elbows out slightly without locking. Engage your core by tucking your tailbone and tightening your abs.

Downward Dog
With your elbows externally rotated, pull your shoulders away from your ears. Press your palms firmly into the floor to engage your arms and protect your wrists. Keep your chest open and back broad.

Ground through the four corners of your feet, and lift up through your knees and quadriceps. Don’t lock your knees or stretch deeper than comfortable. Use a block or chair if you can’t reach the mat.

Warrior 1
Keep your front foot anatomically neutral so that the second or third toe lines up with the center of your ankle. Align the center of your knee over your second toe.

Forward Bend
Before initiating, inhale and lift up through your spine as though trying to touch the crown of your head to the ceiling. Exhale and hinge from your pelvis (not your waist) to protect your lower back and SI joints. Keep your chest open and your back flat. Stay lifted and engage your core.

Inhale and lift through your spine, opening your chest. Then exhale, and twist using your core muscles to move into the pose. Never use your arms as leverage.