Injury Prevention: Yoga

According to the 2005 IDEA Fitness Programs & Equipment Survey, 66% of respondents offer yoga programming and 56% believe it will grow (Ryan 2005). Yoga is an increasingly popular choice because it adds a mindful dimension to fitness repertoires and is easier on joints. The improved strengthening and stretching element complements the appeal.

Many people use “fitness yoga” to describe a series of postures generally taught in a group exercise setting. More intense and dynamic styles—like “hot” yoga (associated with Bikram Choudhury) and power yoga—are also well liked. What’s more, there are many “fusion” styles: yoga with weights, yoga and Pilates, yoga and cycling—to name just a few.

Although yoga is generally considered a relatively safe form of exercise, yoga injuries do occur—usually when participants are too ambitious or instructors fail to give proper modifications. Many times, participants try to force their bodies into positions they are not ready for, or they are inattentive and don’t listen to the messages their bodies (and instructors) give them. It’s a good idea to have a fundamental awareness of the more common yoga injuries and what to do to minimize risk.

Muscles. A strain occurs when muscle tissue stretches or tears. When a muscle is powerfully contracted or stretched too far, the strain is acute. Chronic strains result from excess use over time. A pulled hamstring is a common muscle strain seen in yoga class. This occurs particularly where the hamstring attaches to the sitting bones, and is a result of overstretching in seated forward-bending poses.

Other common muscle strains involve the hip flexors (caused by deep lunges), the neck (brought on by poses such as plow or unsupported shoulder stand) and the low back (from overflexing the lumbar area in seated or standing forward bends).

Tendons and Bursae. Tendonitis and bursitis are common overuse injuries. Tendonitis is inflammation or irritation of a tendon (American College of Rheumatology 2003). Tendons are the thick fibrous cords that attach muscle to bone. They transmit the power generated by a muscle contraction to move a bone. Bursitis is inflammation or irritation of a bursa. Bursae are small sacs located between moving structures such as bones, muscles, skin and tendons. The bursae act as cushioning to allow smooth gliding between these structures. Poses such as downward-facing dog, four-limbed staff pose (the “yoga push-up”) and side plank can place a lot of stress on bursae in the shoulders, elbows and wrists. Spending long periods of time in these postures before developing adequate strength can cause bursitis or tendonitis around the shoulder or elbow joints, exacerbate carpal tunnel syndrome (chronic injury of the median nerve) or produce wrist strain.

Ligaments and Cartilage. Participants who hyperextend their knees or elbows place additional stress on stabilizing ligaments and tendons, potentially causing inflammation of joint structures. Hyperextension of the knees is a common mistake in straight-leg poses like triangle or seated forward bend, whereas elbow hyperextension frequently occurs in upward-facing dog, plank pose with straight arms and downward-facing dog. Instructors or students who try to force their feet onto their thighs for lotus before the hips are adequately flexible may tear or pinch the meniscus (cartilage disks between the tibia and femur) or damage ligaments. A participant who presses down too aggressively in downward-facing dog risks tearing shoulder cartilage.

Spinal Disks. Injuries such as herniated intervertebral disks, fractures and degenerative disk disease are some of the more serious yoga injuries. Plow, shoulder stand and seated or standing forward bends concentrate compression forces on the spine, which can lead to injury. Undertrained or overzealous instructors who try to push students too deeply into these postures may endanger their participants’ safety. It is not only inflexible students who are at risk. Hypermobile students can also get injured, because their looser ligaments make their joints more unstable.

Many experts agree that when executed properly, yoga is a safe form of exercise. The following fundamentals will help you teach safe and effective fitness yoga classes.

Always Warm Up. A good general warm-up increases blood circulation to the muscles, lubricates joints and prepares the body to move more deeply into poses. Follow a logical progression by sequencing less strenuous poses for each body part before going deeper. For example, perform mild backbends common to warrior 1, prone back extension and cobra before deeper backbends like camel or wheel.

Teach Alignment. Reinforce proper alignment in every pose. Begin with your foundation, the feet, and work your way up. By properly aligning the body, you reduce excess stress so that muscles and ligaments are strengthened equally on both sides of the active joint. This creates balance and freedom of movement. Correct alignment also alleviates tension in nonworking muscles, allowing students to concentrate on the working muscles, thereby increasing the pose’s benefit.

Avoid Hyperextension. Cue students to keep a slight bend in their knees during standing poses and to keep their weight evenly distributed among the “four corners” of their feet. In seated forward bends, place a rolled-up towel beneath the knee of the extended leg or legs. Teach students to avoid “popping” their elbows into hyperextension while in upward-facing dog or any other posture in which they bear weight with the arms. Here’s a good cue to help avoid elbow hyperextension: “Align the crease of the elbows (without internally rotating the shoulders) so that they face each other.”

Teach Mindfulness. Encourage students to watch for and listen to the subtle and not so subtle cues their bodies give them about how deeply, how strongly and how long they should hold a pose. This teaches them to direct their attention inward. Modify poses to suit individual muscular imbalances, and encourage a noncompetitive and self-accepting atmosphere.

Use Props. Yoga blocks, straps, bolsters and blankets help correct spinal alignment, facilitate proper stretching, take undue stress off joints and support tight muscles so they can release. Allow students to explore the uniqueness of their own bodies by teaching and encouraging the correct use of props.

Do Your Homework. As yoga’s popularity continues, more and more students flock to classes, increasing the need for skilled instructors. Inexperienced or poorly trained teachers may unintentionally cause harm by teaching above their ability levels. Well-trained instructors have a thorough knowledge of anatomy, human movement and exercise physiology. A basic understanding of the ideology and history of yoga is essential. Focusing on specialties such as seniors, kids or yoga therapy requires additional training above the foundational level. Master new skills before teaching them, and always instruct within your level of training and confidence. Avoid advanced poses, manual adjustments and spotting until you have been thoroughly trained. If possible, keep student-to-teacher ratios low to improve the chances for individual attention.

By arming yourself with sound injury-prevention guidelines, you help increase the level of professionalism and safety in the industry. As a result, participants have safe and enjoyable class experiences and return for more.

Dynalife Fitness Pro Shop, www.leighcrews.com

International Association of Yoga Therapists, www.iayt.org

Yoga Alliance, www.yogaalliance.org

Yoga Basics, www.yogabasics.com

Yoga Journal, www.yogajournal.com