With yoga becoming popular and more health care providers endorsing it as an option for musculoskeletal pain and exercise, patients are presenting with yoga-related injuries. The following research papers highlight the prevalence and type of injuries sustained while practicing yoga.  Case reports are also included. Research papers reviewed were limited to those in English and those pertinent to chiropractor’s scope of practice are highlighted.

What is the incidence of injury sustained in yoga practice?

The results of a 2017 systematic review revealed that the incidence of adverse events during yoga practice was 22.7%, with a twelve-month prevalence of 4.6%.  Yoga practitioners had a lifetime prevalence of 21.3%. Serious events occurred in about 1.9% of the participants studied. 

The most common injuries relate to yoga practice were sprains and strains.  Both yoga practitioners and non-yoga practitioners had comparable risk of falls.  The was also a higher risk of meniscus injuries in yoga practitioners when compared to non-yoga practitioners. 1

In a retrospective review of medical records by the Mayo clinic,  injuries that were directly associated with yoga practice and specific poses that were correlated with the injuries were investigated. The significant injuries were divided into three groups: soft tissue injury, axial non-bony injury, and bony injury.  Eighty nine patients were included, 66 (74.2%) patients had myofascial pain due to overuse. Rotator cuff injury was seen in 6 (6.7%). Trochanteric bursopathy was seen in 1 (1.1%). The axial group included 46 (51.7%) patients with an exacerbation of pain in degenerative joint disease.  Facet arthropathy was observed in in 34 (38.2%) patients. Radiculopathy was seen in 5 patients (5.6%). Bony injury included 15 patients (16.9%) with kyphoscoliosis. Spondylolisthesis was seen in 15 (16.9%) of patients. Anterior wedging was seen in 16 (18%) of patients and compression fractures were observed in 13 (14.6%) patients.  Poses identified as causative include those that involve extreme hyperflexion and extension.2

Does age effect injury prevalence?

In a recent study, participants aged 65 and older had a greater risk of injury from practicing yoga when compared to other age groups.  Most of the injuries included sprains and strain to the trunk.3  

In a prospective cohort study with a one year follow up, results indicated that yoga can cause musculoskeletal pain and care should be taken when recommending yoga to certain patient populations.4

Case studies reporting adverse effects of yoga practice

An interesting case study discussing complications from a yoga posture called pranayama, a vigorous Valsalva maneuver, involved a patient that developed subcutaneous emphysema in the neck identified by air in the retropharayngeal space.5  

A case series flexed reviewed three separate cases of patients that had started yoga in order to improve their musculoskeletal health.  They developed new pain and vertebral compression fractures after participation in yoga activities. The authors concluded that before returning to activity, a health care provider must assess the risk of fractures and recommend postures that avoid extreme flexion, especially with patients over 65.6

Another case report discussed ulnar nerve compression by a ganglion cyst after participation in a yoga class, particularly in the downward dog position.  The pain and motor function resolved after stopping yoga. This case suggests that due to the compression of the hypothenar eminence, the ulnar nerve was compromised.7

A case study described a patient the developed sudden onset of floaters and mild blurring of vision after head down posture.  Examination revealed posterior vitreous detachment with a small blood clot at the inferior margin of the optic disc. The authors conclude that sudden changes in posture may have ocular implication and patients that have ocular conditions need to be informed regarding the possible complications.8

How do these findings apply clinically?

Yoga’s popularity has been rising in recent years.  As a precaution, practitioners need to avoid blindly recommending yoga as a “one size fits all” form of exercise.  In specific patient populations, care should be taken to avoid certain postures which may propagate or exacerbate an injury.  Injuries can be reduced with careful selection of patients and education of which postures to avoid.

References

1. Cramer, H., Ostermann, T., Dobos, G. Injuries and other adverse events associated with yoga practice: a systematic review of epidemiological studies. J Sci Med Sport. 2018;21:147–54

2. Lee M, Huntoon EA, Sinaki M. Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management. Mayo Clin Proc. 2019; 94: 424-31.

3. Swain, T.A., McGwin, G. Yoga-related injuries in the United States from 2001 to 2014. Orthop J Sports Med. 2016;4.

4. Campo, M., Shiyko, M.P., Kean, M.B., Roberts, L., Pappas, E. Musculoskeletal pain associated with recreational yoga participation: a prospective cohort study with 1-year follow-up. J Bodyw Mov Ther. 2018;22:418–423.

5. Kashyap AS, Anand KP, Kashap S. Complications of Yoga. Emerg Med J. 200; 24: 231.

6. Sinaki, M. Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Pain Pract. 2013;13:68–75.

7. Horner L, Edelsohn L, Gakhal M. Yoga induced acute ulnar nerve compression by a ganglion cyst in Guyon's canal. Del med J. 2013; 85: 369-73.

8. Chong SY et. Al. Posterioe Vitreous Detachment precipitated by Yoga. Cureus. 2018; 10: e2109.

Scott M. Schreiber, DC, DACRB

Dr. Scott Schreiber hold numerous certifications and is Board certified in both Nutrition and Rehabilitation.