As a physiotherapist and yoga teacher, I am witness to the great physical benefits my patients develop from a regular yoga practice including increased flexibility, improved posture and better core strength. But I am also privy to the injuries one can sustain from a pose that is performed incorrectly or when form and alignment is not monitored.
Whilst the beauty of yoga has always been that it does not discriminate, that anyone can have a go, its popularity and accessibility (thanks, in most part, to social media) has also meant that many people are self-prescribing an asana practice without correct teaching or knowledge of the risks of certain poses.
In my experience, most injuries within yoga are a result of poor alignment, lack of strength and guidance in carrying out a pose, and poor body awareness. They may arise from attempting a pose that is too advanced for our abilities or through being poorly monitored in a class that has too many students.
The three most common yoga injuries
Wrist pain is the most common complaint I get from students when they start yoga. When looking at the anatomy of the wrist, there are both bony and soft tissue structures. Both the joints themselves and the muscles and ligaments around them take time to become used to bodyweight pressure. Much like when you start running — your body can’t handle running a half marathon straight away, so you use smaller runs to build up the strength to run that distance. Yoga should be the same. The key to reducing wrist pain is to gradually incorporate more load into the wrists and ensure strength through the surrounding muscles and joints.
For teachers, if you are planning a class (particularly for beginners), think about the total number of poses you have students doing where they are loading through their wrists. Start small and focus on standing postures until their bodies build up enough strength and their awareness of alignment is good enough. In a pose where you do have weight through the wrists (e.g. Downward-facing Dog or Crow), make sure that you start by drawing the shoulders down and back (this activates the middle and lower trapezius muscles and the latissimus dorsi), ensure the elbows are not locked out but rather stay soft, and feel even pressure between the base of the thumb and the palm of the hand.
I’ve lost count of the amount of times I’ve cringed at people’s knee position during Warrior II. Kneecap pain is a common complaint in standing postures. From an anatomical perspective, the kneecap is designed to increase the leverage of the quadricep (thigh) muscles, it is not designed to be a load bearing joint. The load bearing portion of our knee is between the femur (thigh bone) and tibia (shin bone). However, as soon as we deviate the kneecap inwards of the big toe or bend the knee so far that the kneecap goes forward over our toes, we begin loading into the kneecap joint. Given it’s not designed to take this load, people will often experience pain. The most common postures I see this problem occur in are Warrior I, II, Triangle and Crescent Lunge. The movement of the knee inwards is generally a result of being weak through the gluteal (buttock) and inner thigh muscles and having poor body awareness.
When teaching these poses, I like to tell my students to keep their knee stacked over the ankle, to align the kneecap with the second and third toes, and to make sure they can always see their toes. I also like to practice some single leg balance poses, such as Tree, prior to doing any poses with a lunge to activate the gluteal muscles.
How good does the perfect backbend on a beach in Bali at sunset look on Instagram? Yes, it’s something we’d all like to be able to do. But like any advanced poses in yoga, our body needs time to adjust and develop the strength to achieve this.
Activation of uddiyana and mula bandha during strength and backbending poses of yoga are essential. Most cases of lower back pain related to yoga that I see are a result of lack of strength or coordination of the muscles that make up these two bandhas. As a quick guide, uddiyana bandha is made up of the abdominal muscles and focuses most closely on the transversus abdominus, the deepest layer of our abdominals which acts like a corset. Mula bandha consists of the pelvic floor muscles. When these two bandhas contract together, they provide support for the joints of the spine and pelvis and allow room for the joints of the spine to bend forwards and backwards. Without the activation of these bandhas, people can experience pain through their lower back, neck and hips.
The importance of bandhas in backbends
I often start a class with a brief meditation and go through the activation of these two bandhas before starting a flow practice. To get a contraction through the transversus abdominus and activate uddiyana bandha, I cue my students with “a pull of the bellybutton to the spine” or “imagine you are pulling on a tight pair of skinny leg jeans”. To get mula bandha and the pelvic floor muscles, I get my female students to imagine they are sitting on the toilet and stopping the flow of urine mid-stream, and for my male students I use the ever-so-delightful “nuts to guts” cue.
How yoga heals: Fundamental considerations
Numerous scientific studies have demonstrated the positive effects yoga can have on muscle flexibility, reducing chronic pain, increasing strength and improving the mobility of our joints. In my experience, the benefits of yoga far outweigh any of its injury-causing possibilities. The two key philosophies to staying injury and pain-free in yoga are ahimsa and alignment. Ahimsa — be kind to your body by practicing at your level. Whilst backbends and other advanced yoga poses look great in pictures, your body may not be ready for them yet. By all means, use these poses as a form of inspiration, but use yoga to make your body feel better, not worse.
Alignment for both teachers and students should be the focus of every pose, not just to ensure free movement of energy and the breath but also to ensure you stay pain-free. Teachers, watch your students closely; look at the position of their joints and make sure they are aligned correctly and not loading one joint or muscle more than another. Try to minimise the size of your classes so that each person gets the greatest benefit out of a class and so you can get around to each of your students and ensure they all feel comfortable within their practice. I am a strong advocate for smaller yoga classes and teach a maximum of 10 students at a time.
Think of your body as a set of dinner plates in a dishwasher. When you line the plates up perfectly — in their correct slot, with enough room between each plate — they come out clean at the end. Think of the joints of your body like this, stack them properly, and the end result is a stronger pose that delivers you the greatest benefit.
If you do happen to experience pain or an injury, look for a physiotherapist who is trained in or has a special interest in yoga. This ensures they will understand the practice and be able to offer alternative poses whilst your body heals, so that you can continue your practice.
Related: swollen wrists after yoga
About the Author
Felicity Dan is a physiotherapist, yoga teacher and pilates instructor based in Newcastle. She owns a clinic, The Physio&Pilates Co., that provides physiotherapy as well as clinical yoga and clinical pilates classes. Her clinical yoga classes focus on pain reduction, improving flexibility and mobility and increasing strength of the trunk muscles. Her classes are individualised to each student based on their injury and medical history so that each student receives specialised care and attention.