Over-Stretching and Movement Safety: Strains, Tears and Overuse

Get urgent care first if you notice these

After an injury, get emergency care if you heard a crack, the body part has changed shape or points at an odd angle, it is numb or tingling, or the skin looks blue or grey or feels cold. The NHS (UK) says these can mean a broken bone.[1] In the United States, call 911 in an emergency.

What over-stretching can do

The NHS says sprains and strains happen when you overstretch or twist a muscle, and that not warming up, tired muscles and playing sport are common causes.[1] Plain definitions from US government health pages:

• A sprain is a stretched or torn ligament, the tissue that connects bones at a joint.[2]
• A strain is a stretched or torn muscle or tendon (the tissue that connects muscle to bone). Strains can happen suddenly or develop over time, and back and hamstring strains are common.[2]
• Tendinitis is inflammation of a tendon, often from repeating the same motion over and over; tendons become less flexible with age.[3]
• Injuries are either acute (sudden) or chronic (gradual, from repetitive overload).[3]

Signs of an acute injury include sudden severe pain, extreme swelling or bruising, not being able to place weight on a leg or move a joint normally, and extreme weakness. Chronic overuse injuries show up as pain when you play or exercise and swelling with a dull ache at rest.[3]

What raises the risk

NIAMS, part of the US National Institutes of Health, lists risk factors for sports injuries that apply to any movement practice, including yoga: not using correct technique, overtraining, increasing intensity too quickly, a prior injury, certain joint features or poor flexibility, and some medicines such as fluoroquinolone antibiotics, which are linked to tendinitis and tendon rupture.[3] NIAMS also says most physical activity is safe for almost everyone, and that benefits far outweigh the risks.[3]

In yoga specifically:

• The most common injuries reported are sprains and strains, and the knee or lower leg is the most often injured area.[4]
• In a 2018 review of nine studies, serious adverse events occurred in 1.9% of practitioners, and yoga practitioners had a higher risk of meniscus (knee cartilage) injuries than non-practitioners (odds ratio 1.72). Falls risk was comparable.[5]
• A Mayo Clinic review of 89 patients with yoga-attributed injuries found most had overuse muscle pain, with some rotator cuff injuries. Poses involving extreme spinal bending forward or backward were most often involved, and people with osteopenia or osteoporosis may face a higher risk of compression fractures.[6]
• A case report described a first-rib stress fracture in a yoga instructor after four months of shoulder pain.[7]

See Common Yoga Injuries, Yoga and Osteoporosis and Movement for People With Hypermobility.

Does stretching prevent injury?

Evidence label: mixed to insufficient.

1. Does stretching reduce total sports injuries?

   Unclear

   A 2004 systematic review of six studies found no significant link (odds ratio 0.93, range 0.78 to 1.11) and said there was not enough evidence to endorse or stop routine stretching[8]

   Older; insufficient evidence

2. Static or PNF stretching and overuse injuries?

   Unclear

   A 2016 review found no clear effect on all-cause or overuse injuries; no data on dynamic stretching. It suggested a warm-up with extra dynamic activity to reduce muscle injuries[9]

   Review authors' recommendation

3. Stretching to reduce next-day soreness?

   Unclear

   A Cochrane review (12 studies, moderate or high risk of bias) found no clinically important reduction in soreness in healthy adults[10]

   Low to moderate quality

None of this says stretching is harmful or useless for comfort or range of movement. It says the reviews did not find that it protects against injury. Read more in Claim Check: Stretching Prevents Injury and Stretching: What Research Shows.

Proper evidence not found for a safe stretch intensity, depth or hold time that prevents tears or strains. We searched PubMed for stretching with pain threshold, stretch intensity, stretch tolerance and injury, and found nothing usable. So this page gives no numbers to aim for.

Signs you have gone too far

Sources describe injury signs, not stretching targets: sudden sharp pain, swelling or bruising, numbness or tingling, and pain that limits use of the area.[11] A hospital sports-medicine page says to avoid movements that hurt, and warns that pushing through pain can turn something that was not an injury into one.[11] See Pain During Yoga: Warning Signs and When to Stop.

If you think you strained something

The NHS says most sprains and strains can be treated at home. For the first 2 to 3 days it recommends protection, rest, ice, compression and elevation, and avoiding heat, alcohol and massage in the first couple of days. Most feel better after 2 weeks, severe ones can take months, and strenuous exercise should be avoided for up to 8 weeks because of the risk of further damage.[1] Seek help if the injury is very painful or worsening, there is large swelling or bruising, you cannot put weight on it, it feels very stiff, or it has not improved after self-care.[1] A rehabilitation program is usually recommended before returning to the activity.[3]

Return gradually and check with a clinician or physical therapist, especially after a significant injury; see Yoga After Surgery or Injury and Mobility Training and Flexibility.