Yoga Safety: Injuries, Heat and Dehydration, Osteoporosis Modifications and Instructor Qualifications

Yoga is generally considered safe for healthy people when practiced properly with a qualified instructor, but injuries do happen.[1] This page covers injuries, hot yoga, bone-health cautions and how to think about teacher qualifications. For the basics of yoga, see What Is Yoga?, and for the style differences, see Yoga Styles.

Get urgent care first if during or after class you have chest pain, fainting, confusion, a very high temperature with hot skin that is not sweating, a fall with a possible head, neck, back or hip injury, or sudden severe pain. In the US call 911; the UK NHS lists these heatstroke and fall signs as reasons to call 999.[2][3]

Injury Prevention

A systematic review of nine observational studies (9,129 yoga practitioners) found adverse events in 22.7% of people during a yoga class setting, a 12-month prevalence of 4.6%, and serious adverse events in 1.9%. Most were musculoskeletal, mostly sprains and strains, mild and short-lived, and the risks were comparable with those of non-practitioners; meniscus (knee cartilage) injury was more common among yoga practitioners.[4] NCCIH adds that the knee or lower leg is the most commonly injured area and that serious injuries are rare.[1] A review of 94 randomized trials (8,430 participants) found yoga appeared as safe as usual care and exercise.[5]

What the sources suggest:

• Learn with a qualified instructor; unsupervised learning has been linked to higher risk.[1]
• If you are new, avoid headstands, shoulder stands, the lotus position and forceful breathing.[1]
• Tell the teacher about injuries before class. Conditions that may call for modified poses include knee or hip injuries, lumbar spine disease, severe high blood pressure, balance issues and glaucoma.[1]
• Older adults, pregnant people and people with health conditions should talk with their health care provider and the instructor about their needs.[1] Emergency department rates for yoga injuries are higher in people 65 and older.[1]
• Back pain can worsen: a Cochrane review found low-certainty evidence of more adverse events, mainly increased back pain, with yoga than with no exercise.[6]

Heat and Dehydration

NCCIH says hot yoga has special risks related to overheating and dehydration, and recommends pregnant people avoid it.[1] ACOG also lists hot yoga and hot Pilates among activities to avoid in pregnancy.[7] We did not find a readable source giving a safe room temperature or class length, and these depend on the person, so we do not give numbers.

The NHS lists heat exhaustion symptoms as tiredness, dizziness, headache, nausea, heavy sweating with pale clammy skin, cramps, high temperature and intense thirst, and describes heatstroke (very high temperature, hot skin without sweating, fast breathing, confusion, seizure, loss of consciousness) as a medical emergency.[2] Babies, children and older adults are more at risk of dehydration, as are people with diabetes or taking medicines that make you pass more urine (diuretics).[8] If you feel unwell in a heated room, leave and cool down.

Osteoporosis-related Modifications

A review by Giangregorio and Ponzano of exercise for people at risk of fracture advises prioritizing balance, functional and resistance training at least twice a week, with yoga or Pilates done in addition to rather than instead of those if they can be done safely or modified.[9] It cautions that blanket "don't bend or twist" advice can create fear, and that the activities that may need modifying are rapid, repetitive, sustained, weighted or end-range twisting or flexion of the spine, especially for people at high risk of fracture.[9] The NHS says having osteoporosis does not mean you will definitely fracture and points to the Royal Osteoporosis Society for exercise advice.[10]

If you have osteoporosis or a past spinal fracture, ask your doctor or physiotherapist which movements to avoid, and tell your teacher. More: Osteoporosis and Bone Health.

Instructor Qualifications

NCCIH recommends practicing under a qualified instructor.[1] In the sources we could read we did not find a US government licence for yoga teachers; Yoga Alliance, a private organization, offers credentials for schools and training programs, including 200-hour, 300-hour and 500-hour programs, and a separate pregnancy and postpartum school credential.[11] A credential shows a program met that organization's standards, not that a teacher is licensed or suited to your health situation. Rules outside the US may differ, and we did not read any other country's regulator.

Questions to ask: What training do you have, and for how long? Have you taught people with my condition or age group? Can poses be adapted? Will you check in during class? We do not list or recommend teachers or studios.