Yoga safety for older adults: injuries, pain and safer practice

Safety conclusions depend on the comparison and your condition

A 2018 systematic review brought together 9 observational studies involving 9,129 yoga practitioners and 9,903 people who did not practice yoga. The proportion experiencing adverse events during a class was 22.7%. The figure for the previous 12 months was 4.6%, while lifetime figures ranged from 21.3% to 61.8%. Serious adverse events were reported in 1.9%.[4] These figures cover different periods and study settings, so they are not directly comparable.

Musculoskeletal events were the most common, and sprains and strains were the most common injuries. Most events were mild and temporary.[4] This pattern is consistent with the need to pay attention to physical symptoms even when a program’s overall safety conclusion is reassuring. It also gives readers a way to ask a more useful question: what kinds of problems were reported, and how much did they affect participation?

Compared with nonpractitioners, the odds ratio for falls was 0.90, with a confidence interval of 0.76–1.08. For fall-related injuries it was 1.04, with an interval of 0.83–1.29. Meniscus injuries, involving cartilage in the knee, were more likely among yoga practitioners: the odds ratio was 1.72, with an interval of 1.23–2.41.[4] Because these were observational studies, the characteristics of people choosing yoga may also have influenced the findings.

The review’s authors found no reason to discourage healthy people from practicing yoga. They advised people with serious acute or chronic illnesses to seek medical advice before taking part.[4] That combination is useful for a reader returning to exercise: encouragement for healthy participants can coexist with a different decision process for someone whose condition affects the movements they can undertake.

Evidence becomes more uncertain when the focus is people at risk of fracture. A systematic review of 9 studies involving men aged 50 or over and postmenopausal women rated the overall certainty of evidence as very low. Randomized trials showed no effect on health-related quality of life; findings for other health measures were mixed or absent. Five studies reported no directly related adverse events, but 2 case series reported vertebral fractures, potentially associated with excessive forward bending of the spine.[9]

This is especially relevant if you have osteoporosis or a known or suspected spinal compression fracture. The appropriate conversation concerns the movements themselves, rather than simply whether a class is called gentle. Avoid deep forward bends with a rounded back, strong twisting, strong backbending, and forceful loading poses; confirm with your doctor which movements are appropriate before participating. These condition-specific cautions should remain part of your choice even if other participants describe the class as comfortable.

The evidence on falls also includes an unfavorable result from a large trial. It involved 700 independently living adults aged 60 or over, with an average age of 67. Researchers compared an exercise program based on Iyengar yoga with seated relaxation yoga. The exercise group was offered 80 supervised classes over 12 months, lasting 1 hour and scheduled twice weekly, with additional home practice encouraged on 2 days a week. The comparison group received two 1-hour workshops focused on seated breathing and stretching. Most classes took place online.[15]

Six participants reported yoga-related musculoskeletal adverse events, and there were no serious adverse events. However, falls occurred more often in the exercise group: 0.87 versus 0.64 falls per person-year. The incidence rate ratio was 1.33, with a confidence interval of 1.01–1.75.[15] A record of no serious class-related events therefore sat alongside a higher fall rate over follow-up.

The exercise program improved planned physical activity, balance confidence, and goal attainment. Nevertheless, the researchers concluded that this program, in its current form, should not be recommended for fall prevention.[15] The series’ falls article examines that question in more detail. For safety decisions here, the key point is that what happens during a class and what happens over the following months are separate outcomes. Greater confidence and a favorable attendance experience cannot substitute for the measured number of falls.

Share chronic conditions and how you feel on the day

In the Japanese class survey, 53.5% of participants had chronic diseases and 42.3% received medication through medical institutions. The odds of adverse events were significantly higher among people with a chronic condition, those feeling physically unwell on the survey day, and those finding the class physically or mentally demanding. More severe events that interfered with subsequent yoga practice were more frequent among participants aged 70 or over and those with chronic musculoskeletal conditions.[2]

Telling an instructor how you feel is therefore relevant to the conditions identified in the research. “I see a doctor, but I usually manage” may leave out the detail needed for a discussion of movement. Explain the condition you receive care for, which movements bring on pain, and whether today feels different from usual. An instructor is not there to diagnose your illness or change your medication. This information helps frame a conversation about participation and the actual content of a class.

A review of case reports recommended that people with medical conditions work with their physician and yoga teacher to adapt postures appropriately.[10] Before starting, consult your treating doctor if you have a chronic condition or take medication. Bring the proposed type of practice into that conversation so that advice can address what you plan to do.

Benefits and unwanted effects have also been examined together among people with chronic conditions. A Japanese study followed 328 adults starting yoga for the first time, grouping them as healthy, in poor health, or living with chronic disease. Classes were typically held once a week for 60–90 minutes. After the first class, the poor-health and chronic-disease groups showed lower tension-anxiety and fatigue scores and higher vigor scores.[20]

After 3 months, perceived stress scores had decreased and quality-of-life scores had increased in those groups. Subjective symptoms, including easy fatigability, shoulder stiffness, and insomnia, also decreased.[20] These findings describe changes reported by adults in general. The study was not a randomized trial with a control group and was not confined to older participants, so it provides a different kind of evidence from the older-adult trials discussed earlier.

The same groups reported more adverse events than the healthy group, and a wider variety of symptoms. The events were not severe enough to make participants stop practicing during class. About 60% of all participants were highly satisfied with attending.[20] This is a useful example of why a safety discussion can include benefits without suppressing symptoms. Both appeared in the same account of participation.

If you are reluctant to mention pain because you fear being excluded, start by explaining what you hope to gain and which demands you want to avoid. That gives your priorities a place in the conversation. Research on tailored gentle yoga and recommendations from the case-report review both support attention to the participant’s physical circumstances.[5][10] For family members, helping someone describe those circumstances can be more useful than urging them to finish every movement on offer.

Common misconceptions

“Slow movement makes every pose safe.” The choice of posture and breathing technique matters as well as the pace. A 2013 systematic review examined 76 cases from published case reports and case series. Headstands, shoulder stands, lotus position, and forceful breathing were among the practices most often mentioned. There were 27 musculoskeletal events, 14 affecting the nervous system, and 9 affecting the eyes.[10]

Fifteen cases reached full recovery. One case did not recover, and one death was reported.[10] These selected reports describe possible harms rather than the proportion of all practitioners who experience them. Their practical relevance lies in the practices and medical circumstances they identify. The authors advised beginners to avoid extreme practices, including headstands, lotus position, and forceful breathing, and to practice with qualified guidance.[10]

The review also advised people with glaucoma to avoid inversions and those with compromised bone strength to avoid forceful yoga practices.[10] Glaucoma is an eye condition, but it still affects the choice of a yoga posture. A useful medical question is specific: “Is this movement appropriate with my condition?” Discussing the actual practice is more informative than asking whether yoga as a whole is safe.

“Learning only from videos is an easier, safer option.” A German cross-sectional survey of 1,702 practitioners, with an average age of 47.2, found that 21.4% reported acute adverse effects and 10.2% reported chronic adverse effects. Practicing only through self-study without supervision was associated with greater risk of both. Handstands, shoulder stands, and headstands were frequently associated with acute events.[12] The survey involved adults generally; it offers a reason to consider guidance, rather than a precise prediction for an older beginner.

The 364 people reporting acute adverse effects described 702 events. The 173 people reporting chronic effects described 239 events. Most involved the musculoskeletal system, and participants with chronic illnesses also had a higher risk of reporting chronic adverse effects.[12] These counts remind readers to consider the nature and persistence of symptoms, not simply whether someone has ever had an injury.

Full recovery was reported for 76.9% of acute events and 51.6% of chronic events.[12] Recovery figures do not justify continuing through pain. If a movement hurts, stop that movement and tell an appropriate healthcare professional or instructor what happened. Include the discussion of the next session in your routine, rather than silently carrying symptoms forward.

“More pain means more benefit.” Pain is not a score for progress. The wellbeing trial measured life satisfaction, while the gentle-yoga study recorded temporary pain as an adverse event.[5][13] A deeper pose therefore gives you no basis for claiming the benefits these studies measured. Being able to communicate the physical demand and make an informed choice about returning is a more useful goal than completing a movement at any cost.

What you can do today

• After checking that it suits your health, choose instructor-led, gentle yoga tailored to older adults, with one 60-minute class weekly. The chronic-pain feasibility study used this format for 10 weeks. Stop any movement that hurts.[5]
• Before starting, tell the instructor about medical care, medication, back or knee pain, and how you feel that day. If you have a chronic condition or take medication, consult your treating doctor first. With glaucoma, avoid inversions and discuss suitable poses with your doctor and instructor.[2][10]
• If you have osteoporosis or other weakened bones, or a known or suspected spinal compression fracture, avoid deep forward bending with a rounded back, strong twisting or backbending, and forceful loading poses. Confirm suitable movements with your doctor before participating.[9][10]
• As a beginner, avoid headstands, lotus position, and forceful breathing. Work with an instructor on appropriate poses instead of making difficult positions your goal.[10]
• If pain appears during or after class, stop the movement that triggers it and describe what you did and felt. Temporary muscle or joint pain still deserves attention; do not push through it into the next practice.[5]

Plan a safer weekly routine at On the Shore Tachikawa

Before a trial lesson at On the Shore Tachikawa, confirm with your doctor which painful movements and poses you will avoid as you choose a fixed weekly time to keep moving.

On the Shore Tachikawa is a lava-stone hot yoga studio, a 1-minute walk from the North Exit of JR Tachikawa Station. Its address is 3F Etoile Building, 2-14-10 Akebonocho, Tachikawa, Tokyo, and it opens every day from 8:00 to 23:30.

Many of our yoga instructors speak English, and the studio’s owner often helps guests from the US bases in English herself. Guests told by a doctor not to exercise cannot join. Pregnant guests cannot participate in lava-stone hot yoga; room-temperature maternity yoga is available. Older guests should start with room-temperature yoga, and anyone sensitive to heat or living with a chronic condition should check with their doctor first.

Room-temperature yoga is among the studio’s more than 25 kinds of yoga lessons. Other activities include Pilates, women-only kickboxercise, boxercise, HIIT, and personal training. A 60-minute trial yoga lesson costs ¥1,980 including tax, with 2 bath towels, 1 face towel, and mat rental included. The prices and trial booking page provide the details for arranging a visit.

References

1. Yoga-Related Injuries in the United States From 2001 to 2014 — Thomas A. Swain et al., 2016, Orthopaedic Journal of Sports Medicine. DOI: 10.1177/2325967116671703
2. A large-scale survey of adverse events experienced in yoga classes — T. Matsushita et al., 2015, Biopsychosocial Medicine. DOI: 10.1186/s13030-015-0037-1
3. Injuries and other adverse events associated with yoga practice: A systematic review of epidemiological studies. — H. Cramer et al., 2018, Journal of science and medicine in sport. DOI: 10.1016/j.jsams.2017.08.026
4. Feasibility study of a modified yoga program for chronic pain among elderly adults in assisted and independent living. — K. Boehnke et al., 2020, Explore. DOI: 10.1016/j.explore.2020.11.010
5. Effect of Yoga on Health-Related Outcomes in People at Risk of Fractures: A Systematic Review. — Kawon Kim et al., 2021, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. DOI: 10.1139/apnm-2021-0736
6. Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series — H. Cramer et al., 2013, PLoS ONE. DOI: 10.1371/journal.pone.0075515
7. Adverse effects of yoga: a national cross-sectional survey — H. Cramer et al., 2019, BMC Complementary and Alternative Medicine. DOI: 10.1186/s12906-019-2612-7
8. Effects of yoga and aerobic exercise on wellbeing in physically inactive older adults: randomized controlled trial (FitForAge). — P. Welford et al., 2022, Complementary therapies in medicine. DOI: 10.1016/j.ctim.2022.102815
9. Yoga to prevent mobility limitations in older adults: feasibility of a randomized controlled trial — E. Groessl et al., 2018, BMC Geriatrics. DOI: 10.1186/s12877-018-0988-8
10. The effect of an Iyengar yoga-based exercise programme versus a seated yoga relaxation programme on falls in people aged 60 years and older (SAGE): a pragmatic, two-arm, parallel randomised controlled trial. — Juliana S. Oliveira et al., 2025, The lancet. Healthy longevity. DOI: 10.1016/j.lanhl.2025.100749
11. The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. — H. Cramer et al., 2015, American journal of epidemiology. DOI: 10.1093/aje/kwv071
12. Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases — T. Oka et al., 2021, BioPsychoSocial Medicine. DOI: 10.1186/s13030-021-00216-z

Cover photo: A yoga mat strap is shown in a wide photograph, revealing its shape. (Photo: Андрей Романенко / CC BY-SA 4.0 / Wikimedia Commons)

Information as of October 2026. For your own health, consult a doctor.

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