Welcome to the final installment of our Yoga Injuries series! Quick recap: it’s been quite a journey thus far. I’ve covered all major areas and gone over some of the biomechanics of how they may get injured during our yoga asana practices.

Big overlying themeHips, Shoulders, Knees, Back, etc. all get commonly injured in our daily off-the-mat life.

This leads me to one of my new favorite quotes:

Yoga is meant to ease stress, not create it!

This is especially true for our necks because we place our necks in a lot of funky positions in our yoga classes.

Here’s what we’ll cover in this article:

  • Neck Stress and the Modern Human
  • Importance of Neck Alignment
  • How Necks get Injured in Yoga
  • Headstand: Why would you even?

Neck Stress and the Modern Human

We spent a lot of our daily life looking at a screen. Often, the screen is below our eye line and our head and shoulders rounded forward to accommodate the position. Even worse, when we look down at our phones, our head “hangs there” as we dump our skull downward to scroll through our social media feeds.

Note: There’s no such thing as “Text Neck” or “bad posture.” Posture is dynamic and relative, and not to be looked at statically. Science has not been able to correlate “bad posture” with pain thus far. (Regarding posture: has your body been in that shape for a while? If yes, then move into a different one!)

So why are we so inclined to round forward to look at our screens?  It’s in our nature!

Human beings are strange animals. We have long limbs, a big brain, and an upright body all so we can scan the horizon to analyze and execute our next movements. Our design favors our eyes to evenly focus on the horizon line. This ancient mechanism called the Righting Reflex is what lets us scan our environment for miles to take in information, like food or predators, to then execute our next actions.

While there may not be Sabertooth Tigers in our lives anymore, our horizon line exists much closer to our face and as a result, we level our head to our focus. This removes us from our upright posture and results in a posture that looks more like a troll or a human cashew.

This is not a bad thing by the way! At least, not initially. Postural research studies haven’t found the link between bad posture and pain… However, the “troll posture” does create an imbalance… which may lead to pain.

The Importance of Neck Alignment:

Cervical Flexors are muscles located in the front of the neck. They flex your head forward or “bring your chin to your chest”

  • They are often “locked short” due to common position of rounding forward

Cervical Extensors are muscles located in the back of the neck.  They bring your head back or “lift your chin to the sky”

  • They are often “locked long” from being repetitively held in their lengthened state when we round our heads forward.

I wish it were as simple as lifting and extending your head back a few times to amend all the moments we spend with our head forward, but this issue is a bit more complicated and requires a look into the deeper muscles of the neck.

The Sub Occipitals:

These muscles on the extensor, or backside, of the skull, are often “locked short” from our head jutting and rounding forward. They are often overworking to keep your head supported. Too much stress here can be affiliated with headaches and neck pain!

The Deep Neck Flexors:

 

The deep neck flexors: Longus Colli & Longus Capitis are often very weak. They are responsible for stabilizing the skull, but our common posture does not promote strength or stability!

Okay, that was a long anatomy lesson, and I bet you’re wondering: “why did I just read all of that?  It has nothing to do with yoga!” 

The imbalance of shortened-overly-stressed Sub Occipitals vs. the weak-lengthened Deep Neck Flexors will influence just about every movement you make!

Dr. Perry Nickelston states: Your neck rules the movement road. Your body will almost always follow the alignment and orientation of your neck. If your neck cannot establish neutral or balance between the flexors and extensors then all your other postures, and even your breathing may be affected!

Examples:

  • When you lean closer in to view your screen, your Thoracic Spine will also round forward along with your shoulders internally rotating to accommodate the position of your head.
  • When you turn your head to the side, your spine and your hips may follow it into the twist.

Neurologic Note: Your Cervical Spine has the most proprioceptors, or nerve cells that relay your posture/position, than any other region in the body. It means that your nervous system is constantly paying attention to the position of your neck, more so than the rest of your body! This mechanism, along with the vestibulocochlear system in your ear, explains why it can be so difficult to move your head around in your balancing poses!

Looping it back into yoga: the best position for our neck starts with establishing neutral position!

Most of our yoga poses, even the ones involving twisting,  should be done with or a neutral neck.

By Neutral Neck I am referring to your head balancing directly over your spine without there being a lean forward/back or sway to the side. 

****Obviously this is relative to the pose, some postures in yoga will have altered alignment.  There are also exceptions to this alignment rule, which depend on the intention behind it.

Axial Extension is another way to say neutral or help establish it.  It refers to the spine extending, or lengthening, upwards towards the sky (instead of backwards like spinal extension).  The feeling is of lengthening/stretching/decompressing where our head is neutral, and there is an even engagement of the front and back of the neck. 

*****Disclaimer: These exercises are not intended to treat or fix neck pain, they are for generalized strength & conditioning of the muscles.  When attempting exercises off the internet, please use common sense and do not perform or modify if there is pain or discomfort!  Necks can be sensitive areas so please seek out a qualified manual therapist if you do experience neck pain, they can treat & supervise you through these exercises.

The Chin Tuck: Start sitting/standing against a wall or laying your back on the ground.  The cue is to pull your chin directly back (fingers on the chin can help to guide it).  If done right you should feel a stretch, or lengthening, at the back of your skull (suboccipitals). You’ll also feel engagement in your throat.

(Another cue that helps:  “Give yourself a double chin” haha).

Cobra Pose & Axial Extension:

Cobra pose is an excellent one to warm up with at the beginning of your asana practice. Cobra carries a lot of functional upper body alignment: it engages your back muscles and opens you up from the rounded forward position. The cue to engage with axial extension is “Headbutt the front of the room”. You’ll feel your neck lengthen behind your ears, and the base of the chin/throat engage.

Deep Neck Flexor Strengthening:  Baby Sphinx Pose

 

How Necks Get Injured In Yoga

Now that we have a good understanding of how critical our neck alignment is and how our neck will govern, or at the very least, influence almost all our movements let’s see what can be deleterious in our yoga practice.

Much like any of the other regions covered in my previous articles repetitive stretching/stressing the neck muscles leads to the most common injuries.

  • It’s all the times we over extend our neck to look up in backbending poses like Upward Dog, Camel, Cobra Pose, etc
  • It’s also all the times we over flex our chin to our chest in forward bends or regular “neck neutral” poses.

Avoid the extreme ranges & practice moving with and from Neutral (that “headbutt” feeling).  Remember: Yoga is meant to ease stress, not create it!

The Gift & Curse of a Front Mirror

If you’re like me and teach at a studio with a front mirror, then necks are guaranteed to over-extend in just about every pose. Don’t get me wrong, front mirrors are great because they can help with alignment, but they also bring out everyone’s inner narcissist. We want to see ourselves in the mirror, and we’ll put our neck into some funky places to do it. We lose that neutral feeling because of that constant desire to see ourselves in the mirror.

Yoga teachers, here’s an experiment for you: Teach a class facing towards the front mirror, then teach that same class facing away from it. When people don’t have something to look at they’ll focus more on what they feel, rather than what they see. The neck alignment will be very different, too!

Hamstring Fun Fact: If your Deep Neck Flexors are weak it will signal your hamstrings to tighten up and act as a postural muscle, rather than their design of movement generation.

Yup! Think about it, if your Deep Neck Flexors are weak your nervous system is going to perceive this instability as if your head could fall off any time you fold forward. It will signal to your back muscles, like your hamstrings, to tense up and keep you from falling forward!

Summary: Common Neck Injuries in Yoga

I want you to remember that there is not one particular thing in yoga that is deleterious to our necks, or any joint in our body. It’s the constant & repetitive end-range passive stretching and movement that creates the stress. Keep the pressure out of your neck by moving it from a more active neutral position. You’ll notice an improvement in your alignment in all of your yoga postures!

Headstands: Why would you even?

We can’t have an article on yoga injuries of the neck without mentioning Headstand or “The King of Yoga Asana”  (more the like “The King of Serious Neck Injuries”).  The most serious of yoga injuries have been reported because of this pose.  It’s common sense too, if you’re going to put your body weight into your head and neck, especially if they are misaligned in relation to your torso and legs, then, of course, you can expect nerve pain, bulged spinal discs, or compressed arteries/nerves. What did you think would happen?

I’ll admit, I’m personally biased when it comes to Headstand. I have yet to hear an anatomically sound reason why we practice it at all. I understand that it’s an accessible way to lift your feet above your head, and can be a fun inversion, but at what cost? As for the other toted benefits of the pose, they are not backed by any solid scientific research.  New’s flash:  Headstand will not cure your grey hairs or give you a face lift.

I’m not here to demonize the pose.  There’s intrinsic value in doing something you like. Keep practicing it if you like doing it, but do it for the right reasons, not bullshit pseudoscience. I’m here to cultivate awareness and hopefully responsibility. YOU ultimately get to choose what YOU do with your own body.

The most important alignment noteYou should have close to no weight in your head.

Supported Headstand (with the forearms on the mat) is much safer than a Tripod Headstand (head and hands on the mat). I know this goes against what B.K.S. Iyengar said in Light on Yoga where he stated “The whole weight of the body should be borne on the head alone”  (That’s the dumbest advice I’ve ever read in a yoga book by the way.)

Headstand & The Modern Human:

  • Remember a lot of modern asana was created for slender hand selected Indian boys at the Mysore palace.
    • A Slender Indian boy in the early 1900’s had much less body weight and didn’t round over a screen all day!
  • Neutral neck is essential to establish and maintain the pose. If your alignment is just a little off, you’ll put a lot of weight in structures of the spine that were not designed to bear your body weight
  • Avoid kicking up! When you kick up, you shift your body and neck alignment. It’s so much safer to lift your legs slowly into the pose.
  • If you have neck pain, you should not practice this pose! Guess what? There are a lot of people with neck pain that take yoga classes. That’s a serious consideration, and you should not place your body weight into your neck if your neck hurts. That’s just plain stupid!  You run the risk of exacerbating that pain or doing some severe damage to something that’s already injured.

Now I will demonize one aspect of this pose:  This pose does not belong in group classes.

Seriously, it should only be taught in small groups with supervision from an experienced yoga teacher.  There are too many variables and I don’t care how great of a teacher you are, there’s no way you can safely and effectively lead a large group of people into this.  One wrong lift, one bad bit of neck alignment and that yogi can get hurt.  Maybe it’s a minor strain or perhaps it’s something way more serious.  Why even risk guiding people into that realm of harm & danger?

Unlike a lot of the other repetitive stress injuries in yoga, this one can be a traumatic, instantaneous, and serious injury (such as a fracture, or in rarer cases a stroke). You don’t want to do that to yourself or your student. Save headstands for the small group or private instruction.  Practice safety and sustainability.

Small groups are perfect because the teacher can supervise and aid anyone that needs assistance. I’m a big fan of certain yoga protocols that approve the student’s progress and build up to the pose. In one that I know of the students go into Headstand by placing their heads & forearms on the mat. They hold that with good alignment with any necessary props/modifications and their feet on the ground. The instructor then walks around and approves or denies yogis to the next step of lifting their legs up.

This protocol approach and approval through progress is so much better than some of the regretful experiences I’ve had with Headstand in group yoga classes. There was one time where I was in class and the instructor told everyone to place their hands & head on the mat then kick up into Unsupported Headstand. UGH, I’m still scarred from that experience.

Yoga teachers, you are responsible for what you teach your students and the effects the poses can have on their bodies. Thankfully, most of the time these effects are positive changes like strength, flexibility, and graceful movement. When it comes to an advanced pose that can create serious injuries, we as a yoga community need to think critically about how and when we teach it.

That’s my soapbox on Headstand. Practice it if you want to, but please be smart about it. You only get one neck and if you jack it up, it’s going to affect the rest of your body for the rest of your life. I truly hope this article inspires a bit of responsibility and critical thinking regarding this posture. I’d hate for any of you out there to hurt yourself, or hurt others, all because you want to get your feet over your head. Build the strength and do a Handstand or check out some of the awesome Supported Headstand modifications with blocks. Practice smart so you can practice for a long time!

Regarding Shoulderstand:

“The Queen of Yoga Asana” also gets an honorable mention for creating neck injuries and being involved in some of the more serious injuries reported. This pose is far safer than Headstand, but it’s still important to make sure you’re doing it with proper support and close to no body weight in your head and neck.

I know in some practices in yoga this pose can be held for long durations. I’m not here to criticize but I don’t understand why you would want to load the Thoracic Spine in flexion for a long period of time. We’re already doing that with gravity throughout our day when we hunch forward to look at our screens.

Please use support, like blankets, and other props if you decide to hold this pose. Also, just like with Headstand, you should not practice Shoulderstand if you have neck pain.

Summary:

  • Take the stress out of your neck in your yoga practice, life already does a good job of putting it there.
  • Proper neck alignment can revolutionize your practice. Your neck rules the movement road so start incorporating it or playing with the alignment to see how it affects your yoga postures and your life!
  • Establish neutral at the beginning of your class, then do your best to maintain and move from it to stay active and avoid some of the extreme ranges we can bring it to.
  • Use your Head! Think critically about what you are doing with your head & neck and avoid the positions that create pain or discomfort.

That’s all folks! These series have been so fun to write and I hope very enlightening for your mind and asana practice. There will be much more in the future so stay tuned!

Until then hold your head up 😉

Dr. YG

 


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