Yoga’s reputation as a gentle, low-risk practice is well earned — but “gentle” is not the same as “risk-free.” A new systematic review, published in the September 2026 issue of the Journal of Integrative Medicine, gathers decades of medical case reports into the clearest picture yet of when, how, and for whom yoga occasionally goes wrong.
The headline finding: across 84 documented adverse events, a small set of poses and breathing techniques — led by the headstand — accounted for a disproportionate share of the serious problems. Here is what the researchers found, and how to fold it into a safer practice without giving up the poses you love.
What the Review Found
A team led by Suprabha Sharma, with colleagues including Maheshkumar Kuppusamy, searched MEDLINE/PubMed, Scopus, and Web of Science from each database’s inception through April 2025, then supplemented that with Google Scholar and hand-searching of reference lists. They included any peer-reviewed case report or case series that described an adverse event temporally or causally linked to yoga practice, and two reviewers independently extracted and validated every entry.
In total, they identified 84 yoga-associated adverse events drawn from 70 studies. The events touched seven different body systems:
- Musculoskeletal — 34 cases (40%), the single largest category
- Ophthalmological (eye-related) — 16 cases (19%)
- Cardio-respiratory — 12 cases (14%)
- Neurological — 10 cases (12%)
- Psychiatric — 6 cases (7%)
- Nasopharyngeal and gastrointestinal — 4 cases (5%)
- Dermatological (skin) — 2 cases (2%)
Two practices stood out. The headstand (sirsasana) alone was implicated in 15 cases (18%), and forceful pranayama — vigorous, forced breathing techniques — accounted for another 8 (10%). By style, Bikram, Ashtanga, and Hatha yoga appeared most frequently in the reports.
Why It Matters
Two things make this review worth your attention. First, it is one of the most comprehensive attempts to categorize yoga harms by body system and by specific technique, rather than lumping “yoga injuries” into one vague bucket. That granularity is what turns an alarming headline into something you can actually act on.
Second — and this is the caveat the authors themselves stress — case reports cannot tell you how common these events are. There is no denominator: we do not know how many millions of headstands were performed safely for every one that ended up in a journal. So the review is best read as a map of how yoga tends to cause harm, not as proof that it frequently does. The authors are explicit that adverse events remain uncommon.
What the data can do is flag the practices and the people that deserve extra caution — and there the signal lines up with what many experienced teachers already suspect: load-bearing inversions on the head and neck, and aggressive breath retention or hyperventilation, carry more downside than a gentle standing sequence.
The findings also build on earlier research. A landmark 2013 review in PLOS One by Cramer and colleagues first flagged that many of the most serious yoga injuries clustered around inversions and the neck. More than a decade later, this larger and more systematic analysis reaches a strikingly similar conclusion — which strengthens the case that these are genuine, repeatable patterns rather than statistical noise, and that the advice to protect the neck and ease off forced breathing has held up over time.
Who Was Most at Risk
The patients ranged in age from 15 to 90, and 60% were women. The most telling number: 54% had a pre-existing vulnerability — an earlier injury, a cardiovascular or eye condition, uncontrolled blood pressure, or a bone-density issue — before the event occurred. In other words, most documented harms happened to people whose bodies were already carrying a hidden risk that a demanding pose then exposed.
Outcomes were broadly reassuring but not uniformly so: 40% of people recovered completely and 27% partially, while one individual did not recover. That tail is exactly why the researchers argue for screening before, not after, someone attempts the riskier end of the practice.
The Poses to Approach With Respect
None of this means retiring the poses on the list. It means practicing them with the respect they have always deserved. A few specifics drawn from the review’s patterns:
Headstand and other inversions. Because sirsasana topped the list, it is the clearest candidate for caution — especially when you load the crown of the head and the neck. If you practice inversions, build the strength and alignment first, use a wall, and consider forearm-based variations that take load off the cervical spine. Our guide to the benefits of yoga inversions covers how to progress toward them gradually rather than rushing.
Forceful breathing. The pranayama cases involved forced, high-intensity breathing, not slow diaphragmatic work. If breathwork ever leaves you light-headed, treat that as a signal to back off. A gentle technique such as three-part dirga pranayama delivers the calming benefits without the breath-holding intensity linked to problems.Anything that spikes pressure in the eyes or head. The 16 ophthalmological cases are a reminder that inversions and strong holds raise intraocular pressure. If you have glaucoma or other eye concerns, read our review of yoga and eye pressure and talk to your ophthalmologist before inverting.
Deep spinal loading. With musculoskeletal events the biggest category, forward folds and twists done aggressively — particularly with an existing disc issue — deserve modification. Our yoga for a herniated disc sequence shows safer alternatives that protect the spine.
Older bodies and hidden conditions. Since more than half of cases involved pre-existing vulnerabilities, screening matters most as we age. If balance is your main concern, a targeted approach like the one behind this fall-risk study in adults over 65 is a smarter starting point than an advanced class.
What This Means for You
You do not need to fear your mat. You do need to treat the harder poses as skills to earn rather than boxes to tick. Practically: tell a new teacher about any injury, heart, eye, or blood-pressure condition before class; warm up fully; skip or modify headstand until your foundation is solid; keep breathwork gentle; and stop the moment a pose produces sharp pain, dizziness, or visual changes rather than pushing through it.
The review’s own recommendations point the same way — routine pre-practice screening, individualized instruction, and better-trained teachers. For students, the takeaway is simpler still: a teacher who asks about your health history before handing you an advanced pose is showing a feature, not a flaw.
Key Takeaways
- A September 2026 systematic review in the Journal of Integrative Medicine catalogued 84 yoga-associated adverse events from 70 case reports and series.
- Musculoskeletal injuries were the largest group (40%), followed by eye-related (19%) and cardio-respiratory (14%) events.
- The headstand (sirsasana) was the single most-implicated pose (18% of cases); forceful pranayama accounted for another 10%.
- Bikram, Ashtanga, and Hatha were the styles most often named, and 54% of those affected had a pre-existing health vulnerability.
- Case reports cannot show how common these events are — the authors stress they remain uncommon — but they do highlight where caution pays off.
- Screening, gradual progression, gentle breathwork, and honest communication with your teacher are the practical safeguards.
Source: Sharma S, Bhandari SS, Malhotra V, Kuppusamy M, Kumar S, Dhakal M. “Yoga and its risks: A systematic review of adverse events reported in case reports and case series.” Journal of Integrative Medicine, 2026;24(5):667–682.
