Is Savasana Trying to Kill Us? Learning to Recognize & Debunk Fragility Fears

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Savasana is also known as “corpse pose”. But is it really trying to make literal corpses out of us? Well, apparently some people would have us think so!

I’m exaggerating here, of course. No one is actually suggesting that savasana - the relaxing, peaceful pose in which we lie and rest for several minutes at the end of every yoga practice - could potentially kill us. But as difficult as it may be to believe, people are seriously proposing that this classic yoga pose could injure us. And so in the interest of some education on interpreting research papers, a little pain science primer, and a continued encouragement for less fearmongering in the yoga world, I’ve decided to examine this intriguing topic today.

IS SAVASANA OUT TO GET US?

I was prompted to write this piece because of a recent widely-read blog post that was brought to my attention. This blog post cited a research paper that seemed to suggest that savasana could potentially be a harmful pose. In order to support this study’s suggestion, the blog post proposed that because our bodies have adapted to the activity of sitting in chairs, most of us are not well-suited to lying flat on the floor. As a result, when we lie in savasana, our back arches and our spine is “compressed” and “overloaded”. The author writes: “For many, lying on the floor creates much higher loads on weakened tissue than you might expect for something as ‘simple’ as lying on the floor.”

The author proposes that instead of lying flat on the floor, most people should bolster their head and shoulders up higher in savasana in order to re-arrange the position of their body and avoid potential injury in the pose.

Before we examine this claim further, let’s first take a look at the research paper that was cited in order to justify the notion that savasana is injurious.


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THE RESEARCH PAPER ON YOGA & INJURIES: A VERY PROBLEMATIC STUDY

I obtained a copy of the full study in question in order to explore its claims further. Titled “Soft Tissue & Bony Injuries Attributed to the Practice of Yoga” (Lee et al 2019), the researchers retrospectively reviewed the medical records of 89 patients who claimed to have experienced yoga-related injuries. According to the researchers, there were 12 “patient reported yoga poses that led to injury” (page 427), and one of these poses was savasana.

This study is significantly problematic for many reasons. First of all, it is a retrospective study, which is a very low-quality form of evidence that relies only on subjective recollections (i.e. anecdotes and not secondary data) to begin with.

Second of all, this study in no way establishes causation between savasana and injury. At most, the study might show that a handful of people claimed to experience a symptom of pain or discomfort while in savasana. This does not establish injury. Additionally, it does not establish time order between the two variables (a necessity for determining causation), and it does not examine any of the myriad alternate explanations that could be (and most likely are!) involved in the reported pain experienced during savasana.

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Another important point about this study is that it was not done on a representative, random sample of people who do yoga, and is therefore not generalizable to the greater yoga population. The people selected for the study all attended the same medical clinic and they all had significant comorbid health conditions such as osteoporosis, cancer, and hyperlipidemia. Therefore we can’t make any inferences from this study about the general population of yoga practitioners.

Furthermore, the researchers did not include any non-injured patients, which means they selected on the dependent variable only. What about all of the people who went into the clinic who happened to practice yoga and were not injured? These patients weren’t considered in this study. And we can safely assume that they all did savasana at the end of every single one of their yoga classes. Why didn’t this injurious pose send them into the clinic as well?

For these and many other reasons that we don’t have time to discuss here, this study is not causal, is not valid, and is honestly not worthy of citing due to its extremely poor quality design. In fact, in the words of an academic researcher I consulted about this study (who just so happens to be my husband :) ): “From a causal standpoint, this study is garbage.”



FLAWED STUDY ASIDE - WHAT ABOUT PAIN SCIENCE?

We’ve established that the study in question is deeply flawed. But that major problem aside, where is an understanding of modern pain science in either this study or the blog post that cited the study? One of the most foundational insights about pain that we understand today is that the link between pain and tissue damage is quite tenuous. Many people experience pain in their bodies with no associated damage, and many people have damage in their tissues and no associated pain.

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This means that just because something hurts or is uncomfortable does not necessarily mean that tissue damage is taking place. A helpful phrase commonly used in the therapeutic and rehabilitation worlds these days is “hurt does not equal harm”, and I believe this is a crucial insight that is missing from this discussion about savasana and injury.

Additionally, we know that in order to sustain an injury (tissue damage), the forces involved generally need to be significantly high and/or fast. The simple act of lying on the floor in savasana includes neither high nor fast forces. It is simply not plausible that this benign pose could actually cause tissue damage in our body.

Now I definitely don’t disagree with the blog post author that many people feel discomfort while lying flat on the floor in savasana. This is absolutely true, and many of us could find a more comfortable and relaxing pose by adding some props so that our body feels more supported.

But there’s an important difference between suggesting that people should prop their savasana up for comfort and suggesting that they should prop their savasana up in order to avoid injury. The former will help people find more ease and potentially embody more “yoga” in their pose; the latter will potentially serve as a nocebo - a negative expectation of an otherwise harmless event or action that causes negative consequences like pain.

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Suggesting that savasana can harm us is nocebic because we understand today that pain is a multifactorial output of our nervous system that can be influenced by many factors beyond biomechanical ones. Beliefs and social influences are two well-established contributors to painful experiences (among many other psychological and social factors as well.)

The more that we spread a message about the fragility and vulnerability of our tissues (especially in low-load contexts that can not realistically injure us), the more we can influence people to have less confidence and trust in the innate strength and robusticity in their body. This can result in people’s nervous systems creating more painful perceptions than they otherwise would have in innocent yoga poses like savasana and beyond.


IN CONCLUSION…

It’s easy for well-meaning yoga and movement teachers to cause unintentional harm when communicating about the human body. The more we can educate ourselves about pain science and the potential negative effects of nocebos, the more likely we will be to teach about the body in productive, empowering ways.

Additionally, I encourage all of us (including myself!) to become more active consumers of knowledge. If we see a single study being used to make a broad claim, rather than taking that claim at face value, we would be wise to feel skeptical and potentially conduct some of our own research to investigate further.

And finally - setting the science and the flawed study aside, let’s not forget the power of common sense. I mean… savasana? Really? Have we become such feeble creatures that we can’t lie on the floor without harming ourselves? We should feel justified in using our common sense to question such claims.

Shoulder Alignment in Downward Dog: Is External Rotation the Best Cue?

I am more than excited about my newest article in Yoga International about the shoulders and downward dog! Externally-rotating the shoulders was thought to be the safest alignment for down dog for years.

But as I explain in this article, newer insights from science about pain, injury, and shoulder impingement syndrome are giving us good reason to re-think the classical way that we practice and teach down dog (and quite a few other asanas as well!)

Read my new article here, and feel free to let me know if you have any questions about it. I hope you enjoy learning new information and a fresh perspective on shoulder alignment!

"To Correct Is Incorrect"

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Everyone is moving in the best way they can with the best tools they have.

There are no inherently bad movements.

Each person in a yoga class is a complex, dynamic organism compromised of numerous subsystems, past experiences, emotions, relationships, beliefs, and an extremely sophisticated nervous system.

Given that our movement emerges out of such unique complexity, how could we possibly know what and how to “correct” in another person’s movement?

As a yoga community, we could use to shift our focus away from “correct alignment”, and more toward exploration, self-knowledge, and helping our students *increase their movement options*.

These types of things can truly make positive change in our students’ bodies - which for me, is the main goal of my yoga practice & teaching!

[Microblog] Should Our Shoulders Always Be "Back and Down"?

You know the idea that we should keep our shoulders "back and down"? Like all the time, in every yoga pose that we do? Well our shoulders were actually designed to *move* - not be pinned into one position all the time.

There are four (four!) joints that make up the shoulder joint complex, and regular movement keeps all of them healthy. Lack of movement, on the other hand, just makes your shoulder joints mad at you.

Why would we want to train our shoulders not to move by keeping them pinned back and down all the time?

[Microblog] Bridge Pose & "The Glutes"

I promise this is a post about yoga, even though I'm at a gym and using a weight in this video! Think for a moment about bridge pose in yoga, which involves lifting your hips up away from the floor (i.e. active hip extension). So often in yoga we hear the cue to "soften" or "relax" our glutes when we're in bridge pose. But this is a holdover old alignment cue that isn't really informed by movement science.

In this video, I'm doing a gym move called the "hip thrust". I'm lifting my hips up away from the floor (just like in yoga's bridge pose, right?!), but do you know what the purpose of doing this movement is in the gym world? It's to *strengthen the glutes"! That's right - because the glutes are the main muscles that are challenged in this movement! It's normal and healthy for them to work a LOT here.
 


If an exercise like the hip thrust was designed specifically to strengthen the glutes, does it make sense that in yoga we *discourage* our students from using their glutes in bridge pose, an extremely similar movement kinematically?

Sometimes in the yoga world we could use to step back and examine the reasonings behind some of the cues we give. Are they informed by the science of how we move, or are they just inherited cues we teach simply because that's what was taught to us?

You can start modernizing your yoga teaching with my new online course called *Keeping Your Yoga Teaching Current*. Learn to shed the many outdated myths about the body that hold us back in the yoga world and embrace effective, new-paradigm approaches to mobilityasana, and movement that are truly evidence-based!

Deconstructing Down Dog Shoulder Alignment

This is a consolidation of a 4-part series of posts that I recently ran on my social media channels (Instagram & Facebook). Social media is a great tool for sharing information because so many of us tune into these outlets regularly, but it's also a somewhat temporary medium because new posts continually arise and replace old posts, etc. So here I've decided to consolidate my 4-part series into a blog post, where it can live more permanently and be accessed easily in the future. (And please excuse the somewhat chatty "social media voice" I wrote this in, because I originally wrote it for that platform. :) ) I hope you enjoy!

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Part 1

In this series of posts we’ll be deconstructing down dog shoulder alignment with *critically-thinking minds* to learn more about the body and why we say what we say in yoga!

Before we can deconstruct down dog shoulder alignment, we need to first establish what the classic shoulder alignment instructions ARE, so we know what we’re going to be deconstructing, right?

Now the anatomy of the shoulder girdle is quite complex, but we're going to keep things pretty simple here because this is just IG/FB and not a full-on yoga anatomy training. (For that, consider one of my online workshops on my website!)

In my long-time experience in the yoga world, the most common alignment for the shoulders in down dog that I see taught is: shoulders *externally rotated* ("outer spiral") and shoulder blades *protracted* (broadened apart from each other). Is this what you've experienced too, or are you used to a different shoulder alignment in DD?

If you have time while you're commenting, can you also share WHY this alignment is believed to be important - what purpose does it serve?

Once we have our basic DD shoulder alignment established, we can start to look at it more closely and question it. (Because that's what we do as evidence-based yogis, right??) Tune into my next post in this series to continue this inquisitive discussion!

 
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Part 2

In part 1, we established that, with a few exceptions, DD is generally taught with the shoulders *externally rotated* ("outer spiral") and the shoulder blades *protracted* (broadened apart).

Now the next thing to establish is WHY. Why this particular alignment? What purpose does it serve?

The general reason given for this alignment is because it helps us to keep the tissues of our shoulders safer.

Specifically, this shoulder position is believed to help us avoid a condition called *shoulder impingement*. (Getting a lil anatomy geeky here - but this is good stuff to know!) In shoulder impingement, the rotator cuff tendons and/or other soft tissues of the shoulder are "pinched" between the head of the arm bone and the bony shelf right above (called the acromion process just FYI) as the arm moves overhead.

When we ER & protract as the arm lifts, we create more space in the shoulder joint - more room between the bones - to help avoid this pinching. Therefore this alignment helps protect us from impingement.

...OR SO THEY SAY!! Heheheh tune into Part 3 of this series to read more and to learn about why there might be reason to doubt this commonly-cited justification for this classic DD shoulder alignment.

(Sorry to be such a yoga rebel sometimes, but hey, the research leads where it leads, and it doesn’t always support our long-held beliefs, does it?)

 
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Part 3

In Parts 1 & 2 we established that we're commonly taught to externally rotate & protract our shoulders in DD because this is supposed to help us avoid a condition called *shoulder impingement*.

(Quick review: shoulder impingement happens when the rotator cuff tendons and other soft tissues are pinched between the bones of the shoulder joint as the arm moves overhead.)

Wellll inspired by my amazing yoga mentor Jules Mitchell who originally connected the dots for me about this topic, I looked at some scientific research and here's what I learned [DM me for the refs!]:

"Shoulder impingement syndrome" is actually highly questioned among experts today - it is suspected as not being a THING at all, and is even hypothesized to be a "clinical illusion". (An illusion!!)

The truth is that we ALL have impingement because no matter who you are, whenever you take your arm overhead, the tissues in your shoulder will always pinch at some point. It just happens and is actually normal - not pathological!

Here's a quote from one research article: "a synthesis of the current research findings suggests that no definitive relationship exists between scapular orientation and SIS (shoulder impingement syndrome)." Translation: the alignment of the shoulders is not (not! despite what we're taught!) related to impingement symptoms.

(There is *tons* more to discuss about all of this, but I have to keep this brief 'cuz this is IG/FB heheh.)

So if impingement isn't as much of a problem as we've been taught, then do we need to always be externally rotating our shoulders in DD to minimize it? DO WE?

Wellll I will leave you with that big thought to ponder for a bit... Stay tuned for Part 4, our final installment in this fresh perspective series!

 
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Part 4

In Parts 1-3, we learned that external rotation & protraction is generally taught in DD because it is believed to be safer, but then we used scientific research to question the idea that this one position is superior and the best.

While ER is just fine to do (absolutely!), we should ideally be able to position our shoulders in DD in ALL WAYS, as long as we have control there! The traditional alignment of ER + protraction is a good way, but it is *only one way*. The body benefits from variety and options, and the more ways we can create a shape, the better.

Is it OK to do DD with shoulder blades down? Yes! Elevated? Yes! Retracted? Yes! With shoulders internally rotated? Yes! As long as you have *control* over these ranges, and as long as you have no pain while you're there, it is fine to practice DD in this wide variety of ways. But position your shoulders intentionally and with control - no dumping or flopping. Know what I mean?

(This conversation is of course more complex than we can delve into in an IG/FB post, but injury-prevention is less about *alignment* and more about progressive loading of our tissues to make them stronger. More movement variability creates more resilient tissues! (And when there are high loads involved i.e. lifting heavy weights overhead 🏋️, alignment for safety becomes more important.)

A great guide for ourselves in DD is: what is our goal in doing the pose in the moment? Then we can base our alignment decisions on that. And if you don't know what your goal is (heheh sometimes we just don't!), then just do what your teacher says - but don't buy into fearmongering messages about it needing to be done that way and only that way to avoid injury.

Enjoy exploring alignment in down dog - your shoulders will thank you!

The Myth of Symmetry in Yoga

You know how we tend to assume that the body should look and feel the same on both sides - an ideal of symmetry? And that tadasana (mountain pose) is our neutral, symmetrical, optimal shape? Well, my newest article for Yoga InternationalThe Myth of Symmetry in Yoga, uses science to challenge these long-held assumptions that most of the yoga world holds dear.

"It's articles like this that help to keep asana teaching science-based and elevate our profession as yoga teachers." --From the comment section of the article!

Check it out here to update your perspective on the body, alignment, & yoga!

 
 

[Microblog] Our Bodies Are Naturally Asymmetrical

I don't know how many images of lungs you've looked at, but have you ever noticed that our two lungs are not symmetrical? Check out this medically-accurate image that shows that the right lung has 3 lobes while the left one has 2, and the left one is also a bit smaller than the right to make room for the heart.

Even though we sometimes hold up balance and symmetry as an ideal that we should strive for in our bodies, as though being "imbalanced" is inherently problematic, the truth is that our bodies are not actually evenly-balanced left-to-right to begin with. We don't need to look or feel even on both sides of our body in order to be healthy, functional beings. Asymmetry is a natural part of who we are!