Yoga and its risks: A systematic review of adverse events reported in case reports and case series

J Integr Med. 2026 Jul 4:S2095-4964(26)00085-3. doi: 10.1016/j.joim.2026.07.001. Online ahead of print.

ABSTRACT

BACKGROUND: Yoga has gained widespread acceptance as a complementary health practice. However, adverse events related to yoga have not been systematically evaluated for the purpose of developing evidence-based safety guidelines.

OBJECTIVE: This study systematically reviews published case reports and case series of yoga-associated adverse events (YAEs), categorizing their clinical features, associated yoga practices, and treatment outcomes to inform safer yoga practice.

SEARCH STRATEGY: A comprehensive search was conducted in MEDLINE/PubMed, Scopus, and Web of Science from database inception through April 2025, supplemented by Google Scholar and hand-searching of reference lists.

INCLUSION CRITERIA: We included peer-reviewed case reports and case series in any language with English abstracts that described one or more adverse events temporally or causally linked to yoga practice.

DATA EXTRACTION AND ANALYSIS: Two authors independently screened records and extracted study identifiers, patient demographics, yoga style and technique, affected systems, management, and outcomes; a third author validated all entries, and two additional authors assessed methodological quality using the Joanna Briggs Institute checklists.

RESULTS: Eighty-four adverse events from 70 studies were identified, affecting 7 physiological systems: musculo-skeletal (34 cases, 40%), ophthalmological (16, 19%), neurological (10, 12%), cardio-respiratory (12, 14%), psychiatric (6, 7%), nasopharyngeal/gastrointestinal (4, 6%) and dermatological (2, 2%). The most frequently implicated practices were headstand (sirsasana; 15 cases, 18%) and forceful pranayama (8, 10%). Bikram, Ashtanga and Hatha yoga were the styles most often reported in association with adverse events. Patients’ ages ranged from 15 to 90 years, and 60% were female. Fifty-four percent had pre-existing vulnerabilities. Complete recovery occurred in 40% of cases, partial recovery in 27%, and one individual had no recovery.

CONCLUSION: Although YAEs are uncommon, they can result in significant morbidity, particularly in individuals with underlying risk factors. Systematic pre-practice screening, tailored instruction, and targeted instructor training are essential to mitigate risk and promote safe yoga practice. Please cite this article as: 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. J Integr Med. 2026; Epub ahead of print.

PMID:42471295 | DOI:10.1016/j.joim.2026.07.001