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

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, 5%) 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; 24(5):667–682. © 2026 Shanghai Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.