Along with the many pleasurable sensations that accompany a yoga class, it’s not unusual for students to feel tingling or even numbness or shaking, or to experience head rushes, muscle cramping, or joint popping.
“I’ve felt all of these in a yoga class,” admits Bill Reif, a physical therapist in Atlanta with almost 40 years’ experience, and the author of The Back Pain Secret: The Real Reason for Women’s Back Pain and How to Treat It.
While we yogis are generally committed to staying away from poses or actions that cause pain, it’s less clear whether these sundry sounds and sensations are to be avoided. Below, Reif shares his level of concern (on a scale of 1 to 10) regarding each of these symptoms—along with his expertise as to their causes, and his advice for how best to alleviate them.
While we yogis are generally committed to staying away from poses or actions that cause pain, it’s less clear whether these sundry sounds and sensations are to be avoided.
1. Tingling, or “pins and needles,” sensations
Reif’s level of concern: Level 1 if the sensation is an occasional occurrence that quickly dissipates; otherwise a 5 or 6 if it is severe and persists.
What’s going on? “Tingling, also called paraesthesias, is an irritation to the nerves,” Reif says. “The two most common locations of tingling are the hands and feet. Lengthening the nerves of the upper extremities too suddenly and/or attempting to stretch areas where soft-tissue restrictions have limited a nerve’s ability to glide can cause tingling in the arms and hands, while overstretching the sciatic nerve can cause tingling in the legs and feet.” Reif cautions that severe and persistent tingling can be a sign of a more serious condition like vascular insufficiency (decrease in blood supply), or possibly peripheral neuropathy (nerve damage), which can result from diabetes (known specifically as diabetic neuropathy).
What to do about it? Reif points out that making postural changes, like keeping the shoulders from rounding forward throughout the day, can help reduce restrictions in and around the neck and shoulders that cause tingling in the arms and hands. Exercising daily and taking breaks to stand and stretch during any prolonged period of sitting can help reduce the restrictions in the lower back and pelvis that lead to tingling in the legs and feet. Physical therapists are often skilled at manually releasing these restrictions, and are also able to recommend specific stretches called “neural glides” that aim to allow the affected nerves to slide freely. For instance, if your time on a keyboard has led to tightness along the forearm that causes your arm or hand to tingle in certain yoga poses, a neural glide for your median, ulnar, and radial nerves can be done reaching both arms straight up overhead, pressing the palms and fingers together as securely as possible (in an upraised anjali mudra), then slowly bending the elbows to lower these prayer hands toward your lower ribs or belly. Hold this prayer position for several breaths, continuing to press your hands together.
Reif encourages moving slowly into any stretch that has caused tingling, so you can be aware of the exact moment when the sensation begins. Once you start feeling the pins and needles, “Do not work through it,” Reif advises. “Ease up to find the position where the tingling subsides, and breathe there. Pushing further into the restricted range may cause tissue damage.” In other words, back off that shoulder stretch or hip stretch to a place where you no longer feel any tingling. By patiently working there, you’ll eventually expand your available range of motion and be able to move further into the stretch before feeling the tingling.
If the tingling does not stop immediately after releasing the pose, get it checked out. “It's important to seek prompt medical evaluation for any persistent tingling in your hands, feet, or both,” Reif says. “The earlier the underlying cause of your tingling is identified and brought under control, the less likely you are to suffer potentially lifelong consequences.”
Reif’s level of concern: A level 1–2 for temporary numbness but a 6 for numbness lasting for hours.
What’s going on? “Numbness may result from poor circulation, nerve pressure, or overstretching,” Reif says. “If it is persistent, it may be the sign of something more serious.” Like tingling, a lasting lack of sensation might be an early sign of vascular insufficiency (decrease in blood supply) or diabetic neuropathy, among other things.
What to do about it? “Do not persist in the pose,” Reif says. “Always get out of, or alter, any position—in yoga class or in daily life—that is causing numbness anywhere.” He emphasizes that holding a pose through numbness is at best unproductive and at worst dangerous. “If the numbness is due to overstretching, it can cause more lasting symptoms, like muscle weakness," he says. So if your feet fall asleep in hero’s pose, or your legs go numb in your easy cross-legged seat, extend your legs out in front of you and shake them until circulation returns. When you approach the pose again, elevate your hips on blocks or a meditation cushion to take pressure off the constricted area. If your feet go numb in legs up the wall pose, try resting your legs on a slanted bolster instead (so that they’re elevated diagonally, rather than vertically) or try bending your knees and supporting your calves on a chair.
If the numbness doesn’t dissipate soon after you come out of the position that caused it, Reif again stresses the importance of medical evaluation.
Reif’s level of concern: A level 1–3 for beginners, a 1 for regular practitioners experiencing occasional shaking in the midst of a challenge, but a 5 for regular practitioners who have suddenly begun to experience shaking.
What’s going on: “Shaking can have many causes,” Reif says. “Shaking in a static yoga pose is usually a non-harmful sign of muscle fatigue. Novices often shake with single-leg balance postures. Over time, as muscle memory and strength improve, the wobble or shake should disappear.
“Dehydration, lack of nutrients, and/or weakness of muscles, tendons, and ligaments can also cause shaking. But if an experienced practitioner suddenly begins to shake without having made any changes to his practice, this could be a sign of a serious condition. Many neurological disorders are accompanied by tremors or shaking of the extremities (including Parkinson's disease, multiple sclerosis, myasthenia gravis, and even stroke)."
What to do about it? Reif recommends that beginners come out of poses shortly after the shaking starts, give their fatigued muscles a break, and rehydrate. “Water, potassium, sodium, calcium, and other metabolites need to be replenished often,” he says, and “many foods like bananas naturally contain these essential nutrients, as do sports drinks.” Advanced practitioners, confident of their hydration, nutrition, and their limits, are welcome to build their strength by holding poses for several breaths, even after mild shaking has started. Reif says, “They can stay in the pose until the shaking becomes unsafe,” Reif advises, ”until they’re about to lose their balance.”
But if experienced practitioners suddenly shake without having made any alterations in their practices or alignment, it’s important that they seek medical attention.
4. Head Rushes/Lightheadedness/Dizziness
Reif’s level of concern: A level 1–2 if occasional and mild after rising from an inversion, but a 7–10 if severe and/or repeated.
What’s going on? “Changing positions too quickly, especially rising to standing from a forward fold or getting up abruptly from a supine position on the floor, can cause a sudden drop in blood pressure, leading to lightheadedness. Dehydration, which reduces blood flow to the brain, contributes to lightheadedness, and is especially likely in hot rooms,” Reif says. “However, there are serious medical conditions, like heart problems, that can also cause such vertigo.”
What to do about it? Since severe head rushes can lead to fainting, especially for students with low blood pressure, it’s important to take precautions to avoid them. Good hydration throughout the course of the day helps, and Reif encourages those who experience frequent, severe head rushes to think twice about practicing in extremely hot rooms.
When practicing, it’s also important to make transitions gradually. “Assuming there’s no underlying heart pathology, coming up slowly from an inverted posture can reduce or eliminate the head rush by slowing down the change in blood pressure,” Reif says. For instance, if you are in a wide-legged forward fold, try coming up just halfway, taking a few breaths with your hands on your thighs (with knees bent), and then hinge the rest of the way up. (Note that while “rolling up to stand slowly” may prevent head rushes, this is a risky movement for the lower back. “Hinging at the hips” is the safest way to come up from a fold.) “If you experience a head rush, lie down and elevate both legs, or sit and place your head between the knees,” Reif advises.
Unfortunately, according to Reif, there is no easy way to tell a “regular head rush” from one arising from a heart condition. If you or your students experience persistent head rushes or dizziness, see a doctor.
5. Muscle Cramps
Reif’s level of concern: A level 1–3 if only occasional, but a 5 or more if severe and widespread.
What’s going on? “Some cramping can be due to dehydration, depletion of metabolites like potassium that are needed for muscle contraction, and wearing shoes with hard soles or high heels,” Reif says. Widespread cramping is a cause for more concern. According to Reif, “Whole-body cramping may be a sign of underlying disease, severe dehydration, or a side effect of drugs like statins (for lowering cholesterol).”
What to do about it? Reif recommends making some life changes to prevent cramping. “Drink plenty of water, eat bananas, and see if wearing a flat shoe with a flexible sole throughout the day makes a difference,” he says. If you feel the first inkling of a cramp when coming into a pose, come out of it and stretch or massage the cramping muscles. For example, if your calves or hamstrings are cramping, you can gently stretch those areas in a half splits pose: Come into a low lunge, straighten the front leg, dig down with that heel, and fold forward until you feel a stretch along your hamstrings. To stretch the calf specifically, while in this position use one hand to pull the ball of the front foot back toward you for 30 seconds or so. Alternatively, you could sit and massage your calves or hamstrings with your hands, or roll them with a foam roller or the ridge of a block.
However, if the cramping you experience continues, is severe, and/or is body-wide, seek medical attention.
Reif’s level of concern: A level 1–2 for that occasional pop, crackle, or snap; a 3–5 for habitual pops.
What causes this? “Occasional, singular ‘pops’ are usually a release of suction in a joint capsule, and tend to happen when you approach end range of a movement, as we often do in yoga class,” Reif says. “Repeated pops or snaps are more likely resulting from a tendon or ligament rubbing over a bone.”
What to do about it? Reif says not to worry about occasional pops. “These are harmless and perhaps needed, and often we feel a sense of increased movement immediately afterward,” he says. “If the first repetition of a triangle pose gives you a one-time pop, this is normal. If, after hours of sitting at a computer, you turn your head or twist your back to get a crack out, that is perfectly acceptable and can be good for mobility of the spine. The occasional manipulation by a chiropractor, osteopath, or physical therapist trained in joint manipulation is also often necessary to restore normal pain-free movement when there has been a loss of normal range of motion in a joint or joints,” he adds.
But Reif cautions that popping one’s joints many times over the course of the day is to be avoided, since that feeling of increased mobility may come at a cost to stability and joint health. “If self-mobilization through cracking and popping the joints becomes a habit, over time, instability and pain may result. It’s theorized that when one pops a joint, the snap and release of supportive ligaments surrounding the joint can lead to ligament laxity or damage. Since ligaments are needed for structural stability, repeated popping might eventually result in hypermobility and a loss of joint protection.” Cracking also does nothing to address the underlying causes of stiffness. For example, if your neck or your back feel chronically tight after prolonged sitting, you might find that by making adjustments to your alignment (bringing your ears over your shoulders and your shoulders over your hips, for example) and moving more throughout the day, you alleviate the need to “get a crack out.”
The pops, cracks, and snaps that occur in quick succession during a repetitive movement in yoga class (such as a hip snapping over and over when you lie on the back and bicycle the legs) are best avoided, as they can easily lead to tendon inflammation. “Do not allow frequent pops and snaps,” Reif says. To steer clear of that repeated pop, realign your movement, decrease its range, or, if need be, skip it entirely.
Staying attuned to the sensations that accompany yoga practice can help us to maximize the benefits of our poses, prevent injury, and heighten our awareness of our habits outside of class. Not only might we be primed to notice when we’ve crossed our legs in such a way that one of them is going numb or when we are again cracking our necks, we might also find ourselves making adjustments to our spinal alignment, our shoulder placement, our hydration and nutrition, and maybe even our footwear to better guard the bliss of our yoga practices.