Understanding Common Contraindications in Yoga
Contraindications, Health Considerations, and Guidelines for Teaching Yoga
with senior trainer Heather Agnew, ERYT-500
Welcome to our latest discussion where we explore common contraindications in yoga.
Join us as we explore the nuances of contraindications in yoga, focusing on creating a safe and accessible environment while empowering our students to make conscious choices in their practice.
Watch the video, or read over the discussion notes below:
Common Contraindications in Yoga
Contraindications, Health Considerations, and Guidelines for Teaching Yoga
Today we discuss contraindications in yoga. It’s a complex topic with not a lot of clear research or guidance. In fact, this is an area where every year I seem to get different guidelines from yoga and fitness organizations that my courses are registered with, so it’s a challenge for teachers to have a clear understanding of contraindications, but today we are going to have a go!
We’ll talk about a few things, yoga poses or techniques that are generally considered contraindicated for particular conditions or health issues, poses that are contraindicated for particular environments, and we’ll talk about the risk-to-benefit spectrum and how this might guide you in making choices for your classes.
Our focus of course is to provide a safe and accessible class and encourage agency, self-knowledge, and supporting our students in making conscious choices in practice.
Contraindications often revolve around individual needs and comfort rather than strict limitations, so we’ll talk a bit about how to provide options, variations, and props.
And we’ll explore common conditions that our students may experience, including back pain, sciatica, dizziness, frozen shoulder, carpal tunnel syndrome, and more.
I hope through this discussion we can shed light on adaptive strategies to ensure a safe and inclusive yoga experience for all practitioners.
A few reminders to begin:
We will have a general chat about common contraindications, but this does not replace the guidance of each students’ health team.
We are not doctors, physiotherapists, or knowledgeable enough about specific students or specific conditions to advise people what to practice or not practice. That role is their medical teams.
Two guidelines to keep at top of mind:
1. If in doubt, refer. If you aren’t sure your class is safe or suitable for a student with a medical or health condition, refer them back to their doctor for clearance and guidance.
2. If in doubt, leave it out. If you aren’t sure a pose or pose version is suitable for a student or environment, leave it out. Find another pose or pose version that will suit.
What does contraindication mean in yoga?
Any health or medical condition or limitation that could make a particular pose or technique, or activity harmful. Or, a specific pose, pose version, or technique that reasonably should not be practiced because it may be harmful to an individual or general group.
For example, when we talk about individuals, that might be people with high or low blood pressure, bone or joint problems, dizziness, osteopenia or osteoporosis, arthritis, pre or postnatal students, hernia, glaucoma, joint replacement, medications, mental health like PTSD, anxiety or panic disorders, or past issues with movement, breathwork, or meditation.
When we talk about general groups, we might include pre and postnatal students, kids, older adults, people in treatment for cancer or other medical conditions.
Contraindication can also relate to a particular environment where certain poses or techniques should not be used due to a higher risk of injury, or a lack of suitability due to population, equipment, environment, or expectations.
A few examples include:
• If you are teaching with no props available
• If you are teaching outdoors
• If the room is very hot or very cold
• If you are teaching in aged care, recovery centers, schools, or any institutional environment.
This can even include places like fitness facilities. For many years the fitness industry considered a few poses contraindicated for the gym environment, including:
• Shoulderstand
• Plough
• Upward Facing Dog
• Locust
• Upward Bow
These changed a lot year by year, and at the moment there is no definitive list of poses that I’m aware of that are considered contraindicated by the fitness industry at large but may be considered too risky (on the risk-benefit spectrum) may be guided by your specific gym, or your insurance provider.
High Risk – Low Reward or Risk/Benefit Spectrum
Risk-reward or risk-benefit analysis is a comparison between the potential risks of a situation and its potential benefits. In yoga, it’s my view that we err on the side of safety – so choosing less risky, more beneficial techniques. Particularly in a group class environment, there are really no techniques whose benefits outweigh potential risk, because there is always another technique or pose or pose version that could be less risky, and still maintain the benefits.
General Contraindications and Considerations:
I’ve done my best to compile a list based on my learning, but it’s a challenge to find clear, evidence-based guidance out there at the moment. As well, it’s challenge to put together a comprehensive list of contraindications because it depends on the individual and the pose version. However, I’ve done my best and look forward to continuing learning in this area.
I want to point out that many of the suggestions on my list are just about letting people know if they have discomfort, here are some versions, options, or props to find your place in the pose.
Note: all of these conditions should be assessed by a doctor prior to practice, and students should be informed by their doctor or health team about how to practice, what to reduce/modify/avoid, and how to keep their bodies safe during yoga.
High blood pressure
- Take care with poses where the head is below the heart. This includes standing forward folds, Downward Dog, inversions. Also take care with poses where students might hold their breath or strain.
Low blood pressure
- Take care with poses where the head is below the heart, particularly poses like Wide Leg Forward Fold, and poses where you go up and down a lot (Sun Salutations)
Osteopenia/Osteoporosis
- Take care with twists, poses where there might be bodyweight on the spine (Bridge), and poses that put the spine into deeper stretches.
Pregnancy
- Depends on the trimester, but take care with poses that compress the belly, over-stretch joints, and both prone and supine poses. Temperature is a key concern, especially in hot months. A good guideline is to reduce overall intensity, avoid or modify all inversions.
Pelvic floor injury/disfunction
- Take care with poses that put downward pressure on the pelvic floor (Plank, Boat).
Hernia
- Reduce intensity overall and avoid movements that compress the core, for example Child, Boat, Kapala Bhati breathing.
Sciatica and high hamstring tendinopathy
- Take care with deep forward folds, do not bend knees in forward folds.
Hypermobility
- Reduce the depth of stretches, encourage strength and stability.
Dizziness/inner ear/POTS
- Use support when balancing, keep eyes open, reduce intensity of poses that cause discomfort, which may include flows that go up and down (Sun Salutations), and coming out of deep forward folds.
Frozen shoulder
- Reduce the size of shoulder movements to that which is comfortable. Consider accessible options for any arm balancing, including poses like Downward Dog.
Carpal tunnel syndrome
- Reduce pressure on hands in arm balances or use alternative poses e.g. seated warmups instead of hands and knees position.
Osteoarthritis
- Take time to warm up, use supportive props, take care when bearing weight on affected joints.
Glaucoma
- Take care with poses with head below the heart. This include standing forward folds and Downward Dog.
Knee Pain
- Reduce flexion, put props under knees when kneeling, reduce/avoid/modify any poses that cause discomfort. Common poses that could be contraindicated for knee pain or joint replacement are Child, Lotus, kneeling lunges, Pigeon, any deep flexion, rotation, or kneeling.
Joint Replacement
- Students should be guided by their health team about safe range of motion. Joint replacements can vary widely with each approach (posterior, anterior etc.), but some hip and knee replacements should not be taken beyond 90-degrees of flexion. It is wise to avoid or modify strong poses such as Pigeon, Half Spinal Twist (Ardha Matsyendrasana), and the Marichiasana series.
Back Pain
- This one is tricky because, what kind of back pain, what intensity, for how long, what cause? For disc herniations, recent surgery, sciatica, or any diagnosed spinal condition (stenosis, spondylolisthesis, rheumatoid arthritis, degenerative disc) students should first consult with their health team. If a student is medically cleared for yoga or exercise, follow any guidance provided by their health team, and work together to find versions of poses that allow them to challenge their bodies within a comfortable range.
- General guidance may include taking care with poses that put excessive stress on the spine or put the spine in an unstable position. Common poses that could be contraindicated for back pain include: Upward Dog, Boat, Upward Bow, Warrior 1, Triangle,
What Are the Riskiest Poses?
Risk is a complex conversation because what is a risky movement depends on a number of factors, including someone’s health or medical conditions, their regularity in practice, their fitness and adaptation to yoga – that includes strength, flexibility, structure, posture etc. It also includes your ability as a teacher to provide step-by-step guidance in new, stronger, or more complex poses.
So, for the purposes of this discussion we’ll talk about the general yoga student who attends irregularly, or only 1-2 classes a week without a lot of time spent educating and workshopping poses.
Poses on the riskier end of the spectrum include:
• Shoulderstand
• Headstand
• Plough
• Lotus
• Upward Bow / Full Backbend
• Kapala Bhati or Bhastrika Pranayama
• Anything with legs behind the head
If you want to teach those techniques, there’s nothing in inherently dangerous about these techniques. It’s just that students been prepared for these techniques through regular practice. Have they had an education in how to move into these techniques? Do they know their bodies well enough? To move into these techniques? And is there space and time available for students to approach these techniques safely and steadily?
If you want to include more complex poses, you just need to make time and space to progress towards them intelligently, and provide solid, step-by-step guidance while offering options and versions.
How do you know if someone has a health condition?
We talk a bit about this here: Should I Ask About Injuries Before a Yoga Class?
But, in short, you might not. You might not be the one doing the intake or screening of new students, or if you do, students might not always divulge their medical conditions, or even know that it’s important for you to know so that you can provide guidance.
So, this is where we can be providing guidance throughout class to empower our students to be listening to their bodies and making choices about how to practice. We can make suggestions like ‘if your wrists are uncomfortable here you might try’, or ‘if your knees don’t like being on the ground you might try’, or, ‘if you get dizzy coming out of this pose you might…’
This strategy puts the power back into the students’ hands to remember what guidance they’ve received from their medical team, and to listen to their bodies and choose versions, adaptations or props that suit where their bodies are at today.
I also want to briefly mention that we can also create an environment of safe practice by speaking openly about how we approach movement in general, for example letting go of ideas of ‘perfecting’ poses, ‘full expression of the pose’, or excessive enthusiasm for striving for more intensity or complexity.
In Closing: Understanding Common Contraindications in Yoga
Thank you for sharing this discussion with me on common contraindications in yoga. I hope that we can continue to learn together with an aim to provide a safe and accessible class and encourage agency, self-knowledge, and supporting our students in making conscious choices in practice.
Remember that contraindications often revolve around individual needs and comfort rather than strict limitations. We can create an environment for safe, joyful practice through how we develop our class culture, through our communication skills and teaching strategies and through enthusiastically providing options, variations, and props to support participants in finding comfort and safety in each pose.
I look forward to continuing this discussion together as we continue to develop strategies to ensure a safe and inclusive yoga experience for all practitioners.
Final Note: This discussion is for educational purposes only and should not replace individualized medical advice. Always consult with a healthcare professional before beginning any exercise program, especially if you have pre-existing health conditions or concerns.
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