Yoga Contraindications

Yoga Contraindications

A Reference Guide For Practicing Safe Yoga With Physical Conditions

Before we get into the nitty gritty of this very important topic, let’s make sure you understand what yoga contraindications are.

Although we always hear about how healthy and great yoga is for the body, not all asanas (poses/postures) and pranayama (breathing exercises) are recommended for every body, all the time. A yoga contraindication is a specific situation in which a particular pose or breathing exercise is NOT advised, because it could jeopardize one’s health. Such instances include low pack pain, shoulder injury and pregnancy.

Injury prevention lies within the hands of both student and teacher. As a student, you should know enough about your condition to recognize when you may be headed for trouble. As teachers, we should know how to safely guide our students by understanding the most common conditions and what is contraindicated.

As yoga spreads and reaches the far corners of the planet, our safety net needs to cover a drastically broader range of people. For some, yoga is being used therapeutically to treat a condition or heal an injury. For others, yoga is a method of toning the physical body and challenging its limits. And yet for another group, yoga is tool for spiritual transformation. We all show up on the mat for different reasons and with different strengths and limitations. This is not a one-size-fits-all guide, nor are humans, and nor is yoga. My intention is to provide a starting point focused on safety from which to explore and fine tune individually, and not instill fear. As students and teachers, it’s important to inform ourselves, so we can all practice yoga that is safe and sustainable for a lifetime.

Please use this guide as reference and not a substitution for medical advise from a doctor. Please share your conditions with your teacher and forgo anything that simply doesn’t feel right.

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Learn more about each condition

ASTHMA

THE CONDITION

Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing.

CONCERNS WITH PRACTICING YOGA

  • Restricting the airways
  • Inducing an asthma attack

GENERAL INFO 

Because asthmatics have difficulty breathing, they tend to “over-breathe” or experience abnormal and unstable breathing patterns. Although an asthma attack is typically triggered by an allergy or external irritant such as pollen, emotional and cognitive distress can set off an attack or worsen one. As a result, yoga and pranayama (breathing exercise) have been shown to reduce symptoms and prevent attacks.

Learning how to slow down the breath with pranayama is key to helping asthmatics through yoga. This can be done by practicing extended exhales and diaphragmic breathing.  Asthmatics will also benefit from balancing their breathing patterns with ujjayi breath or nadi shodhana (alternate nostril breathing).

Generally, there are no contraindicated asanas (poses) for asthma, although one should practice with caution when it comes to poses that constrict the airways, such as forward bends like Paschimottanasana, twists, and abdominal strengtheners like Boat Pose. Inversions such as Downward Facing Dog and Shoulder Stand can help clear the lungs for some, but strain the breath for others, thus inversions should also be practiced with caution.

 

HAMSTRING INJURY 

(STRAIN OR SPRAIN)

THE CONDITION

A hamstring injury occurs when a person strains or pulls one of the hamstring muscles — the group of three muscles that run along the back of the thigh.

CONCERNS WITH PRACTICING YOGA

  • Causing further injury by straining the muscles or spraining the ligaments
  • Causing repeated injury by overstretching

GENERAL INFO 

Hamstring injuries happen when a muscle or ligament is stretched beyond its capacity or challenged with a sudden load. Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers.

While practicing yoga, hamstring injuries occur most frequently where the muscle meets the tendon and are the result of overstretching in forward bends like Paschimottanasana (Seated Forward Bend) and “from overexposing the hamstring attachments at the ischial tuberosities (sitting bones) by pulling the flesh of the buttocks away during seated forward bends” (Mark Stephens, Teaching Yoga).

In the first week of injury, rest is critical to healing and yoga should not be practiced. For mild strains, practice with caution and modify asanas that stretch the hamstrings with bent knees, for example Standing Forward Bend (Uttanasana), Downward Facing Dog, Triangle Pose, and Wide-Legged Forward Bend (Prasarita Padottanasana). If pain is present, avoid practicing poses just mentioned, as well as seated forward bends and Wide-Leg Seated Forward Fold (Upavista Konasana). For severe strains, do not practice yoga until injury is fully healed and approved by a doctor.

 

HIP REPLACEMENT

(POSTERIOR TOTAL HIP REPLACEMENT)

THE CONDITION

A total hip replacement is a surgical procedure where diseased cartilage and bone of the hip joint (the head of the femur and acetabulum) are surgically replaced with artificial materials.

CONCERNS WITH PRACTICING YOGA

  • Dislocating the hip joint

GENERAL INFO 

When it comes to hip replacements, the first thing to consider is the method of surgery- either anterior or posterior. The posterior approach poses a significantly higher risk of instability and dislocation because accessing the hip from the rear requires cutting through the supporting muscles of the buttocks. The anterior lateral approach reaches the hip joint with a minimal incision on the side body that does less damage to soft tissues and does not cut into any supporting muscles. For both approaches, practitioners should not practice yoga until completely healed and with consent of their doctor (generally six months to one year).

For those practicing with a posterior total hip replacement, adduction (crossing at the knees as in Eagle Pose), flexion past 90 degrees (bending forward at the hips as in Child’s Pose) and internal rotation (turning the thighs in as with Mountain Pose) are contraindicated. By combining these actions in one asana, we pose even more risk. For example,  Uttanasana (Standing Forward Bend) flexes the hip while internally rotating the thighs. Simply lying on the back and pulling the knees in towards the chest (hip flexion past 90 degrees) can be dangerous. Thus, Child’s Pose is even more risky because of the additional weight of the body bearing down on the hip joints.

For anterior hip replacement, the risks are minimal after recovery. However, one should still be cautious and/or limit leg abduction, external rotation of the thigh, and leg extension (basically the opposite of what’s contraindicated for the posterior approach).

 

HYPERTENSION

(HIGH BLOOD PRESSURE)

THE CONDITION

Blood pressure is the amount of force exerted against the walls of the arteries as blood flows through them. If a person has high blood pressure it means that the walls of the arteries are receiving too much pressure repeatedly. Normal range is 120/80. High blood pressure is a sustained 140/90 or higher.

CONCERNS WITH PRACTICING YOGA

  • Adding additional pressure to stressed blood vessels or causing hemorrhage

GENERAL INFO 

While most forms of exercise reduce stress, increase blood flow and lower blood pressure, those who are new to yoga and/or coming from a sedentary lifestyle may experience increased blood pressure in the beginning of starting a yoga practice.

Poses where the heart is above the head are of major concern for those with high blood pressure. When the body is inverted, blood tends to pool in the head, which is OK for those with normal blood flow. However, for those with high blood pressure, the added pressure on the cranial blood vessels can cause severe damage, such as hemorrhage. Mild inversions like Downward Facing Dog, Bridge Pose, and Standing Forward Bend (Uttanasana) should be practiced with caution and extra attention on pressure in the head. Full inversions where the lower body (legs) is also above the heart should be avoided or practiced with extreme caution. Be aware, as much as inversions can be problematic (especially for severe cases or those coming from sedentary lifestyles), they can also be beneficial if the individual body allows. In his book, The Science of Yoga, William J. Broad explains that Shoulder Stand is particularly effective in lowering blood pressure by acting on the parasympathetic system and carotid sensors that help regulate blood flow to the brain.

 

KNEE INJURY 

(STRAIN & REPAIRS)

THE CONDITION

The most common knee injuries include fractures around the knee, dislocation, and sprains and tears of soft tissues, like ligaments. In many cases, injuries involve more than one structure in the knee.

CONCERNS WITH PRACTICING YOGA

  • Deep bending
  • Direct weight/pressure on the knee
  • Pushing the joint past its current range of motion

GENERAL INFO 

Being that the knee joint is a hinge joint, any movement that pushes it past its natural range of motion should be avoided. For example, hyperextension, pressure from placing the foot on the knee in Tree Pose, or the twisting action that can occur in the back knee with Warrior I.

Depending on the injury, the problems usually occur by putting direct weight on the knee, bending the knee, or both. Be very aware of postures that stress the knee with a wide range of motion, such as Lotus Pose, or combine deep range with bearing weight, such as Child’s Pose or Pigeon Pose. Don’t force full flexion or extension of the knee.

With knee injuries, proper alignment in standing asanas is crucial in preventing further stress. Generally speaking, the hip, knee and ankle should all be in line with one another, especially in Warrior I. If the back foot is turned out 45 degrees, the knee and hip should face the same 45 degrees. Otherwise a twist arises in a joint that is not designed to twist. The front knee should never bend so deeply that it passes the ankle in postures like Warrior I and Warrior II. To prevent hyperextension, slightly bend the knee and engage the thigh in asanas, such as Triangle Pose and Standing Forward Bend.

 

LOW BACK PAIN 

THE CONDITION

“Most low­ back pain results from degeneration of the intervertebral discs and the consequent pressure on the nerves” (Mark Stephens, Teaching Yoga). Common conditions that cause pain include stiffness, sciatica, stenosis, bulging disc, and herniated disc.

CONCERNS WITH PRACTICING YOGA

  • Exacerbating pressure on the discs
  • Causing further inflammation
  • Overextending the vertebral joints
  • Overstretching supporting muscles

GENERAL INFO 

When experiencing any form of low back pain, one should be extra mindful to practice consciously and gently (reduce normal effort, range and depth to 70% or less). Avoid or stop any posture and transition that causes pain or discomfort. On one hand, backbends and forward bends can provide relief. On the other hand, they can do further damage. It varies person to person, so be aware and test the waters before doing too much. If experiencing a disc herniation, backbends and forward bends are contraindicated until healed, then practiced with caution.

Do not extend the spine (bend backwards) while rotating (twisting). This happens while grabbing the foot in Mermaid Pose, when reaching back to grab the ankles one side at a time in Bow Pose (Dhanurasana), and if not careful, it can occur when lowering down or rising up one side at time in Camel Pose. Additionally, do not bend forward and twist simultaneously as with Head To Knee Pose (Janu Sirsasana).

For mild pain, modify Downward Facing Dog by bending the knees and/or stepping the feet farther apart. Modify all forward bends (standing and seated) by bending the knees. Twist from the mid to upper spine and keep the hips square to avoid overextending the lumbar spine. Additionally, avoid rolling up on vertebrae at a time from Standing Forward Bend, as the weight on the upper body unnecessarily compresses the lumbar discs.

 

SCOLIOSIS 

THE CONDITION

Scoliosis is a condition in which the spine bends to the side abnormally; either to the right or left. The curvature can be moderate to severe. Any part of the spine can be bent in scoliosis, but the most common regions are the chest area (thoracic scoliosis) or the lower part of the back (lumbar scoliosis).

CONCERNS WITH PRACTICING YOGA

  • Exacerbating pain in the back and the scoliotic curve

GENERAL INFO 

Anyone with scoliosis should really familiarize their self with the unique qualities of their personal condition and practice yoga with caution and acute awareness to changes and sensations throughout practice.

Modifications based on the individual’s curve are essential to prevent further progression of the condition. For example, when lengthening the spine, you generally want to lengthen the opposite side of the curve, not both sides. In Triangle Pose (Trikonasana), a person with the right leg forward and a right thoracic curve will want to focus on lengthening the left side of the body. Use the breath to create space in compressed areas around the spine.

Some find backbends helpful in reducing pain and opening up spinal movement. However, others find that backbends exacerbate it. Again, this is why it’s so important for practitioners to pay close attention to what’s happening in their unique bodies. However, all practitioners should still approach backbends and forward bends with great caution, as the conditions of our spines vary with day to day activities. If comfortable, proceed with contraction backbends like Locust Pose variations to strengthen the supporting muscles of the spine.

 

SHOULDER INJURY 

(PAIN & IMPINGEMENT)

THE CONDITION

Shoulder impingement occurs as the result of chronic and repetitive compression or “impingement” of the rotator cuff tendons in the shoulder, causing pain and movement problems. General tightness or pain commonly arise from an imbalance in the four muscles of the rotator cuff as well.

CONCERNS WITH PRACTICING YOGA

  • Dislocation
  • Straining the joint or ligaments
  • Exacerbating rotator cuff imbalance

GENERAL INFO 

The shoulder joint has a wide range of motion and is considered one the “loosest” joints in the body. With this great mobility, however, comes instability and shoulders are prone to injury. Since most pain and impingement of the shoulder stem from an imbalance with the rotator cuff, the key to health is balancing strength and flexibility and building stability.

If pain is persistent, avoid poses that draw the elbow above the shoulder or arms above the head. For example, poses as basic as Upward Salute (Urdhva Hastasana) can exacerbate pain. More complex poses with the arms over head include Downward Facing Dog, which poses even more risk due to pressure on the shoulder from bearing body weight.

You shouldn’t try to “work through” shoulder pain, but there are modifications. Downward Facing Dog can be modified by rotating the hands out 20 degrees or done at a wall. To avoid shoulder pain in Warrior II, modify by flipping the palms up so the arm weight is supported by the shoulder blades.  Arm balances are contraindicated when pain is present or healing an injury, however, they can be used to strengthen the joint after an injury. Use caution when stretching the shoulder, as with Cow Face Pose (Gomukhasana) or Eagle Pose, and forgo them all together if painful.

 

SI (SACROILIAC) JOINT 

(PAIN & DYSFUNCTION)

THE CONDITION

Sacroilliac pain shows up in many ways such as strain, inflammation, arthritis, and degeneration. Dysfunction generally refers to pain in the SI joint region that is caused by abnormal motion in the SI joint, either too much motion or too little motion. It typically results in inflammation and can be debilitating.

CONCERNS WITH PRACTICING YOGA

  • Causing the joint to slip out of place
  • Generating inflammation
  • Creating hypermobility in the joint from overstretching

GENERAL INFO 

The beginning stage of SI joint dysfunction usually starts as a consequence of strained, injured or weakened ligaments, with degenerative conditions following after years of sustained dysfunction. The joint that was once stabilized by strong ligaments, now moves beyond it’s normal range of motion (hypermobility), resulting in pain. Note, that what happens in one side, doesn’t always show up in the other. For example, while one side is hypermobile, the other can hypomobile (loss of normal range of motion).

Asymmetrical poses are problematic because one side of the body is doing something different than the other, which can stress the SI joint. Especially poses where the hip is in a fixed position and the spine is being pulled in the opposite direction, such as Warrior I and Janu Sirsasana. Progressing into a sequence of multiple asymmetrical poses is even more stressful on the joint and should be avoided. For more extensive information about asymmetrical poses and the SI joint, check out this really informative article, Too Many Asymmetrical Poses Can Create Sacroiliac Joint Issues.

In forward folds, bend (hinge) from the hip sockets, not from the waist, and bend the knees. Be very cautious when it comes to twisting. Keep the twist in the mid to upper spine. Contrary to most cues, allow the hips to move with the spine as one, and instead of anchoring the pelvis, anchor the thigh, leg or foot.

 

WRIST INJURY

(PAIN & CARPAL TUNNEL SYNDROME)

THE CONDITION

Common wrist conditions include a sprain (injury to the ligaments), a strain (tearing of a muscle) and carpal tunnel syndrome (compression of the medial nerve in the wrist).

CONCERNS WITH PRACTICING YOGA

  • Causing inflammation
  • Compressing the medial nerve
  • Hyperextending the joint. Spraining the ligaments

GENERAL INFO 

Carpal tunnel syndrome is often misdiagnosed, with the nerve compression taking place in the neck or shoulder, as opposed to the flexor tendons of the wrist. Conditions and pain in the wrist can result from problems directly in the wrist or often show up through imbalanced use forearm and shoulder muscles.

Many people have imbalanced muscle tone between the muscles in the forearm due to daily activities such as driving and typing. The forearm flexors (muscles used to help grip the hand) are often overused as compared to forearm extensors (muscles used to help open the hand). This imbalance creates an unequal pull on the wrist joint, which can result in pain. In this case, a person would want to strengthen the wrist extensors and stretch the wrist flexors.

If pain is persistent, arm balances and other asanas that bear weight on the wrist are contraindicated (including Plank Pose and Downward Facing Dog). To prevent wrist injury, distribute the weight over the entire span of the hand and firmly press the knuckles down. Additionally, incorporate plenty of wrists therapy, such as simple wrist rotations, into your practice and ensure the arms and shoulders are properly warmed up before practicing arm balances.

 

PREGNANCY

PREFACE

In his book, Teaching Yoga, Mark Stephens explains a simple approach to practicing yoga while pregnant. He suggests two simple categories for pregnant women:

1. those with sedentary lifestyles, poor physical health, or high-risk pregnancy

2. those with active lifestyles, good overall health, and minimal pregnancy risks

Women in category 1 are encouraged to attend pre/post natal classes only, as the teachers are specifically trained to care for students who are new, pregnant and have special conditions.

Women in category 2, who are experienced yogis are encouraged to stay with their practice, but modify their practice with the help of an informed teacher.

Either way, Mark emphasizes that “pregnancy is not the time to begin a vigorous yoga practice, nor the time to attempt new or more complex asana”.

Pregnant women in category 2 should reduce their practice to 70% of their normal effort, range and depth.

 

PREGNANCY

(1st TRIMESTER)

WEEKS 1 to 12

CONCERNS WITH PRACTICING YOGA

  • Disrupting attachment of the embryo to the uterus
  • Miscarriage

GENERAL INFO 

During the first trimester, the sensations of pregnancy can be new and intense. With an assortment of hormones being released, the body begins its work of creating a safe, supportive environment for the growing baby inside. With the body transitioning and transforming, this is the time for women to ground, balance the effects of the hormones, and turn their attention inward.

Pranayama that encourages forceful movement of the belly should not be practiced, such as kapalabhati (breath of fire). Any movements that create a jarring or jolting impact on the body, specifically the belly region, such as jumping back to Chaturanga, should be avoided, as they can induce detachment of the embryo to the fetus. The same is true for deep belly twists. Twisting should be light and focused around the upper thoracic area, as twisting in the belly can pull on the ligaments that attach the embryo. Additionally, exercises that target strengthening the abdominal muscles should be left out, as hardening the belly area does not create a soft and comforting space for a delicate and growing embryo.

 

PREGNANCY

(2nd TRIMESTER)

WEEKS 13 to 27

CONCERNS WITH PRACTICING YOGA

  • Putting additional strain, compression and pressure on the belly and uterus

GENERAL INFO 

With hormones settling down and morning sickness subsiding, yoga in the second trimester can help a woman feel more physically comfortable and prepare the body for the months ahead. This is a great time for hip openers and standing postures that help build strength.

During this trimester a woman begins to show and the uterus is no longer protected by the pelvis, so avoid asanas that are done lying prone (on the belly, face down). However, poses such as Cobra Pose and Locust Pose can be modified to make room for the belly by placing a bolster or rolled blanket under the hips. Lying supine (on the back) should be done with caution because it compresses the vena cava, which can result in abnormal breathing and decreased blood flow.

Do not practice deep twists. Pranayama that pulses the belly (kapalabhati) or retains the breath should not be practiced. In general, avoid compression of the abdomen. This includes abdominal strengtheners such as Boat Pose (Navasana). The strengthening and hardening of abdominal muscles can prevent the baby and uterus from natural upward growth. This results in downward pressure in the uterus that can lead to perineal tears during delivery.

Additionally, avoid inversions such as Handstand and asanas that pose the risk of falling.

 

PREGNANCY

(3rd TRIMESTER)

WEEKS 28 to BIRTH

CONCERNS WITH PRACTICING YOGA

  • Causing joint instability by overstretching the ligaments due to the hormone relaxin
  • Maintaining balance

GENERAL INFO 

When it comes to asana during the third trimester, the greatest concern is stabilizing the joints and maintaining balance. At this point, the uterus is very crowded and the mother is more than likely dealing with frequent urination, low back pain, and fatigue. A practicing mother should be cautious of slowed circulation, dizziness and loss of breath and balance. Inversions that pose the risk of falling should be avoided. After week 36, be very cautious of Downward Facing Dog. Modify by holding for shorter durations of time or with Puppy Pose. In some cases, Downward Facing Dog can help position the baby into ideal presentation, but in other cases it can lead to abnormal presentation.

A hormone called relaxin is working hard to relax the ligaments and prepare the pelvis to widen. Relaxin, however, doesn’t just work on the pelvis, so a practicing mother should be cautious of any new found flexibility in joints throughout her body. She should practice with ease at about 60-70% or her normal range and not push herself to her deepest edge. Be aware, that relaxin is produced until a month or so after a mother stops lactating, so the same rules about joint stability apply to her post-natal practice in order to prevent a lifetime of loose ligaments.

References

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