You may have heard that Yoga Alliance recently initiated a standards review project. One of the standards undergoing revision is scope of practice. If you aren’t familiar with what this means, “scope of practice” is typically defined as the procedures and actions a teacher is allowed to undertake while staying within the boundaries of a professional license.
Reviewing and defining scope of practice is important because, while yoga has existed for thousands of years, there is no single, universally shared scope of practice for yoga teachers as there is for instructors of other comparable activities (for example, Pilates or personal training). This means that the scope for different teachers can vary depending on their educational backgrounds.
For example, if you are both a yoga teacher and a physical therapist with appropriate insurance, it would be within your scope of practice to make a manual adjustment to a student in a private session. However, if you had a 200-hour yoga teacher training but did not have a license to touch, it would then be out of your scope of practice to apply manual adjustments—even if you had learned how to do them in your yoga teaching training. Knowing this, it would seem that keeping students safe is dependent on all yoga teachers following a similar scope of practice.
In my experience as a yoga teacher trainer and continuing education provider, I’ve noticed five primary areas in which well-meaning yoga teachers unintentionally go beyond what should be their scope of practice. These are touch, mental health counseling, diagnosis, prescription, and nutrition.
It is important to note that each of these categories is or relates to a professional industry that requires specific education and licensing that goes beyond what would be within your scope of practice if your only education is from a yoga teacher training.
In this article, my hope is to give you a framework by which you can know if you are teaching within your scope of practice and to identify when you should refer out to an expert in a different field.
When you took your teacher training, you may have been taught hands-on assists for yoga poses. However, if you teach yoga in the United States, you should be aware that the laws governing a license to touch and the education required to perform any type of adjustment involving stretching or moving another person’s body part can vary from state to state.
Every state has its own laws and guidelines on what defines appropriate touch, and you should review your state’s laws and consult an attorney.
Some of the professionals with a license to touch include physical therapists, doctors, chiropractors, massage therapists, and others in the medical field. In a broad sense, unless you are a physician or licensed massage therapist, if you perform hands-on adjustments, you are considered in many states to be practicing medicine without a license. Teacher trainings are not carefully regulated, so if you haven’t heard this before, it’s not your fault. However, the good news is that now, with this information, you can adjust your teaching accordingly.
It’s also the case that many students don’t expect to receive hands-on adjustments when they take a yoga class—unlike when they get a massage or go to see a chiropractor. This is because many view yoga as a workout or a group fitness class.
With this in mind, you are better off not performing hands-on adjustments when working with students, unless you have a license to touch, the appropriate education, insurance, and your students’ consent. Even if you are also a physical therapist, you may still want to avoid hands-on adjustments in class, because you don’t have enough information about each individual student’s body and medical history.
Mental Health Counseling
Many people seek out yoga as a way to reduce stress in their lives and improve their mental health. While yoga can help with these things, as yoga teachers we are not licensed (nor usually qualified) to provide mental health counseling.
Examples of professionals who are licensed to offer mental health counseling include social workers, psychologists, and psychiatrists. If a student comes to you asking for advice on topics such as marriage, emotional trauma, depression, or anxiety, you should refer them to a licensed mental health professional.
Many of your students will come to you after class, point to an area of their body, and ask you, “Why does this hurt?”
While it is within your scope of practice to offer feedback on form or modifications for a specific pose that feels uncomfortable, as a yoga teacher, it is outside your scope of practice to diagnose your students’ aches and pains. For example, if a student reports having knee pain in pigeon pose, it would be within your scope of practice to suggest that they perform figure 4 as a modification. It would be out of your scope of practice to tell them that they might have a torn meniscus.
When you get this question, it is an excellent time to have on hand a roster of physical therapists and doctors to whom you can refer your students for diagnosis and treatment.
While it is within your scope of practice to suggest poses to promote relaxation, flexibility, strength, and balance, it is beyond your scope of practice to prescribe a specific pose, breathing technique, supplements, or diet to treat a medical condition. If someone has a specific medical condition, it is their personal responsibility to see a medical professional and find out what they can do, what they can’t do, what they should do, and what they shouldn’t, and to know that this may change over time, depending on their diagnosis.
This is where it can be beneficial to work in conjunction with a medical professional overseeing your student’s medical condition. The clinician who performed the diagnosis will know what the appropriate prescription is for their patient, which also may change throughout the healing process. By following the medical provider’s recommendations, you will have a better sense of what is appropriate and not appropriate for a student working with you.
Some students may ask you for nutrition advice. Unless you are a registered dietician or other medical professional with appropriate training and licensure, it is out of your scope of practice to recommend a specific diet, cleanse, food, or supplement for your student.
A student who asks you specific questions related to food and nutrition will be best served if you refer them to a registered dietician or similar professional.
With this in mind, what is in your scope of practice?
As a yoga teacher, the following are within your scope of practice, based on the scope of practice guidelines from similar professions:
• Design a yoga sequence or program according to a student’s individual needs.
• Coach and provide general information.
• Direct a student to seek medical attention as necessary.
• Receive recommendations and clearance from your student’s medical provider to ensure student safety.
• Cooperate with referring medical providers.
• Promote yoga to improve general health.
• Request permission to touch your students, and observe the laws within your jurisdiction governing touch.
• Use appropriate touch to facilitate movement, position, and prevent injury within those laws.
Despite Yoga Alliance’s standards review, scope of practice will undoubtedly continue to vary on an individual basis depending on where you live and what education you’ve received. I hope you find these guidelines helpful as a framework for ensuring that your students get the help they need—from you, as well as from any other appropriate professionals.
Photography: Andrea Killam