Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional.
Even when yoga is strenuous, ideally it is free of strain. We practitioners should aim to steer clear of sensations like pain, tingling, and numbness, and no pose should stress our joints or put us at risk of injury. While students are often encouraged to “listen to our own bodies,” and to tailor practice so as to avoid discomfort and make poses safer, it is not always clear how to do that.
Below are some general suggestions on making practice feel better for those who feel discomfort in particular areas of the body, or who have an underlying condition that could be aggravated by certain movements or positions. By avoiding some poses, emphasizing some alignment points already in our repertoire, and adding a few modifications designed to take weight or pressure off an injured or vulnerable area, we can substantially increase ease and safety.
It is important, however, that any injuries be properly diagnosed by a medical professional. If you are a student, let your teacher know about any injuries you may have and any medical advice you’ve been given. If you are a teacher, ask your students about injuries, as well as the movement recommendations they’ve received from doctors.
If pain or numbness persists even with the suggested modification, back off and take a rest.
1. Wrist or Forearm Discomfort
(e.g., from carpal or ulnar tunnel syndrome, De Quervain’s syndrome, wrist sprain, old Colles’ fracture)
If you do repetitive activities with your hands, you may find that the nerves in your wrist become aggravated, especially after multiple vinyasas.
Poses/actions to avoid if they cause discomfort: Placing your wrists in extension (as in poses like plank) while bearing weight.
The alignment and modifications that may help: Avoid further irritation to the three nerves that run through your wrist (medial, radial, ulnar) by keeping your wrist “flat,” or in its neutral position whenever possible; in other words, create a smooth line from the forearm to the back of the hand.
Instead of practicing plank and similar poses with your palms down, practice them on fists, knuckles down, index-finger sides of hands forward, and wrists flat. To create a neutral wrist, you could also practice plank and similar poses with hands around dumbbells (with the dumbbells running parallel to the long sides of your mat, with wrists flat).
Alternatively, instead of plank, practice forearm plank with palms down or hands holding a block between them.
As wrist pain eases, it may be possible to simply lessen wrist extension rather than avoiding it entirely. For example, place a wedge under the front of the mat that tilts your fingers and palms downward in poses like table, plank, and downward dog.
2. Elbow Pain
(e.g., from lateral epicondylitis [tennis elbow], or medial epicondylitis [golfer’s elbow])
Those who do repetitive activities with their arms may find that the tendons or ligaments around the elbows become torn and/or inflamed.
Poses to avoid if they cause discomfort: Since the muscles and tendons that extend your wrist attach to your elbows, it may be wise to avoid practicing any pose in which you bear weight with your wrist in extension. Steer clear of poses that place weight directly on top of the elbow, such as crow, side crow, or similar arm balances.
The alignment and modifications that may help: Practice plank pose (and similar poses) with neutral wrists as described in #1 (using fists or dumbbells) to prevent pulling on the tendons that attach to the elbow. Be careful not to hyperextend your elbows; instead, press your inner upper arms away from each other until your biceps engage. Be sure to keep your collarbones broad and your shoulders back while externally rotating your upper arms until the eyes of the elbows point toward the thumbs of each fist.
Maintain external rotation in your upper arms as you lower toward chaturanga. (External rotation will help to keep your elbows near your torso as you bend them to go into chaturanga, alignment that encourages balanced work from the muscles on the inside and outside of the elbow.) Since a greater degree of bend in the elbows places more pressure on them, do not lower so far that you feel strain.
3. Neck Pain
(e.g., from disc problems or muscular strain)
Forward head posture, in which the head is habitually positioned in front of the shoulders, is correlated with neck pain. Those who work at a desk or use handheld electronic devices often find that their heads move forward; over time, this may reduce neck length, stress the muscles of the neck and the intervertebral discs, and even lead to a rounding of the upper back.
Poses to avoid if they cause discomfort: If you are experiencing neck pain, avoid poses that potentially compress the cervical vertebrae. These include inversions like shoulderstand and headstand that place pressure on the head and/or neck. Also, avoid moving into big backbends like camel pose before shoulder alignment has been established, and avoid extremes of neck extension: In poses like camel (and even in savasana) do not tip your head back to the point that the back of your neck creases.
The alignment and modifications that may help: In mountain pose, roll your shoulders up and back, and draw your shoulder blades toward your spine until there is a crease between them. Tuck your chin enough that the back of your neck lengthens, reach up through the crown of your head, then bring your ears back over your shoulders as much as you can while keeping the back of your neck long.
Keep this spaciousness across your chest and length at the back of your neck in poses ranging from savasana to camel. lf the back of your head does not come to the mat comfortably in savasana, place a blanket under your head to keep the back of your neck long.
To modify camel pose, in a high kneeling position, take hold of a strap between your hands, with your hands a little wider apart than your hips and your palms facing forward. Roll your shoulders into place, and tuck your chin slightly, drawing your ears back until they are roughly in line with your shoulders. Keep your chin slightly tucked as you focus on lifting your heart and perhaps take the strap an inch farther back. (Do not take the strap so far back that the tops of your shoulders roll forward.) Stay here for several breaths, keeping the back of your neck long instead of tipping your head back.
4. Shoulder Pain, Rounded Upper Back, Upper Back Pain
(e.g., from shoulder bursitis, biceps tendinitis, rotator cuff strain and thoracic kyphosis)
In part because of prolonged periods of sitting or time spent carrying or lifting heavy loads (including small children), our upper backs may round and our shoulders roll forward—a suboptimal position that can cause upper back pain and make the shoulders susceptible to injury when bearing weight or performing repetitive motions. (For practice suggestions that will help position the shoulders well and minimize the rounding of the upper back, check out our article “Yoga for Kyphosis.”)
Poses you may need to avoid: Since it can be risky to support much weight with the hands and arms if your shoulders and upper back are not optimally aligned, steer clear of poses such as side plank, forearm balance, and chaturanga. If downward facing dog does not feel good, skip it.
The alignment and modifications that may help: Work on shoulder alignment by rolling your shoulders onto your back, then drawing your shoulder blades toward your spine as much as possible. Avoid rounding your back in weight-bearing poses like tabletop and plank. Instead, flatten the area between your shoulder blades.
In poses like chaturanga and baby cobra, stay broad across your collarbones rather than letting your shoulders round forward. When your arms are higher than your shoulders, as in urdhva hastasana (upward reaching pose) and warrior I, allow the outer edges of your shoulder blades to lift up (pressing your shoulder blades down your back when your arms are overhead disrupts the scapulohumeral rhythm and impinges on the spaciousness of the shoulder joint).
Until you are able to maintain optimal shoulder alignment, stick with poses that put less weight on the shoulders: You can practice tabletop instead of plank, downward facing dog, side plank, and other strenuous arm balances.
Take weight off your shoulders in chaturanga by lowering your knees to the floor and bending your elbows only a small degree.
5. Loss of Bone Density (Osteoporosis)
One’s degree of bone loss, which can only be assessed by a physician, must be considered when determining the degree to which a practice must be modified. Those with significant loss of bone density are generally advised to avoid extreme ranges of movement, especially extremes of spinal movement. The thoracic spine is particularly vulnerable; not only can fractures here lead to a rounding of the upper back, but a rounding of the upper back can lead to fractures. (A detailed sequence designed for those with osteoporosis can be found here.)
Poses you may need to avoid: Forward folding is considered the riskiest movement for those with osteoporosis, especially when the spine is flexed (rounded) with no support under the hands. A deep unsupported standing forward fold, for instance, places a greater load on the thoracic vertebrae than it would when modified with the hands and arms supporting some of the body’s weight. Big backbends, sidebends, and twists should also be avoided. Further, it may be unsafe to begin an inversion practice after your diagnosis, though some students with longstanding inversion practices and a minimal degree of bone loss may be able to continue with their doctor’s okay.
The alignment and modifications that may help: Throughout as much of yoga practice (and as much of your life) as possible, aim to create a neutral spine (by aligning your ears, shoulders, and hips) and find as much spinal length as possible (by reaching the crown of your head away from your tailbone). Roll your shoulders onto your back, and bring your shoulder blades toward your spine, as if trying to make a crease between your shoulder blades.
Avoid moving so deeply into forward folds that your spine rounds; instead, forward fold only to the degree to which you can still keep your spine long. For instance, instead of practicing uttanasana—a standing forward fold—practice a high version of ardha uttanasana, with your hands on your thighs or on a chair and your spine long.
Instead of forward folding into paschimottanasana, stay in staff pose.
Take precautions against falling, since falls can lead to fractures; have a wall or a chair available for support during balance poses, and take transitions slowly.
6. Moderate to Severe Hamstring Tightness/Pain
(including hamstring microtears or a history of hamstring strain)
Tightness at the back of the legs, caused by athletic activity or prolonged sitting, can inhibit one’s ability to forward fold. Forward folding repeatedly without time to recover, or while in suboptimal alignment, may lead to hamstring tears.
Poses to avoid: For those with hamstring tightness or tears, there is often no need to avoid any particular pose, though the way you practice forward folds might need to be adapted. This is discussed under modifications.
The alignment and modifications that may help: A pelvis that is tilted too much in either direction (forward or back) is correlated with feelings of hamstring tightness. So work to create a neutral pelvis, tilted forward enough that your lower back curves in gently while your belly draws in and up on each exhale to support the spine. Because misaligned movement can lead to injury or tightness, when standing (both in and out of yoga class), track your knees toward the centers of your feet, and root down through the four corners of each foot. (See this article for more alignment suggestions for the hamstrings.)
If you have tightness or microtears in your hamstrings (most often felt underneath the buttocks), fold forward only as much as you can without pain, tingling, or numbness. Those with tightness or microtearing should work up to forward folds over time, starting first with hamstring stretches done lying on the back, lifting one leg toward the ceiling with a strap around that foot.
When those poses begin to go well, progress to seated poses with your legs extended. Leaning back with your hands a few inches behind your hips is one way to create spinal length while seated: This position may make it possible for you to curve your lower back gently inward and reach out through the crown of your head.
Gradually work to keep this elongated spine while seated upright, with your hands alongside your hips. As that becomes more accessible, begin folding forward with your hands alongside your hips or on your thighs, keeping your legs straight and pausing at the first degree at which you feel a stretch. (While bending the knees is not unsafe as long as the knees track well, that common modification may cause a student to avoid stretching certain areas of their hamstrings in a quest to bring their hands nearer to their feet.)
Once it is possible to fold forward with some ease, progress to a standing forward fold with your hands on your thighs, a chair, or blocks (not dangling, since hamstring issues may make the SI joints, intervertebral discs, and lower back muscles especially vulnerable to strain).
Generally, in all folds, we want to aim to cultivate a gradual rounding from the lower to upper spine. However, when hamstring tightness is combined with lower back pain, students should typically avoid folding to a degree that rounds the lumbar spine.
7. Lower Back Pain
(e.g., from muscle strain, disc problems, sacroiliac joint dysfunction)
While there can be many factors at play in lower back pain, some involve injury or a slumped or overarched seated position held for a prolonged period. Pregnancy or asymmetrical movement can be among the causes of sacroiliac joint dysfunction (explained in this article and this ebook), another cause of back pain.
Poses you may need to avoid: Depending on the source of pain, either deep backbends or deep forward folds—or both—may be problematic. Rolling up to stand, a difficult movement for many students to make safely, places a great load on the lumbar vertebrae and may aggravate lower back pain.
The alignment and modifications that may help: Work to maintain a neutral spine with a gentle inward curve in the lower back, belly drawing in to support the spine. Forward fold by hinging at your hips instead of by rounding at your waist. Limit how far you go into forward folds or backbends, at least until you ascertain which of these is aggravating for you.
To release your lower back in savasana, support your knees and/or shins and feet with a bolster or chair seat.
8. Knee Discomfort
(e.g. from patellofemoral alignment syndrome, tightness around the IT band, chondromalacia patella, crepitus)
Students may develop knee pain or crackling sounds as the result of injury, time spent kneeling, or long-term poor knee tracking (some degree of “knock-knees” or “bowlegs,” the former of which may be helped by a practice that addresses this common leg misalignment). Younger students may even feel knee pain as a result of growth spurts.
Poses to avoid: Avoid kneeling on the mat without padding beneath your knees. All movements that cause repeated clicking of the knees should be avoided.
The alignment and modifications that may help: In general, the knees should track toward the center of each foot. If you have knee pain, avoid hyperextending your knees, which can overstretch the ligaments in back and potentially allow the patella (kneecap) to move off course. Regardless of whether you feel pain in your knees when they are on the mat, place padding under them. Why? This can prevent compression of the patella, irritation of the underlying tissue, and possible knee-tracking issues later on.
Similarly, whether or not you feel pain while in a kneeling position, place support underneath your sitting bones so that your knees do not have to bend as deeply.
The suggested practice modifications are by no means the only ones that might help you avoid discomfort; rather, they are just a few examples of ways in which weight can be taken off an injured or vulnerable joint in order to make a pose more comfortable. As you continue to tailor practice for yourself or your students, you can find more useful modifications if you keep these considerations in mind: Which poses in the sequence could place pressure on an area that is already hurt or at risk? And how can you lighten the load on that area?
Photography: Andrea Killam
Bill Reif, the author of The Back Pain Secret: The Real Cause of Women’s Back Pain, is a Masters of Physical Therapy graduate of SUNY Buffalo & Emory University Physical Therapy programs, the... Read more>>