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. Yoga teachers should remain within their scope of practice: This means not attempting to diagnose, treat, or offer medical advice to students.
Students with mobility limits due to multiple underlying injuries and conditions may feel excluded by one-size-fits-all practices, but they, and even their teachers, may not know how to adapt those practices. So how can we change this?
Musculoskeletal problems affect roughly half of all Americans and 75 percent of those over 65. And it is not uncommon to have more than one condition, each of which could make certain yoga poses uncomfortable or inaccessible.
According to Bill Reif, author of , the accessibility of a practice is closely tied to practitioners and teachers knowing which movements and poses are contraindicated for those with common health concerns. For an individual who may have more than one underlying condition and wants to practice safely at home, or a teacher leading a group class in which different students have different conditions, “Poses which require ‘pushing the envelope’ to extremes of available range of motion would best be avoided,” he adds.
To Jivana Heyman, the founder of Accessible Yoga and author of a recent book by the same name, it’s the approach to practice that is key. “Accessibility is an orientation,” he says. He sees accessibility as a how rather than a what. Heyman believes that “The ‘how’ includes alignment—keeping students safe and empowering them to explore their own limits and potential.”
Some poses and transitions can aggravate multiple conditions, and including these types of poses in a group class without offering variations may make some students feel excluded. (And despite our best intentions, so might some variations, especially if they segregate students by ability level or single students out.) Sometimes, skipping the poses and transitions that don’t work for some people benefits everyone, even those without underlying conditions.
Choices about the types of poses you include in a sequence go to the core of yoga itself. What is the point of doing a more inaccessible pose? Heyman prefers “not judging one form as better or more advanced than another. Yoga is about self-awareness, not gymnastics.” If we take Heyman’s words to heart, there is no need to dive into a more extreme pose: If our goal is to cultivate self-awareness, the “simple” pose can get us there, too.
Below are some practices that can “push the envelope” and thus may be less accessible for those with multiple conditions. These are necessarily generalities. Because some conditions entail different limitations, it’s important for students to seek personalized medical recommendations about movement and exercise and to share those recommendations with their teachers and keep them in mind when practicing at home.
• Inversions: While some inversions can be made safe and accessible for some students, Reif says that full inversions like headstand and handstand may best be avoided by those with heart conditions, uncontrolled blood pressure, a history of stroke, any dizziness or balance challenges, and spinal vulnerabilities (such as osteoporosis, lumbar stenosis, arthritis, or neck issues). (All inversions, even standing forward folds, downward facing dog, and legs up the wall are best avoided by those with glaucoma.) Those with no underlying conditions may benefit from this omission as well, since full inversions are commonly listed among the higher-risk yoga poses.
• Weight-bearing in the hands: The poses of the vinyasa, downward facing dogs, arm balances, wheel, or reverse tabletop may best be avoided by those with carpal tunnel syndrome, tennis elbow, or arthritis in the hands, as well as rotator cuff problems and some stages of frozen shoulder. Those with none of these issues may also appreciate doing fewer poses where the hands bear weight or more accessible versions of them (like bridge pose instead of wheel) since, according to one study, most yoga injuries occur in the shoulders, wrists, and hands.
• Extreme ranges of spinal motion: Forward folding so deep that the spine rounds can aggravate spinal issues like kyphosis, osteoporosis, lumbar stenosis, and sciatica and place stress on unsound intervertebral discs, SI joints, and hip prostheses. (Many transitions—e.g., walking hands and feet together, stepping a foot forward from downward facing dog, rolling up to stand, lifting into a full inversion—require potentially problematic flexion as well.) Big backbends, as well as deep twists and side bends, may also pose challenges for those with spinal problems. While these movements are often safe for those with no underlying problems, staying closer to a neutral spine, as in mountain pose, can enhance spinal stability, postural awareness, and a sense of general well-being.
• Extreme ranges of knee motion: Those with many types of knee sensitivity may not be happy in poses that require the knees to rotate (like hero pose, pigeon, and lotus), or deeply flex, as in thunderbolt and child’s pose. For some, even the 90-degree knee flexion often encouraged in warrior poses may be too intense. Omitting poses that twist the knees or place pressure on them—and inviting students to bend their knees only as much as is comfortable for them—may also be helpful for students without injuries, since knees are common sites for yoga-related injuries.
• Frequent, fast transitions: Moving up and down from the floor repeatedly or quickly may be burdensome for those with some mobility challenges, balance issues, or orthostatic hypotension (which causes lightheadedness). Grouping similar poses together—so that there are fewer “ups and downs”—can create a more balanced and mindful flow for all practitioners, including those without underlying conditions.
Even with the omissions above, some people may require additional considerations. Those who cannot stand comfortably without support, or are unable to transition up from or down to the floor may be better served by one of Heyman’s many chair-based practices or this chair yoga practice created for those with neurological conditions. If a student in a group class finds a chair helpful, the teacher could consider having everybody do a chair-based sequence: Chances are the entire class would benefit from a chair yoga practice.
Certainly, for studios and gyms, having folding chairs on hand is a good move toward accessibility. Run-of-the mill folding chairs, as opposed to the more expensive backless yoga chairs, are sufficient for many poses. Look for those with high weight limits to ensure sturdiness.
After eliminating these common poses and movements, what’s left? Plenty. Even with differences in our limitations, many of us share a large swath of common ground: “Those with—and those without—common conditions could benefit from a practice that focuses on the mind-body connection and promotes balance, coordination, flexibility, and strength, especially core strength: That’s beneficial for everything,” says Reif.
After eliminating these common poses and movements, what’s left? Plenty. Even with differences in our limitations, many of us share a large swath of common ground.
When creating a practice that is less likely to exacerbate underlying conditions and will also help to keep all students safe, one approach would be to focus on neutral spine poses that do not take joints to their end ranges. Such a practice could also include breath awareness, careful transitions, and minimal weight-bearing in the hands.
For an example of a practice that accommodates many underlying conditions, check out this one.
Even with a focus on the most approachable poses, Heyman reminds: “It’s impossible to create a yoga class that is accessible to everyone...” In fact, sometimes people’s needs are at odds with each other—for example, someone needs a warm room and someone else needs a cool room. Similarly, one instruction works for one student and is ineffective for another.”
For teachers working in a group context, he suggests that they “simply offer many variations of a practice” (variation is a word Heyman prefers to modification, which he sees as carrying more of a value judgment) in order to “help the students find the level that is best for them. So teachers do need to be skilled at seeing practices as a spectrum of possibilities rather than a finite thing.”
Unveiling the possibilities that increase accessibility is the focus of Heyman’s book. “These techniques include using props to support the body, turning poses upside down, dissecting poses into parts, etc,” he says. He points out that since we are all aging and may experience issues along the way that necessitate changes to practice, learning to adapt poses will help yogis of all stripes.
However, the foundation to accessibility may be to reframe practice so that the goal is not on accomplishment. Heyman says, “Even before focusing on adapting practices, I ask teachers to start by instructing students in what yoga really is—an inward journey. The first step is to let go of the external orientation of performing poses that look a certain way. Rather, begin to explore interoception [a sense of what is going on inside your body] and the way the mind works. Begin to understand the relationship between the mind and the breath, and the way the mind responds to movement, challenge, and relaxation.”
Choosing from a range of accessible poses and adopting a perspective of exploration are approachable first steps in designing an approachable practice: one whose embrace is wide enough to make students with many different needs feel at home.