the CONTRAINDICATION INDEX for YOGA ASANAS

CONTRAINDICATION
INDEX for YOGA ASANAS
the
The Essential Guide
for Yoga Practitioners
and Medical Professionals
INCLUDES GUIDANCE FOR:
High Blood Pressure
Stroke
Heart Conditions
Low Back Pain
Knee Injuries
Spine & Disc Issues
Wrist Pain
Glaucoma
+ 29 More Common Ailments
Victoria E. McColm
INTENTIONALLY
LEFT BLANK
CONTRAINDICATION
INDEX for YOGA ASANAS
the
Victoria E. McColm
Written by Victoria E. McColm, MSc, RYT200
Design by Sande Edwards
Cover photo by Bartosz Hadyniak
Copyright © 2012 by Citizen International Group LLC - Washington D.C.
Text Copyright © 2012 by Victoria E. McColm
All rights reserved, including the right of reproduction in whole or in part in any form. Unless for use in a review
written for inclusion in a magazine, newspaper or broadcast or in accordance with the terms of the purchased
Institutional License, reproduction or utilization of this work in any form or by any electronic, mechanical, or
other means, now known or later invented, is forbidden without written consent of the publisher.
DISCLAIMER: This book does not provide medical advice, and the information in this book should not
be considered as medical advice. The content of this book is in no way intended to be a substitute for
professional medical advice, diagnosis, or treatment, or a substitute for the guidance of an experienced yoga
teacher. The information provided in this book is for informational use only and meant to be used as a basis
for discussion with your doctor and yoga teacher only. Always get your doctor’s permission before beginning
a yoga practice, especially if you have an injury or medical condition. Always inform your yoga teacher of your
injury or ailment so that he or she can provide guidance and recommend modifications for certain postures.
The publisher, the author, or any third parties mentioned in this publication are not liable for any damages
—to include, but not be limited to, incidental and consequential damage, personal injury, wrongful death,
lost profits or damages resulting from employment or business interruption—resulting from the correct or
incorrect use or inability to use the information contained in this book. By purchasing and utilizing this book,
you are agreeing to these terms of use. If you do not agree to the above terms, please do not use this book.
Intention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . .
Gratitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
About the Index . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contraindication Index . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
10
A
Abdominal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acid Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ankle Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
11
12
13
B–G
Back Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carpal Tunnel Syndrome . . . . . . . . . . . . . . . . . . . .
Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Elbow Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Groin Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
16
17
18
19
20
H
Headaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Heartburn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Heart Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hiatal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
High Blood Pressure. . . . . . . . . . . . . . . . . . . . . . . . .
Hip Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hyperlordosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hypothyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
11
23
25
26
27
29
30
26
41
31
I–L
Inguinal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Knee Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Leg Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Low Back Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Low Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . .
32
33
34
37
38
41
M–S
Menstruation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Migraines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Neck Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sacroiliac Joint (SI Joint) Issues . . . . . . . . . . . . . .
Sciatica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shoulder Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sinus Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Spinal and Disc Issues . . . . . . . . . . . . . . . . . . . . . . .
Stroke, History or Risk . . . . . . . . . . . . . . . . . . . . . . .
43
44
46
49
51
52
53
55
56
58
V–Z
Wrist Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
INTENTION
Establishing intention is a vital piece of yogic teaching and
lifestyle. If you don’t direct your mind, you allow your mind to
direct you. I established my intention for this project early on—
to ensure yoga students have the safest practice possible.
I offer this reference book as a contribution to the growing body
of yoga literature and hope that it serves as a useful tool for
students, their teachers, and their doctors.
6
ACKNOWLEDGEMENT
I would like to acknowledge the existing work on yoga as
medicine and yoga therapy. There is mounting evidence that a
regular yoga practice can have an immensely positive impact
on emotional and physical health. The fact that many doctors
and physical therapists now recommend yoga asana and
pranayama techniques to treat common ailments is a testament
to yoga’s healing power. For each condition listed in this Index,
there is likely a different yoga asana that can be prescribed as a
treatment. I want to express my gratitude to these authors for
the work they’ve done to educate readers on all the benefits
of yoga. I now understand the commitment, time, and work
involved in such an endeavor. The intention of this book is not to
scare people away from yoga practice, but to keep them coming
back by ensuring that individuals with medical conditions (and
the people who work with them—teachers, doctors, etc.) have
the information needed for a safe and confident practice.
7
GRATITUDE
The following individuals were extremely generous with their
time, thoughts, feedback, and encouragement throughout the
process of creating this book.
VIRGINIA MCCOLM, RN
CHRISTINE MCCOLM, RN
EVA JEAN JONES, RN
COOPER MCCOLM
JENNIFER WHITE
NATASHA SUGATHAPALA
LARA LEVI
IVONNE LEDESMA
JAN LOEFFLER BIRD
BONNIE BIRD
BRIAN WELLS, MD
JOSHUA ELDER
A special thanks to the teachers and trainees at Yoga District
Studios in Washington D.C. for helping me identify the need
for this book:
MICHELLE, JASMINE, & STEVE
ABEER, AMY, CARA, CASEY, EMILY, GRANETTA, JAMIE, LIZ, NICK, RACHEL,
SEEMA, SONIA, SUNNY, & TRICIA
More special thanks to my graphic designer, SANDE EDWARDS,
SANDE EDWARDS DESIGNS, and my copy editor, MANDY JORDAN, for
taking on this project with me.
And all my gratitude, respect, and love to TUG SWAFFAR for
putting up with me during the journey and process of seeing
this project through.
8
HOW TO USE THIS INDEX
This quick reference index is organized to be easy and intuitive. Here are some things to remember when
using the index:
1. WHAT IS A CONTRAINDICATION? Stating that an asana is “contraindicated” for certain ailments, conditions, or
injuries means that the pose should be modified or avoided altogether according to the severity and duration
of the condition presented. While a recommendation of “avoid” is typically black and white, “modify” can be a
little more gray and require clear student/teacher communication on levels of discomfort.
2. MEDICAL DESCRIPTIONS: The descriptions of ailments and conditions included in this book are by no means
comprehensive. The intent is to provide a busy individual with a 10-second overview for quick reference
before practice.
3. SEVERITY AND DURATION: Everyone’s body is different and may react to illness and injury in different ways. This
means there is a “gray” area that the teacher must navigate in close communication with the student. When
cueing modifications, always begin with the most basic version of the contraindicated asana and tell the
student to stop immediately if he or she feels any abnormality, pain, or discomfort. Never push a student to
attempt an advanced version of a contraindicated asana.
4. GROSS VS. SUBTLE ANATOMY: Most of the recommendations for avoidance or modification of certain asanas are
based solely on the asana’s impact on the gross anatomy and physiology of the body. There may be additional
impacts (positive or negative) of asanas on the subtle anatomy in individuals presenting the covered ailments,
conditions, or injuries.
5. INCLUSIVE HEADINGS: The word “issues” is used as an umbrella term that includes pain, weakness, surgeries,
injuries, ailments, and conditions of varying magnitude.
6. ORGANIZATION AND LAYOUT OF THE INDEX: This publication is organized primarily for yoga teachers. It assumes a
level of asana understanding consistent with a 200 hour RYT certification. It is focused on the fundamental
asana poses and their modifications. Each chapter contains a chart that clearly lists what asana postures can
impact a condition, ailment, or injury. Guidance is categorized as follows:
Avoid: This means that the asana shouldn’t be practiced under any circumstance if the condition,
ailment, or injury is severe, life-threatening or could cause a fall resulting in further injury.
Modify: This means that certain modifications can be cued that will allow safer practice of
the asana, even when the condition is present.
Use Caution: This means that the asana impacts the area of the body affected by the ailment
or condition, so practice with caution if the injury or condition is minor or healed. The teacher
should communicate very clearly with the student regarding severity and duration.
7. RESEARCH METHODS: This index was compiled through extensive research—sources include published print
books, trusted yoga websites, and popular blogs—in an effort to create a comprehensive list of known
contraindications according to injury or condition.
Please keep in mind:
t When two (or more) sources presented different information, both items are included for
safety’s sake.
t This list may not be complete. Use your judgment when teaching students or practicing
yoga. If you are uncertain, or an asana causes pain, it is always best to avoid that posture.
t Any posture performed incorrectly can have an adverse affect on a student—potentially
exacerbating an existing issue or causing a new one. Foundation and alignment should always
be the cornerstone of asana practice.
8. INPUT & IMPROVEMENTS: If you know additional contraindication information not listed here or learn of
additional postures that exacerbate other conditions, please send that information or experience to
feedback@preventyogainjury.com, and we’ll be sure it’s included in the next edition. Suggestions, feedback,
constructive criticism, and information from the yoga and medical communities are always welcome.
9
ABDOMINAL ISSUES
DESCRIPTION:
The abdomen is the area between the diaphragm and
pelvis. It is the cavity that houses important organs
like the stomach, intestines, colon, appendix, liver,
gallbladder, pancreas, spleen, kidneys, and adrenal
glands. All of these organs are held in the cavity by
muscles. In yoga, this part of the body is typically
called the “core.” Issues here refer to any condition that
interferes with the normal functioning of these organs
and the muscles and tissue that surround them—like
surgeries (including C-section deliveries), diseases,
viruses, and so on.
GENERAL GUIDELINES:
Many asanas require activation of the core muscles
in the abdomen. Disorders, injuries, or surgeries
affecting any of the organs housed in the abdominal
cavity will impact a student’s ability to practice
yoga. Be sure to communicate clearly with the
student regarding the severity and duration of the
condition they report. It is best to avoid any postures
that require twisting, pressure, or straining in the
abdominal cavity until a student has completely
healed from a surgery and has received permission
from their doctor to resume or begin a yoga practice.
See also: Diarrhea, Hernia, Hiatal Hernia, Pregnancy
10
ENGLISH
SANSKRIT
GUIDANCE
Balancing Half Moon
Ardha Chandrasana
Modify, don't twist body or
extend upper arm
Bow
Dhanurasana
Modify, lie on the side to avoid
putting weight on the abdomen
Camel
Ustrasana
Modify, place hands on lower back
instead of heels. Lean back slightly.
Cobra
Bhujangasana
Avoid or Modify, lie forward on a
bolster, lift gently
Crane
Bakasana
Avoid/Use Caution
Crow
Kakasana
Avoid/Use Caution
Extended Side Angle
Utthita Parsvakoasana
Modify, place hand on knee
instead of forearm, shorten stance
Locust
Salabhasana
Avoid/Use Caution
Lord of the Fishes
Ardha Matsyendrasana
Avoid/Use Caution
Marichi Twist
Parivritta Marichyasana
Avoid/Use Caution
Prone Boat
Navasana
Avoid/Use Caution
Rabbit
Shashangasana
Avoid/Use Caution
Revolved Head to Knee
Parivritta Janu Sirasana
Modify, don't twist body
Revolved Side Angle
Parivritta Parsvakonasana
Avoid/Use Caution
Seal of Yoga
Yoga Mudra
Avoid/Use Caution
Seated Boat
Paripurna Navasana
Avoid/Use Caution
Shoulder Press
Bhuja Pidasana
Avoid/Use Caution
Side Plank
Vasisthasana
Avoid/Use Caution
Standing Forward Bend
Uttanasana
Avoid/Use Caution
Standing Half Forward Bend
Ardha Uttanasana
Avoid/Use Caution
Triangle
Trikonasana
Modify, don't twist body
Upward Facing Dog
Urdhva Mukha Svanasana
Avoid/Use Caution
Pyramid
Parsvottanasana
Modify, support hands on chair
or block
ACID REFLUX
DESCRIPTION:
Acid reflux occurs in individuals whose esophageal
sphincter is weak. When this muscle can’t close
tightly, stomach acid and contents can leak out
into the esophagus. The result can be a burning
sensation in the chest (known as heartburn),
nausea, and the feeling that something is stuck in
the throat. In the long term, untreated reflux may
cause damage to the esophagus. It is especially
common in pregnant women and those who are
obese. Acid reflux is generally treated with lifestyle
changes (avoiding problem foods and activities) and
over-the-counter medications.
GENERAL GUIDELINES:
Encourage students with acid reflux not to eat for at
least an hour prior to practice. This may be enough
for most students to practice comfortably. Since
acid reflux is non life-threatening, it’s OK if a student
wants to try all the poses to see which ones, if any,
cause them discomfort after practice. If a yoga
session results in heartburn, or any other reflux
symptoms, even after fasting before practice, then
advise the student to avoid inversions and any asana
in which the head is lower than the stomach.
ENGLISH
SANSKRIT
GUIDANCE
Bridge
Setubandhasana
Use Caution
Dolphin
Use Caution
Downward Facing Dog
Adho Mukha Svanasana
Use Caution
Extended Puppy
Uttana Shishosana
Use Caution
Feathered Peacock
Pincha Mayurasana
Use Caution
Forearm Stand
Pincha Mayurasana
Use Caution
Handstand
Adho Mukha Vriksasana
Use Caution
Head Stand
Sirshasana
Use Caution
Knee Down Twist
Jathara Parivartanasana
Use Caution
Legs Up the Wall
Viparita Karani
Use Caution
Plow
Halasana
Use Caution
Rabbit
Shashangasana
Use Caution
Shoulder Stand
Sarvangasana
Use Caution
Thread the Needle
Use Caution
Wheel
Chakrasana
Use Caution
Wide Legged Forward Bend
Prasarita Padottanasana
Use Caution
11
ANKLE ISSUES
DESCRIPTION:
The ankle is a synovial hinge joint that connects the
foot to the leg. Ankle issues include any condition
that interferes with the normal functions of the
bones, tissue, and ligaments that form the ankle
joint. Breaks, strains, sprains, weakness, and tears
can be aggravated by certain postures. Ankle
injuries are typically treated by applying a brace or
wrap, ice, elevation, and rest. Severe ankle injuries
may require surgery or physical therapy to regain
balance and range of motion.
GENERAL GUIDELINES:
Asanas that require the foot to point or flatten (when
the shoelace part of the foot is flat to the floor) may
cause pain or discomfort. Poses in which the body
weight is held on one leg (Dancer, Balancing Half
Moon, etc.) may be problematic for some. Older
students may have range of motion issues. Most
ankle contraindications are subjective to the student,
meaning that advice listed below will vary from
student to student. Teachers should communicate
clearly with students regarding severity and duration
of the injury and use their best judgment.
ENGLISH
SANSKRIT
GUIDANCE
Balancing Half Moon
Ardha Chandrasana
Use Caution
Chair
Utkatasana
Use Caution
Child's
Balasana
Modify, place a rolled hand towel
under the ankle
Crescent Lunge
Anjaneyasana
Use Caution
Dancer
Natarajasana
Use Caution
Eagle
Garudasana
Use Caution
Extended Hand to Big Toe
Utthita Padangusthasana
Modify, hold onto the knee, do
not extend the leg fully
Goddess
Deviasana
wall
12
Hero
Viransana
Modify, place a rolled hand towel
under the ankle
Heron
Krounchasana
Modify, place a rolled hand towel
under the ankle
King Pigeon
Kapotasana
Modify, place a rolled hand towel
under the ankle
Lotus
Padmasana
Modify, do simple cross legged
instead
Low Lunge
Anjaneyasana
Use Caution
One Legged Pigeon
Eka Pada Rajakapotasana
Modify, place a rolled hand towel
under the back ankle
Powerful
Utkatasana
Use Caution
Reclining Hero
Supta Virasana
Modify, place a rolled hand towel
under the ankle
Standing Splits
Urdhva Prasarita Eka Padasana
Use Caution
Warrior I
Virabhadrasana I
Modify, practice seated on chair
if needed
Warrior II
Virabhadrasana II
Modify, practice seated on chair
if needed