the CONTRAINDICATIONINDEX for YOGA ASANAS

The Essential Guide for Yoga Practitioners and Medical Professionals

INCLUDES GUIDANCE FOR:

High Blood PressureStrokeHeart ConditionsLow Back PainKnee InjuriesSpine & Disc IssuesWrist PainGlaucoma+ 29 More Common Ailments

Victoria E. McColm

INTENTIONALLY LEFT BLANK

the CONTRAINDICATIONINDEX for YOGA ASANAS

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 modi!cations 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 pro!ts 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . 7Gratitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8About the Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Contraindication Index . . . . . . . . . . . . . . . . . . . . . 10

AAbdominal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Acid Re#ux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Ankle Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

B–GBack Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Carpal Tunnel Syndrome . . . . . . . . . . . . . . . . . . . . 16Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Elbow Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Groin Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

HHeadaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Heartburn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Heart Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Hiatal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . 27Hip Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Hyperlordosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Hypotension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Hypothyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

I–LInguinal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Knee Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Leg Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Low Back Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Low Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . 41

M–SMenstruation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Migraines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Neck Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Sacroiliac Joint (SI Joint) Issues . . . . . . . . . . . . . . 51Sciatica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Shoulder Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Sinus Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Spinal and Disc Issues . . . . . . . . . . . . . . . . . . . . . . . 56Stroke, History or Risk . . . . . . . . . . . . . . . . . . . . . . . 58

V–ZWrist Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

INTENTIONEstablishing 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 o$er 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.

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ACKNOWLEDGEMENTI 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 di$erent 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 bene!ts 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 con!dent practice.

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VIRGINIA MCCOLM, RNCHRISTINE MCCOLM, RNEVA JEAN JONES, RNCOOPER MCCOLM

JENNIFER WHITENATASHA SUGATHAPALALARA LEVIIVONNE LEDESMA

JAN LOEFFLER BIRDBONNIE BIRDBRIAN WELLS, MDJOSHUA 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.

GRATITUDEThe following individuals were extremely generous with their time, thoughts, feedback, and encouragement throughout the process of creating this book.

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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 modi!ed 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 di$erent and may react to illness and injury in di$erent ways. This means there is a “gray” area that the teacher must navigate in close communication with the student. When cueing modi!cations, 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 modi!cation 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 certi!cation. It is focused on the fundamental asana poses and their modi!cations. 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 modi!cations 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 a$ected 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 e$ort to create a comprehensive list of known contraindications according to injury or condition.

Please keep in mind:

When two (or more) sources presented di$erent information, both items are included for safety’s sake.

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.

Any posture performed incorrectly can have an adverse a$ect 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.

HOW TO USE THIS INDEX

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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.

See also: Diarrhea, Hernia, Hiatal Hernia, Pregnancy

GENERAL GUIDELINES:Many asanas require activation of the core muscles in the abdomen. Disorders, injuries, or surgeries a$ecting 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.

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 CautionCrow Kakasana Avoid/Use CautionExtended Side Angle Utthita Parsvakoasana Modify, place hand on knee

instead of forearm, shorten stanceLocust Salabhasana Avoid/Use CautionLord of the Fishes Ardha Matsyendrasana Avoid/Use CautionMarichi Twist Parivritta Marichyasana Avoid/Use CautionProne Boat Navasana Avoid/Use CautionRabbit Shashangasana Avoid/Use CautionRevolved Head to Knee Parivritta Janu Sirasana Modify, don't twist bodyRevolved Side Angle Parivritta Parsvakonasana Avoid/Use CautionSeal of Yoga Yoga Mudra Avoid/Use Caution

Seated Boat Paripurna Navasana Avoid/Use CautionShoulder Press Bhuja Pidasana Avoid/Use CautionSide Plank Vasisthasana Avoid/Use CautionStanding Forward Bend Uttanasana Avoid/Use CautionStanding Half Forward Bend Ardha Uttanasana Avoid/Use CautionTriangle Trikonasana Modify, don't twist bodyUpward Facing Dog Urdhva Mukha Svanasana Avoid/Use CautionPyramid Parsvottanasana Modify, support hands on chair

or block

ABDOMINAL ISSUES

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ENGLISH SANSKRIT GUIDANCE

Bridge Setubandhasana Use CautionDolphin Use CautionDownward Facing Dog Adho Mukha Svanasana Use CautionExtended Puppy Uttana Shishosana Use CautionFeathered Peacock Pincha Mayurasana Use CautionForearm Stand Pincha Mayurasana Use CautionHandstand Adho Mukha Vriksasana Use CautionHead Stand Sirshasana Use CautionKnee Down Twist Jathara Parivartanasana Use CautionLegs Up the Wall Viparita Karani Use CautionPlow Halasana Use CautionRabbit Shashangasana Use CautionShoulder Stand Sarvangasana Use CautionThread the Needle Use CautionWheel Chakrasana Use CautionWide Legged Forward Bend Prasarita Padottanasana Use Caution

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 re#ux not to eat for at least an hour prior to practice. This may be enough for most students to practice comfortably. Since acid re#ux 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 re#ux 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.

ACID REFLUX

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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 #atten (when the shoelace part of the foot is #at to the #oor) 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.

ANKLE ISSUES

ENGLISH SANSKRIT GUIDANCE

Balancing Half Moon Ardha Chandrasana Use CautionChair Utkatasana Use CautionChild's Balasana Modify, place a rolled hand towel

under the ankleCrescent Lunge Anjaneyasana Use CautionDancer Natarajasana Use CautionEagle Garudasana Use CautionExtended Hand to Big Toe Utthita Padangusthasana Modify, hold onto the knee, do

not extend the leg fullyGoddess Deviasana 4VKPM �̀�WYHJ[PJL�S`PUN�ÅH[�VU�[OL�

ÅVVY�^P[O�ZVSLZ�VM�MLL[�HNHPUZ[�wall

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 CautionOne Legged Pigeon Eka Pada Rajakapotasana Modify, place a rolled hand towel

under the back anklePowerful Utkatasana Use CautionReclining Hero Supta Virasana Modify, place a rolled hand towel

under the ankleStanding Splits Urdhva Prasarita Eka Padasana Use CautionWarrior I Virabhadrasana I Modify, practice seated on chair

if neededWarrior II Virabhadrasana II Modify, practice seated on chair

if needed