202
CAUTIONS
Just as the Hippocratic Oath states “first do no harm,the first principle of yoga
is ahimsa, which translates to nonharm. To avoid harm, it is important to know
your body and adapt or modify poses and practices based on your needs and
health conditions. Everyone is different, so use these pages as a general guide.
Injuries in yoga do happen, as
they do in all types of physical
activity, from walking down the
stairs to lifting weights at the gym.
A meta-analysis of randomized
controlled trials, however, found
that yoga is as safe as other types
of recommended exercise. In fact,
yoga may be safer than many
forms of exercise because it often
incorporates slow transitions,
present-moment awareness, and
an emphasis on nonharm.
That said, if you believe that
yoga practices are powerful
enough to profoundly benefit you,
you must also acknowledge that
yoga has the power to harm, and
you must treat it with that level of
respect. To prevent injury, therefore,
practice the first two limbs of
yoga—the Yamas and Niyamas—
both in yoga class and in life (see
p.205). It is also advisable to bear in
mind the following guidelines:
We all have differently shaped
bones and bodies, so poses will
look different when practiced by
different people. Some postures
may not be accessible to you
without modifications
Allow recovery after strains,
sprains, tears, breaks/fractures,
surgery, or wounds. After surgery,
ask your surgeon for guidance
CAUTIONS
The point of yoga is not to
be able to perform an asana
perfectly, or to do any particular
technique or pose. Enjoy the
journey of self-exploration!
Avoid anything that causes
pain or increases existing pain
Be careful of sharp sensations
inside the body or sharp, shooting
sensations down the limbs
Avoid anything that causes
numbness in the limbs.
CONDITIONS
The following pages outline any
cautions and considerations for
specific health conditions that you
should bear in mind when practicing
yoga, as general guidance. However,
you should always ask your
professional medical team what
is right for you. If in doubt, work with
a qualified yoga professional, such
as a yoga therapist.
Acid reflux/GERD/heartburn
Be careful of or avoid any full or
partial inversion where the head
goes below the heart, and fast
breathing (kapalabhati).
Ankylosing spondylitis
Be careful of spinal flexion
and move slowly into gentle
spinal extension.
anxiety/tendency toward
panic attacks
Be careful of inversions, backbends,
fast breathing (kapalabhati), or
holding the breath (kumbhaka)
during symptoms.
Arthritis (including osteoarthritis
and rheumatoid arthritis, and other
conditions that involve joint
inflammation)
For osteoarthritis and rheumatoid
arthritis, avoid anything that
increases joint pain, and focus
on modifying poses for comfort,
strengthening, and learning to
meditate to cope with pain; for
rheumatoid arthritis, avoid hot
yoga and overheating.
Asthma
Be careful when practicing
backbends, holding the breath
(kumbhaka), and fast breathing
(kapalabhati); avoid intense back
bending during symptoms.
Bursitis and tendonitis
Avoid anything that increases pain
or swelling; rest the affected area
during acute stages.
Carpal tunnel syndrome
Be careful of or avoid arm balances
or weight bearing while wrists are
extended (e.g. Plank or Crow pose),
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especially if it increases numbness;
consider resting your forearms
on the floor or blocks, or try
using a wedge.
Degenerative disk disease
Practice spinal flexion and spinal
rotation gently; avoid or be careful
during headstands, shoulderstands,
or anything that puts pressure
on the neck.
Diabetes
For type 1, avoid anything that puts
pressure on your insulin pump; for
type 1 and 2, eat before class if
needed, and rest if lightheaded.
Disk herniation (Slipped,
bulging, protruding)
Be careful of unsupported spinal
flexion, such as a Standing or Seated
Forward Fold, and spinal rotation;
focus on lengthening the spine
before gently entering a pose, and
consider keeping the spine neutral
and bending at the hips into a
Forward Fold—Child’s or Cat pose
may be safer forms of spinal flexion;
be careful during headstands,
shoulderstands, or anything that
puts pressure on the neck.
Ear infection
Be careful with inversions and
in balancing poses.
Eye conditions that
increase pressure (such
as glaucoma, detached retina,
diabetic retinopathy, or recent
cataract surgery)
Be careful with or avoid any
pose in which the head goes
below the heart, holding the breath
(kumbhaka), and fast breathing
(kapalabhati); seek the advice
of your ophthalmologist if you
are unsure.
Fibromyalgia
Consider restorative yoga and yoga
nidra; use lots of props and let your
teacher know if you prefer not to be
touched in a hands-on assist.
Frozen shoulder
(adhesive capsulitis)
Move slowly into shoulder stretches
and gradually increase the stretch
over time.
Heart conditions
Be careful when performing
inversions, holding the breath
(kumbhaka), and fast breathing
(kapalabhati); you should also seek
the advice of your cardiologist.
High blood pressure
(hypertension)
Be careful with any pose where the
head goes below the heart, holding
the breath (kumbhaka), and
fast breathing (kapalabhati); if
your blood pressure is not
currently regulated, avoid full
inversions, intense practice, and
hot yoga completely.
Hip replacement
Follow these precautions 6–8 weeks
after surgery, and with the advice of
your doctor. In the anterior approach,
be careful of or avoid extension (as
in the lifted leg in Warrior III); in the
posterior approach, be careful of or
avoid hip flexion past 90 degrees,
internal rotation, and crossing the
midline (crossing legs); after proper
healing, you are likely to be able to
perform all of these movements,
but move slowly into the poses and
ask your doctor for advice.
Hypermobility
Avoid any extreme movement or
hyperextension of joints; focus on
strengthening.
Knee ligament injury (ACL,
PCL, LCL, MCL)
Be careful with poses that involve
rotation (e.g. Triangle pose and
Warrior II); for ACL, avoid deep knee
flexion and for PCL, be careful
of hyperextension/locking your
knees; for both, be careful of or
avoid jumping into poses.
Continued
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CAUTIONS
Knee Meniscus tear/injury
Be careful of or avoid deep knee
flexion, especially if weight bearing.
Knee replacement
Avoid extreme knee flexion; cushion
the knee with blankets or padding
when in kneeling poses.
Low blood pressure
(hypotension)
Move slowly out of any pose where
the head goes below the heart;
pause a few moments in a restful
pose, such as Child’s pose, after full
inversions to prevent dizziness; move
slowly when rising from the floor.
Migraine
Be careful when performing full
inversions; try practicing in a room
with the lights dimmed.
Multiple sclerosis
Be careful of intense practices
that make you feel overheated;
avoid hot yoga.
Obesity
Be careful of unsupported spinal
flexion and full inversions, such as
headstands, shoulderstands, or
anything that puts your weight
on your neck.
Osteoporosis/osteopenia
For spinal areas, talk to your doctor,
as what you can do will depend on
the severity of your condition.
However, general guidelines are to
be careful of unsupported spinal
flexion and spinal rotation; move
slowly and focus on elongating the
spine before coming into twists, and
consider flexing at the hips and try
keeping the spine neutral in many
Forward Folds to avoid the risks of
spinal flexion (Child’s or Cat pose
may be safer forms of spinal flexion);
avoid or take extreme caution during
headstands, shoulderstands, or
anything that puts pressure on the
neck; take particular caution to move
slowly and gently in movements that
combine spinal flexion and rotation
such as Triangle pose; take care in
transitioning poses and balancing
poses to reduce the risk of falling;
for nonspinal areas, such as hips or
wrists, move slowly into poses and
focus on mindfully strengthening
muscles around the affected areas.
Parkinson’s disease
Be careful of inversions and
balancing poses; try holding onto
the wall or a chair to prevent falls;
use props as needed.
Plantar fasciitis
Avoid or be careful jumping into
poses, or any movement that
exacerbates symptoms; stretch the
feet and legs slowly and mindfully.
Pregnancy
Be careful of full inversions,
especially if you don’t already have
an inversion practice; be careful of
or avoid anything that puts pressure
on the abdomen (e.g. Locust pose
or extreme abdominal engagement);
avoid extreme abdominal stretching
(e.g. Wheel pose); don’t stay too long
lying on your back in later stages of
pregnancy if uncomfortable, and
consider lying on your side with a
pillow between your legs, or propping
yourself up to lie at an angle.
Rotator cuff (tear,
tendonitis, instability)
Be careful with any shoulder
stretches; avoid Low Plank pose
(Chaturanga), particularly in acute
stages; focus on strengthening over
stretching, e.g. consider holding a
forearm version of Plank or
Downward Dog on the floor or wall.
Sacroiliac (SI)
dysfunction/pain
Avoid extreme twists and be
careful in wide-legged postures
(e.g. Triangle pose). Being in
asymmetric poses, such as Warrior
poses or Triangle pose, for a
prolonged period on one side may
be uncomfortable; if so, consider
switching sides more often.
Sciatica
Be careful of anything that
increases numbness; if the condition
is due to a tight piriformis, consider
modified versions of Pigeon pose,
e.g. figure 4 on your back (see p.82).
CAUTIONS continued
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Scoliosis
Avoid anything that causes
numbness; consider strengthening
your back muscles by practicing
Side Plank pose and gently
stretching in the opposite
direction of the curvature.
Shoulder dislocation,
history of
Avoid any extreme shoulder
extension, especially while weight
bearing, such as in Wheel pose;
consider focusing your practice
on strengthening.
Sinusitis
Be careful of inversions and
spinal extensions; you may find
the alternate nostril breathing
technique difficult.
Spinal Stenosis
Be careful of spinal extension.
Spondylolisthesis
Ask your doctor what to avoid
in your individual case. However,
general guidance is: be careful of
spinal extension and spinal rotation;
avoid deep twisting, moderate or
deep backbends, and jumping
into poses.
Stroke, history or risk of
Be wary of inversions and extreme
cervical extension; avoid anything
that puts pressure on the neck.
Vertigo/dizziness
See Low Blood Pressure.
YAMAS (SELF-CONTROL)
Ahimsa (nonharm): don’t do
anything that hurts or increases
current pain
Satya (truthfulness): be truthful
with yourself about what your body
can do today
Asteya (nonstealing/abundance):
focus on the things you can do instead
of what you cannot do
Brahmacharya (moderation):
practice everything in moderation to
regulate your energy
Aparigraha (nonpossession):
there is no need to grasp for a body
you used to have, or to be jealous of
the person practicing next to you.
NIYAMAS (SELF-REGULATION)
Saucha (cleanliness): organize
your props and practice area to
prevent falls or distraction
Santosha (contentment): find
contentment with where you are
physically and mentally today
Tapas (self-discipline): balance
your burning desire to improve with
the practice of nonharm
Svadhyaya (self-study): observe
your breath and energy today and adjust
your practice to respect that
Ishvara Pranidhana (surrendering/
accepting): allow a sense of
surrendering to what is in the present
moment, changing what you can (for
example, using a prop for comfort in a
pose), but accepting what you cannot
change. Just be.
Approaching yoga with respect
The Yamas and Niyamas are the ethical guidelines for a yogic lifestyle.
Traditionally, a guru would require that a practitioner lives these principles
before learning any asana, to prevent ego and injury.
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