Contraindications Guide

Overview

Safety is the foundation of good teaching. Every student who walks into your class brings a unique body with its own history—past injuries, current conditions, and individual limitations. Understanding contraindications—situations where certain poses or practices should be avoided or modified—is essential for creating classes that heal rather than harm. This comprehensive guide covers the most common conditions you'll encounter as a teacher, drawing on the wisdom of B.K.S. Iyengar and modern therapeutic yoga approaches to help you teach with confidence and care.

Key Concepts

What Are Contraindications?

A contraindication is a specific situation in which a particular pose, practice, or approach should not be used because it could cause harm. Contraindications fall into two categories:

Absolute contraindications mean the pose should be completely avoided. For example, students with detached retinas should never practice inversions, as the increased pressure in the eyes could cause further damage.

Relative contraindications mean the pose requires modification or careful consideration. For example, students with high blood pressure can practice inversions with proper preparation and modifications, but they need a different approach than students without this condition.

Understanding this distinction helps you make informed decisions. Not every contraindication means "never"—many mean "not yet" or "not this way."

Your Role as a Teacher

As yoga teachers, we occupy a unique space. We're not doctors or physical therapists (unless we hold those credentials), but we do work intimately with students' bodies and well-being. This means we need to be clear about our scope of practice.

You can offer three forms of support to students with injuries or conditions:

1. A safe setting where they can explore within their own bodies how to move in ways that facilitate natural healing
2. Modifications of poses and use of props that help reduce further injury
3. Poses that enhance healing when appropriate for their condition

What you cannot do is diagnose conditions, prescribe specific therapeutic protocols, or guarantee healing outcomes. When in doubt, encourage students to consult with their healthcare providers and ask for clearance to practice yoga.

The Principle of Ahimsa (Non-Harming)

The yogic principle of ahimsa—non-harming—applies first and foremost to our teaching. Every choice we make should prioritize student safety over aesthetic perfection, impressive poses, or our own ego as teachers.

This means:

• Always offering modifications and alternatives
• Creating a culture where students feel empowered to rest, modify, or skip poses
• Watching for signs of strain or distress in students
• Being willing to say "I don't know" and refer students to specialists
• Continuously educating yourself about anatomy, injuries, and therapeutic applications

Ahimsa also means recognizing that sometimes the most healing thing a student can do is rest in Child's Pose while the class moves through a challenging sequence. There's no shame in honoring the body's needs.

In Practice

Cardiovascular Conditions

High Blood Pressure (Hypertension)

B.K.S. Iyengar provides clear guidance on this common condition. In Light on Yoga, he states: "Persons suffering from high blood pressure or heart trouble should never attempt to hold their breath (kumbhaka)." This is an absolute contraindication—breath retention in pranayama can dangerously elevate blood pressure.

However, students with high blood pressure can practice many poses safely with modifications:

Avoid or modify:

• Inversions (initially)—Iyengar advises: "Do not start with Śīrṣāsana and Sarvāngāsana if you suffer from dizziness or high blood pressure"
• Intense backbends that compress the chest
• Breath retention (kumbhaka) in pranayama
• Poses held with excessive strain or effort

Safe practices:

• Forward bends—Iyengar notes: "All forward bending poses are beneficial for persons suffering from either high or low blood pressure"
• Gentle inversions with proper preparation (Legs-Up-the-Wall with support)
• Restorative poses that calm the nervous system
• Pranayama without retention—Nāḍī Śodhana without kumbhaka is specifically recommended

Teaching approach: Emphasize steady, calm breathing throughout practice. Avoid competitive or heated environments. Build toward inversions gradually over months, starting with forward bends (Paśchimottānāsana, Uttānāsana) and Downward Dog before attempting Headstand or Shoulderstand.

Low Blood Pressure (Hypotension)

Students with low blood pressure have different needs. Iyengar notes they "can do this prāṇāyāma with retention after inhalation (antara kumbhaka) only, with beneficial effects."

Modifications:

• Move slowly when transitioning from lying to sitting to standing (avoid dizziness)
• Include more standing poses to build strength and circulation
• Practice breath retention after inhalation (not after exhalation)
• Avoid long holds in forward bends that may cause lightheadedness

Heart Conditions

Students with heart conditions require medical clearance before practicing yoga. Once cleared, they should avoid:

• Breath retention
• Intense physical exertion
• Poses that compress the chest
• Hot yoga or heated environments

Focus instead on gentle, restorative practices that support cardiovascular health without strain.

Pregnancy

Pregnancy is not an illness, but it does require thoughtful modifications as the body changes. Iyengar provides specific guidance: "All the āsanas can be practised during the first three months of pregnancy."

First Trimester (Weeks 1-13)

Most poses are safe with gentle practice. Focus on:

• Standing poses with mild movements to strengthen the spine
• Hip openers to prepare for birth
• Avoiding abdominal compression

Iyengar specifically recommends: "Baddha Koṇāsana and Upaviṣṭha Koṇāsana may be practised throughout pregnancy at any time of the day (even after meals, but not forward bending immediately after meals) as these two āsanas will strengthen the pelvic muscles and the small of the back and also reduce labour pains considerably."

Second Trimester (Weeks 14-27)

As the belly grows, modify:

• Avoid deep twists that compress the abdomen
• Avoid lying on the belly (obviously)
• Modify prone poses (Cobra becomes hands-and-knees Cat-Cow)
• Use props to create space for the belly in forward bends
• Continue hip openers and gentle standing poses

Third Trimester (Weeks 28-40)

Focus on comfort and preparation for birth:

• Avoid lying flat on the back after 20 weeks (can compress vena cava)
• Use props generously—bolsters, blocks, walls for support
• Practice squatting and hip opening
• Emphasize breath awareness and relaxation
• Avoid inversions unless already established in practice

Postpartum

Wait 6-8 weeks (or longer for C-section) before returning to full practice. Focus initially on:

• Pelvic floor reconnection
• Core rebuilding (gentle, not crunches)
• Upper back and shoulder opening (for nursing/carrying baby)
• Restorative poses for recovery

Back Pain and Spinal Issues

Back pain is one of the most common reasons students come to yoga. The approach depends on the specific condition.

General Back Pain

Research shows yoga can be highly effective for chronic low back pain by reducing physical impairment, positively impacting cognitive appraisal (decreasing fear avoidance), and improving neurophysiological functioning.

Safe practices:

• Gentle spinal movements in all directions (Cat-Cow, gentle twists)
• Core strengthening to support the spine
• Hip opening to reduce lower back compensation
• Avoid deep forward bends initially if they cause pain

Herniated or Bulging Discs

Requires careful attention to spinal mechanics:

Avoid:

• Deep forward bends with rounded spine
• Twists that compress the affected area
• Jumping or jarring movements

Emphasize:

• Spinal extension (gentle backbends) to create space
• Core engagement to stabilize
• Neutral spine positions
• Props to support proper alignment

Sciatica

Pain radiating down the leg from nerve compression requires specific modifications:

Avoid:

• Deep hip stretches that aggravate the nerve (Pigeon may or may not work)
• Forward bends that increase pain
• Poses that compress the affected side

Try:

• Gentle hip opening that doesn't aggravate symptoms
• Poses that create space in the lower back
• Supine leg stretches with strap
• Restorative poses—note that some restorative texts specifically warn: "Avoid this pose if you have sciatica or disc problems in your lower back"

Scoliosis

Lateral curvature of the spine requires asymmetrical practice:

• Work to lengthen the concave (compressed) side
• Strengthen the convex (stretched) side
• Use props to create symmetry
• Avoid poses that exaggerate the curve

Knee Issues

The knee is a hinge joint designed for flexion and extension, not rotation or lateral stress. Knee injuries are common and require careful attention.

General Knee Pain

Avoid:

• Deep knee flexion if painful (deep squats, Hero Pose)
• Twisting on a bent knee
• Hyperextension in standing poses
• Kneeling without padding

Modifications:

• Use blocks under hips in Hero Pose or skip it entirely
• Keep knees tracking over ankles in lunges
• Engage quadriceps to protect knee joint
• Use blankets under knees for padding

Meniscus or Ligament Injuries

These require medical evaluation and clearance. Once cleared:

• Avoid deep flexion and rotation
• Build strength gradually through standing poses
• Use props to reduce range of motion
• Focus on alignment over depth

Knee Replacement

Students with knee replacements can practice yoga but need modifications:

• Avoid kneeling directly on the replaced knee
• No deep flexion beyond comfortable range
• Focus on maintaining mobility and strength
• Use chair yoga variations when needed

Shoulder Issues

Shoulder injuries are increasingly common, especially with the popularity of arm balances and Chaturanga-heavy classes.

Rotator Cuff Injuries

The rotator cuff stabilizes the shoulder joint. Injuries range from tendinitis to tears.

Avoid:

• Bearing full weight on injured shoulder
• Overhead reaching if painful
• Chaturanga without proper strength
• Poses that cause sharp pain

Modifications:

• Practice Plank on forearms instead of hands
• Skip or modify Chaturanga (knees down, or skip entirely)
• Use wall for Downward Dog
• Focus on scapular stability exercises

Frozen Shoulder

This condition involves loss of range of motion and requires gentle, progressive work:

• Move to the edge of restriction, not through it
• Use props to support arms in restorative poses
• Practice gentle range-of-motion exercises
• Avoid forcing or pushing through pain

Wrist Issues

With the prevalence of typing, texting, and weight-bearing poses in yoga, wrist issues are common.

Carpal Tunnel Syndrome

Compression of the median nerve causes numbness and pain.

Avoid:

• Extended weight-bearing on hands
• Deep wrist extension (hands flat in Downward Dog)
• Repetitive Chaturanga

Modifications:

• Practice on fists or forearms
• Use wedges under hands to reduce wrist angle
• Take frequent breaks from weight-bearing
• Focus on poses that don't stress wrists

Wrist Tendinitis

Inflammation of wrist tendons requires rest and modification:

• Reduce or eliminate weight-bearing on hands
• Use forearm variations (Dolphin instead of Downward Dog)
• Ice after practice if inflamed
• Build strength gradually as healing occurs

Osteoporosis

Loss of bone density requires careful attention to avoid fractures.

Avoid:

• Deep forward bends with rounded spine (risk of compression fractures)
• Deep twists
• Jumping or jarring movements
• Inversions if severe

Emphasize:

• Gentle backbends to strengthen spine
• Weight-bearing standing poses to build bone density
• Balance poses to prevent falls
• Core strengthening for spinal support

Glaucoma and Eye Conditions

Increased intraocular pressure can damage the optic nerve.

Avoid:

• Inversions (Headstand, Shoulderstand, Downward Dog held long)
• Poses where head is below heart for extended periods
• Breath retention

Safe practices:

• Standing poses
• Seated poses
• Gentle backbends
• Restorative poses with head elevated

Detached Retina

This is an absolute contraindication for inversions. Students with history of retinal detachment should never practice poses where the head is below the heart.

Neck Issues

Neck pain and cervical spine issues require gentle attention.

Avoid:

• Deep neck flexion or extension
• Shoulderstand without proper support
• Headstand if neck is unstable
• Plow Pose if contraindicated

Modifications:

• Support neck in Shoulderstand with blankets
• Practice Bridge instead of Shoulderstand
• Keep neck neutral in most poses
• Avoid looking up in Upward Dog if painful

Digestive Issues

Acid Reflux/GERD

Avoid:

• Inversions immediately after eating
• Deep forward bends after meals
• Poses that compress the abdomen

Helpful:

• Gentle twists
• Poses that lengthen the torso
• Breathing practices that calm the nervous system

Hernias

Avoid:

• Core strengthening that increases intra-abdominal pressure
• Deep backbends
• Inversions (depending on type and location)

Safe:

• Gentle stretching
• Restorative poses
• Breathing practices

Menstruation

Traditional teachings suggest avoiding inversions during menstruation, though this is debated in modern practice. The reasoning is that inversions may interfere with the natural downward flow (apana vayu).

Traditional approach:

• Avoid inversions
• Avoid intense core work
• Focus on gentle, restorative practice
• Honor the body's need for rest

Modern approach:

• Let students decide based on their own bodies
• Offer modifications for those who prefer to avoid inversions
• Emphasize that there's no shame in resting

The key is giving students information and autonomy to make their own choices.

Common Questions

Q: What if a student doesn't tell me about their condition?

A: This is why intake forms and verbal check-ins are essential. At the start of class, always ask if anyone has injuries or conditions you should know about. Create a culture where students feel safe sharing information.

However, students aren't required to disclose medical information. Your job is to teach in a way that offers modifications and empowers students to make their own choices. Remind the class regularly: "You're the expert on your own body. Modify or skip any pose that doesn't feel right."

Q: How do I remember all these contraindications?

A: You don't need to memorize every detail. Focus on understanding principles:

• Inversions affect blood pressure and eye pressure
• Forward bends compress the abdomen and can stress the lower back
• Twists can compress organs and stress the spine
• Weight-bearing poses stress joints

With these principles, you can reason through most situations. Keep reference materials handy and continue your education.

Q: What if I'm not sure if a modification is safe?

A: When in doubt, err on the side of caution. Offer the most conservative modification and suggest the student consult their healthcare provider. It's always better to be too careful than not careful enough.

You can say: "I'm not familiar with that specific condition. Let's work with gentle modifications today, and I encourage you to check with your doctor about what's appropriate for your practice."

Q: Should I ask students to get medical clearance?

A: For serious conditions (recent surgery, heart conditions, pregnancy complications, severe osteoporosis), yes. Many teachers include language in their waiver forms requiring medical clearance for certain conditions.

For minor issues (general back pain, mild knee discomfort), use your judgment. The goal is safety without creating unnecessary barriers to practice.

Q: How do I handle a student who ignores modifications?

A: This is tricky. You can offer modifications and explain why they're important, but ultimately, students make their own choices. If a student consistently ignores safety guidance and you're concerned about liability, you may need to have a private conversation.

You might say: "I notice you're not taking the modifications I've suggested for your knee. I'm concerned about your safety and my responsibility as a teacher. Can we talk about how to make your practice work for your body?"

Q: What if a student gets injured in my class?

A: First, attend to their immediate needs. If it's serious, call for medical help. Document what happened. Follow up with the student.

This is why liability insurance is essential for all yoga teachers. It's also why teaching with attention to safety, offering modifications, and creating a culture of body autonomy is so important.

Q: How detailed should my intake forms be?

A: Detailed enough to catch major contraindications, but not so complex that students skip questions. At minimum, ask about:

• Recent surgeries or injuries
• Chronic conditions (heart, blood pressure, glaucoma, osteoporosis)
• Pregnancy
• Current pain or limitations
• Medications that might affect practice

Include a space for students to describe anything else you should know.

Next Steps

Now that you understand common contraindications and modifications, here are ways to deepen your knowledge:

• Read next: Targeting Body Regions to understand how anatomy informs safe sequencing
• Study: Keep a copy of Light on Yoga by B.K.S. Iyengar as a reference for contraindications and modifications
• Practice: Start noticing contraindications in your own body. How do different poses feel on different days? This builds empathy for your students' experiences.
• Educate: Consider taking workshops or trainings in therapeutic yoga, yoga for specific populations, or anatomy for yoga teachers
• In Sutrix: Use Step 4 (Anatomy & Safety) in the wizard to specify contraindications and ensure your generated sequences account for student limitations

Sources

This article draws on authoritative yoga teachings and modern therapeutic approaches, including:

• Light on Yoga by B.K.S. Iyengar, which provides specific guidance on contraindications for cardiovascular conditions, pregnancy, and various poses. Iyengar's clear statements—such as "Persons suffering from high blood pressure or heart trouble should never attempt to hold their breath" and his detailed pregnancy guidelines—form the foundation of safe practice.

• Yoga Sequencing and therapeutic yoga texts that emphasize the teacher's role in working with injuries: offering "a safe setting in which they can explore within their own bodies how to move and hold in ways that facilitate the natural healing process" along with modifications and healing-focused poses.

• Restorative Yoga teachings that provide specific contraindications for supported poses, reminding us to "avoid this pose if you have sciatica or disc problems" and other condition-specific guidance.

• Research on yoga's effectiveness for chronic low back pain, showing that yoga reduces physical impairment, positively impacts cognitive appraisal, and improves neurophysiological functioning.

• The principle of ahimsa (non-harming) from the Yoga Sutras, which reminds us that safety and compassion must guide all our teaching choices.

The goal is not to memorize every contraindication, but to develop a framework for thinking about safety, a commitment to ongoing education, and the humility to say "I don't know" when needed. Your students' safety depends on your willingness to prioritize their well-being over impressive sequences or advanced poses.