When Is It Safe to Return to Yoga Class?

There are more than 15 million people in America who practice yoga, according to a 2008 Yoga Journal study. Most likely that number is even higher now compared to four years later. It’s inevitable that a physical therapist working in an outpatient clinic will face the question, “When can I go back to yoga class?” or “Is taking yoga a good idea for me?”

Earlier this year, the NYT Magazine caused quite a stir when they published an article entitled “How Yoga Can Wreck Your Body”. Given the popular hysteria that resulted from this article, physical therapists may feel more obliged than ever to make sure our patients are not putting themselves at risk by doing yoga.

My colleagues will often refer those patients to me in order to assess their readiness to return to a community-based yoga class but not every physical therapy clinic has a yoga-trained physical therapist on hand. Even if you are not trained in yoga therapy or have no experience teaching or even participating in yoga, there are some basic criteria you can use to help you guide your patient to a safe return to a community-based yoga class.

• Always recommend that your patient start with a gentle or beginner level class even if they are not a beginner. These slower paced classes provide opportunity for testing the waters and exploring how the body feels in basic postures. It also helps to establish neuromuscular patterns that will optimize alignment, muscle recruitment, and endurance in various poses.

• Make sure your patient has full and painless range of motion in their affected joint. It is sometimes appropriate to begin to practice some yoga postures when the injured joint is still impaired, however this should be under close supervision from a physical therapist or a physical therapy assistant or as part of a controlled home program. A class setting is more likely to exacerbate an injury because there is often not enough time to move slowly and mindfully enough in and out of various postures.

• There is a psychological element of participating in a class that stokes a natural tendency to compete with other students or to want to perform well for the teacher. Because of these psychological factors, your patient should demonstrate a record of not pushing themselves too fast and hard in the clinic or with their home physical therapy exercise program before you give them the green light to attend a general yoga class.

• Forge a relationship with one or more teachers in your community who you can trust. Make sure they are well trained and have the students’ best interests at heart. Then when you are ready to send your patient off to class, make sure the teacher is aware of the injury and will encourage modification as needed.

• Your patient should demonstrate independence with awareness of proper alignment and neuromuscular control of the involved body part.

          Examples:

Spine. For patients with back or neck pain, make sure they are aware of good yoga postures and can find neutral spine position with minimal cues. They should be able to achieve this while seated on the floor (with props as necessary), standing, on hands and knees and while standing with a split stance (one leg forward, one leg back).

Shoulder. Make sure that your shoulder patients can distinguish scapular motion from glenohumeral humeral motion and are not stuck in any compensatory patterns. This should be true for both open and closed chain motions.

Foot/Ankle. Patients with foot and ankle problems should be familiar with neutral foot position and be able to demonstrate demonstrate pronation and supination while standing. They should be pain-free with a split stance, especially the Warrior poses. In warrior pose, the back foot will be positioned at or near end-range dorsiflexion/abduction/pronation.

Knee. Make sure that your patients with knee injuries can recognize when they hyperextend their knees in strait leg poses such as Triangle and when they tend toward an IR/adduction pattern (knee to far toward midline) in lunge-like postures.

 

Consult the Pragmatic Yogi for questions or concerns you and your patient have about any specific poses. There are currently over 40 poses covered in my ‘Asana Analysis’ posts. Just enter the pose you are interested in in the search box on the side bar. Or you can enter a body part to get a list of relevant posts. Each post includes general information about the pose, points of body awareness, modifications and notes relative to the pose’s use in physical rehabilitation.

Contrary to the NYT Magazine’s article, attending a yoga class will not wreck the body when done in a mindful, conscientious and non-competitive manner. The collaboration of healthcare professionals and yoga instructors can further the chance that yoga will be a healthy, healing experience rather than an ego-driven, contortionist sport that is indeed risky business.

Resources:

http://www.yogajournal.com/advertise/press_releases/10

http://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html?pagewanted=all

http://www.thepragmaticyogi.com/2010/11/asana-analysis-warrior-ivirabhadrasana.html

http://www.thepragmaticyogi.com/2010/05/asana-analysis-triangle-posetrikonasana.html

http://www.thepragmaticyogi.com/

About the Author: Lisa B. Minn is a licensed physical therapist and yoga enthusiast. She has been incorporating aspects of Yoga her physical therapy practice since 2001 and became a certified yoga instructor in 2004. You can read more about the theraputic applications of yoga on her blog, ThePragmaticYogi.com.

Click here for more articles by and information on Lisa Minn.

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