Yoga Poses to Avoid or Modify for Common Conditions

Osteoporosis or low bone mass

A Mayo Clinic review of 89 yoga-related injuries found the poses most often involved extreme spinal flexion and extension, and advised people with osteopenia or osteoporosis to avoid extreme spinal flexion.[2] A case series of 9 people (median age 66) reported vertebral compression fractures from one month to six years after they started yoga with spinal flexion exercises.[3] A report of three otherwise healthy people with low bone mass describes new pain or fractures after yoga flexion exercises.[4] A literature review concluded that spinal flexion can raise fracture risk, mild flexion and extension may be beneficial, and there are insufficient data on which poses carry the least risk.[5] A systematic review of nine studies found very low certainty evidence overall.[6] The Royal Osteoporosis Society says most people with osteoporosis can exercise safely and advises talking to a doctor or physiotherapist first if you have had many broken bones or spinal fractures, or are recovering from a break.[7] Evidence label: harm from forceful spinal flexion in case reports; insufficient evidence for pose-level lists. See Yoga and Osteoporosis.

Glaucoma and head-down poses

In small studies, eye pressure rose within a minute in head-down poses in people with and without glaucoma and returned to baseline afterward.[10][11] A review found rapid pressure increases soon after starting inversion poses.[12] A case report describes progressive glaucoma damage in a patient who practiced headstand daily for many years.[13] A review of case reports advises that people with glaucoma avoid inversions.[14] Whether yoga causes glaucoma to progress is unclear.[11] Evidence label: short-term pressure rise established in small studies; long-term harm insufficient evidence. See Inversions in Yoga.

High blood pressure

NCCIH lists severe high blood pressure among conditions that may call for modified practice.[1] Proper evidence not found for a source-backed list of poses to avoid with high blood pressure. We searched PubMed for yoga with hypertension, inversion and blood pressure poses. One small study of 22 healthy young volunteers found heart rate and blood pressure responses differed between poses, with heart rate rising significantly after one pose, Dhanurasana.[15] See Yoga With High Blood Pressure or Heart Conditions.

Disc problems and sciatica

A small trial of adults with disc bulges or extrusions used a course designed with disc safety in mind and reported no adverse effects.[16] A larger back-pain trial excluded people with sciatica and spinal stenosis.[17] Proper evidence not found for a validated list of poses to avoid with a disc problem; the abstracts do not list poses. See Yoga Poses Used in Back-Pain Trials.

Wrists, shoulders, knees and hips

NCCIH reports sprains and strains as the most common injuries, most often at the knee or lower leg.[1] A review found a higher risk of meniscus injuries in yoga practitioners than non-practitioners.[18] Clinic reports link wrist pain to arm-supported positions in yoga.[19] Insufficient evidence for pose-level cautions; see Downward-Facing Dog, Plank and Chaturanga.

Hypermobility, older age and recent surgery

• Hypermobility: the NHS says the main treatment for joint hypermobility syndrome is improving muscle strength and fitness so joints are better protected, and a GP may refer you to a physiotherapist.[20] Proper evidence not found in the sources we read for yoga pose guidance in hypermobility. See Yoga and Hypermobility.
• Older adults: US emergency-department data show a yoga injury rate of 57.9 per 100,000 estimated participants aged 65 and older, against 11.9 for ages 18 to 44, in 2014.[21]
• Recent surgery or injury: NCCIH lists preexisting injuries as a reason to modify.[1] Proper evidence not found for pose restrictions after specific surgeries; ask your surgeon or physical therapist. See Yoga After Surgery or Injury.

For beginners and in hot rooms

NCCIH advises newcomers to avoid headstands, shoulder stands, the lotus position and forceful breathing, and warns that hot yoga carries overheating and dehydration risks.[1]