10.4 Contraindications, Misalignments, and Adaptations

Yoga Alliance lists contraindications, misalignments, and adaptations as a Biomechanics sub-competency and asks how that content relates to movement in yoga (Standards for RYS Credentials, May 2025). A 200-hour teacher learns category-level red flags, not a differential diagnosis. You offer versions of poses, you watch for common misalignments, and you stay inside the Scope of Practice (last updated 27 February 2020). This OpenExamPrep section is independent classroom teaching. It is not a claim that OpenExamPrep speaks for Yoga Alliance, and it is not permission to play clinician.

Category Red Flags (Not a Diagnosis Chart)

A contraindication in teacher training means “do not treat this as a default group cue; offer an alternative and do not pretend you have medically cleared the student.” Students may still choose, with their own clinicians, to practice versions you would not assign to a mixed-level room. Your job is the room you are teaching.

Inversions raise the question of head-below-heart load and, in Sirsasana and related shapes, cervical compression. Teaching flags that belong on your intake radar include uncontrolled hypertension, glaucoma or other conditions a clinician has flagged for inverted postures, recent stroke or eye surgery, cervical injury, and late pregnancy as many prenatal-aware schools handle it. You do not diagnose those conditions. You listen, you believe the student’s report, and you offer Viparita Karani, a chair-supported forward rest, or a simple reclined pose instead of a pressured headstand. Adho Mukha Svanasana is a mild inversion for some bodies; it is not a substitute medical screening.

Deep backbends concentrate extension, often in the lumbar spine if the thoracic spine and hips do not share the work. Teaching flags include acute lumbar pain the student reports, a clinician’s caution after spinal surgery, and situations where a pregnant student (or a student with a recent abdominal procedure) does not want deep end-range extension. Offer a smaller cobra, a supported Bridge on a block, or a prone rest. Do not sell Urdhva Dhanurasana as a cure for a back condition.

Loaded spinal flexion—rolling up from a forward fold with a rounded lumbar spine while the body is still a long lever, yanking on the feet, or adding external weight—is a category red flag because it concentrates compression and shear on lumbar discs and posterior tissues. Osteoporosis or a clinician’s bone-density caution is a reason to prefer hip-hinge folds with a long spine, bent knees, hands on thighs, or a seated chair fold, not a dare to “round more to stretch the back.” Unloaded, gentle flexion in a student who has no red-flag history is a different story from bouncing with a barbell. Teach the difference.

Twists, heat, and long holds can also be school-specific flags (pregnancy, recent abdominal work, inflammatory flare). When in doubt, reduce load and stop adding heat as a personality test.

Common Misalignments You Can See

A misalignment in this competency is an observable pattern that changes load, not a verdict that the student’s skeleton is wrong. You describe what you see and you offer a mechanical change.

Typical 200-hour patterns:

• Front knee collapsing inward (valgus) in lunges and Warrior II: often a hip-rotation and foot-tripod story. Shorten the stance, track the knee toward the second toe, or take a smaller bend.
• Hyperextended elbows in Down Dog or Plank: micro-bend and use the scapular platform from section 10.2.
• Hyperextended knees in Tadasana or straight-leg folds: soft knees, or a bend that lets the hips take the fold.
• Rib flare in backbends: lower-rib softening and a smaller extension so the lumbar is not the only hinge.
• Collapsed inner arches / rolled-in ankles: shorten stance, use a wedge or rolled mat, reduce depth.
• Hiked hip in Triangle or half-moon: less side-bend amplitude, block under the bottom hand, both sides of the waist long.
• Cervical crunch in Cobra or Shoulderstand family: look slightly forward or skip the cervical load entirely.
• Shoulders shrugged into the ears in any arm-supported pose: broaden the scapulae, bend the knees, or take the wall.

Do not narrate these as “your SI joint is out” or “you have a herniated disc.” That is diagnosis. Say “I see the front knee dropping in; let’s shorten the stance.”

Props, Regressions, and Adaptations

An adaptation keeps the intended action available. Props are tools, not apologies.

• Blocks raise the floor so Triangle, half-splits, and seated twists do not require collapsing.
• Straps shorten the reach in folds and shoulder work so the student does not round or shrug to grab skin.
• Wall gives a vertical reference for balance, handstand prep, and Down Dog load reduction.
• Chair offers sit-to-stand strength, seated twists, and inversion alternatives.
• Bolster and blankets turn an aggressive shape into a rest shape (supported Bridge, reclined bound-angle).
• Bent knees are a hip-and-spine adaptation, not a demotion.

Offer the adaptation to the whole room when you can (“blocks are part of Triangle today”) so the student who needs it is not singled out. Consent still governs any hands-on correction (Scope of Practice Principle 3: explicit and informed consent). Many misalignments are better addressed with a demonstration and a verbal cue than with unsolicited touch.

Stay Inside Scope of Practice: Refer Out, Do Not Diagnose

The Yoga Alliance Scope of Practice has six principles, including follow the Code of Conduct, teach yoga, consent-based adjustment, cite sources for philosophy/history/anatomy, advise and teach within permitted scope, and maintain relevant credentials. Principle 5 prohibits members from advising or teaching in areas where they do not have appropriate credentials and competence. The SOP is not intended to limit a licensed healthcare practitioner from practicing according to that other license. It does limit using a yoga credential as if it were that other license.

The Yoga Therapy Policy (last updated 18 November 2021) is explicit: Yoga Alliance RYS standards do not credential yoga therapy techniques, including the diagnosis or treatment of a mental or physical injury or illness. Members may not rely solely on RYS, RYT, or YACEP designations to present themselves as yoga therapists. If a student asks you to confirm a herniated disc, to clear them after surgery, or to prescribe a medical backbend protocol, you decline the diagnostic role, you keep the class invitation general (“here is a supported option; here is rest”), and you refer out to a licensed clinician. You can still teach yoga. You cannot turn RYT 200 into a compact MRI.

Use this list when a question leaves the mat:

1. Is this a pose-version question (yes: teach) or a “what is wrong with my body” question (refer)?
2. Have I used diagnostic labels (disc, tear, disease) as if I had examined them? Stop.
3. Have I promised a therapeutic outcome (“this will fix your sciatica”)? Retract and refer.
4. Did I offer a regression, a prop, and permission to rest?
5. Did I document, if my studio requires it, that I suggested they consult their clinician—without writing a diagnosis in the note?
6. If I hold another license, am I clearly using that license, not the RYT, as the basis for any extra claim?
7. Did I get explicit informed consent before any touch?
8. If I am unsure, is the conservative class choice rest or a smaller shape rather than a deeper peak?

Category red flags, visible misalignments, and practical adaptations are the 200-hour toolkit. The professional boundary is the same on every toolkit: teach yoga, do not diagnose, and send medical questions to people whose credentials actually cover those questions.