Some Commonly-Taught Yoga Poses May Present Risks for Older Adults

By Carol Krucoff, C-IAYT, E-RYT

Teaching yoga to seniors is often erroneously considered an entry-level job for a yoga instructor, since older adults aren’t likely to attempt complicated, “advanced” postures. Unfortunately, this ill-informed attitude puts the most vulnerable students with the least-trained instructors who may  unknowingly put their students at risk.

Older adults are arguably the most challenging—and rewarding– yoga students to teach. Of all age groups, seniors are the most complex and varied, with some able to run marathons and others unable to get out of bed. About half of Americans over age sixty-five have a disability, such as difficulty hearing, seeing, or walking, and more than a third have a severe disability. [1] More than 87 percent of seniors take at least one prescription drug, and nearly 60 percent take three or more. [2] Even fit older athletes have vulnerabilities that are often not understood by many yoga teachers.

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For example, these commonly-taught yoga practices may be risky for seniors:

Forward Bends with Straight Legs

Forward bends with straight legs, such as the postures Uttanasana and Paschimottanasana, may increase the risk of vertebral fracture for people with low bone density, which is common in older adults. By 2020, one in two Americans over age fifty is expected to have or be at risk of developing osteoporosis of the hip; even more will be at risk of developing osteoporosis at any site in the skeleton. [3]  We encourage students to hinge at the hips (not at the waist), bend their knees, and keep their spine in a neutral alignment when folding forward.

Deep Twists  

Deep Twists are contraindicated for people with low bone density. [4] The National Osteoporosis Foundation advises people with low bone density to avoid “twisting of the spine to a point of strain.” We recommend keeping twists in mid-range and using a fluid quality of motion.

Breath-Holding

Breath-holding can affect blood pressure and is inadvisable for people with heart disease and/or hypertension. Extreme breathing practices such as Kapalabhati and Bastrika may also be problematic. More than 63 percent of Americans over age 60 have high blood pressure. [5] We remind students to keep their breath flowing and comfortable.

These important considerations are generally not included in basic yoga teacher trainings.  This is why, back 2007, we launched our first Integrative Yoga for Seniors Professional Training at Duke Integrative Medicine.  As yoga teachers working in medical settings, Kimberly Carson and I sought to combine the best of current, evidence-based medicine with the ancient wisdom, experience, and tradition of Yogic teachings. We invited Duke Faculty experts to present talks on age-related health issues such as heart disease, arthritis, and osteoporosis, and used the science-based movement considerations they recommended to inform our approach to teaching yoga to seniors.

Today the program has evolved into an annual 50-hour master training designed to give yoga instructors the skills and confidence to safely and effectively teach older adults. A prerequisite for enrollment is the completion of at least a 200-hour yoga teacher training or equivalent, and graduates have the opportunity to receive continuing education credits from the Yoga Alliance, the International Association of Yoga Therapists, and the National Board for Health & Wellness Coaching. The course text is our book, Relax into Yoga for Seniors: A Six-Week Program for Strength, Balance, Flexibility, and Pain Relief. 

Along with the challenges involved in teaching yoga to older adults also come unique opportunities. Seniors, perhaps more than any other age group, recognize that yoga is not just about postures, and they tend to be extremely receptive to its profound physical, emotional, mental, and spiritual benefits. Unlike younger practitioners who are often distracted by the desire for a shapelier body, older adults typically have an eagerness and deep appreciation for the experience of ease and union, which is the true heart of the yoga practice.

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Over nearly two decades of teaching yoga to people facing health challenges and age-related issues, we have gained a deep respect for individual differences and the importance of honoring each person’s unique journey. We begin by encouraging people to start where they are, not where they think they should be. Then we offer appropriate tools of yoga, including postures, breathing, meditation, and principles, to help them deepen their awareness and find ease. We use inclusive, nonjudgmental, and encouraging language that validates each person’s experience. The priority is creating a safe and welcoming environment for each student. Equally essential is ensuring that this imperative of safety does not create a sense of fear or limitation but rather invites the empowering recognition of yoga’s highest teachings that our true nature is already whole.

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[1] Brault MW. Current Population Reports: Americans with Disabilities. 2005, Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, 2008. https://www.census.gov/library/publications/2012/demo/p70-131.html

[2] Table 98. In: National Center for Health Statistics. Health, United States, 2008: A Report of the Department of Health and Human Services, Hyattsville, MD: National Center for Health Statistics, 2009. https://www.cdc.gov/nchs/data/hus/hus08.pdf

[3] https://www.ncbi.nlm.nih.gov/books/NBK45515/

[4] https://cdn.nof.org/wp-content/uploads/2016/05/Safe-Yoga-NOF-Flyer-2016.pdf

[5] https://www.cdc.gov/nchs/products/databriefs/db289.htm