YOGA & PILATES: WHEN TO AVOID OR MODIFY PRACTICE

Yoga and pilates are popular forms of exercise. Yoga is a form of exercise involving the mind and the body. It incorporates meditation, breathing exercises, and movements. Pilates also involves mind and body exercises. While both techniques incorporate certain poses, pilates also includes moving your limbs, while yoga involves holding the position for a certain period of time. It is crucial to note that while yoga and pilates may serve as valuable complementary forms of therapy in the management of some medical conditions, they should not be considered as standalone or curative treatments.

Health Benefits of Yoga and Pilates

Yoga has many benefits, including helping with back pain, building strength, and improving balance and flexibility. It can also help with relaxation, alleviate arthritis symptoms, and even benefit your heart.

Pilates is also helpful, having benefits such as improving your posture and balance, increasing your energy, and helping to prevent injury. According to studies, pilates has also been shown to improve the quality of life of patients with kidney disease and decrease menstrual pain in women.

While yoga and pilates offer numerous potential benefits, it is crucial to recognize that individual needs and circumstances vary significantly. In some cases, these practices may not be suitable or may require modifications. Sometimes, yoga may even cause pain, and there are risks associated with pilates in some situations. It is essential to consult with a healthcare professional before starting any new exercise program, including yoga or pilates, to ensure they are safe and appropriate for your individual health status.

Contraindications and Conditions Requiring Caution

For people with certain conditions, pilates and yoga may not be safe exercise options and should either be avoided or modified. These include:

• Spinal Issues and Herniated Discs

If you have knee/hip injuries and lumbar (lower back) spine disease, you should avoid or modify yoga to prevent further injury. A herniated (prolapsed) disc is when the tissue between your vertebral bones is displaced and bulges out towards the spine. Care needs to be taken if you have this condition, and it is wise to consult a physiotherapist who can prescribe safe exercises for you to do if you have a herniated disc.

• Radiculopathy

This is the condition where a nerve root or roots leaving the spine are pinched or irritated. Pilates should be avoided or done with care if you have radiculopathy.

• Sciatica

Sciatica is a type of radiculopathy where the sciatic nerve becomes irritated or inflamed in some way. While yoga can be helpful for sciatica, there are some poses that should be avoided, like bending forward. It is also recommended to avoid high-impact yoga practices if you have sciatica.

• Spondylolisthesis and Fractures

Spondylolisthesis is when a vertebra slips out of place compared to the adjacent vertebra in the backbone. Unstable spondylolisthesis and fractures are contraindications for pilates.

• Spinal Stenosis

People with spinal stenosis (narrowing of the spinal canal) need to be cautious because certain poses can worsen the condition. Twisting yoga, such as janu sirsasana and full inversions, should be avoided since these could compress the spine.

• Chronic Lower Back Pain

Some research indicates that pilates does not help improve lower back pain and functionality. In fact, pilates may increase pain in patients with chronic lower back pain.

• Severe Osteoporosis

Osteoporosis occurs when bones are demineralized. Such advanced bone loss can increase the risk of fractures. If you have osteoporosis, doing pilates can be risky since there is a possibility of over-flexing your back.

• Joint Problems and Hypermobility

People with advanced stages or severe forms of musculoskeletal disorders should not do certain types of yoga. Individuals who have joint hypermobility should avoid overstretching while exercising. Those with hypermobility may benefit from training to improve balance and proprioception, which can help prevent overstretching. Older adults are advised to consult a healthcare provider to determine suitable modifications of yoga to help reduce the chance of injury.

• Heart Conditions

Certain types of yoga should be avoided if you have underlying heart conditions. Some exercises like Kapalbhati Yoga may even cause ischemic heart problems. Individuals with unstable heart disease should avoid exercise, and those with Brugada syndrome should avoid hot yoga. Additionally, patients who have had recent heart surgery should also avoid exercise for at least 3 months and consult their healthcare provider for advice before starting an exercise program.

• High Blood Pressure

Stretching and restorative yoga both appear to reduce blood pressure and heart rate and may be a suitable therapeutic option for hypertensive patients. However, studies also reveal scenarios where caution is advised. Certain yogic cleansing techniques (shat kriyas), like jala neti (cleansing the nasal passages) and trataka (visual concentration), can be practiced with caution; however, there is limited scientific evidence on the efficacy of these practices in hypertension. On the other hand, dhauti kriyas (internal cleansing), such as vaman dhauti (regurgitative cleansing) and varisara dhauti (digestive tract cleansing), are contraindicated for those with high blood pressure. People with glaucoma, which causes high pressure in the eye, should avoid head-down poses since these increase eye pressure, which could result in further damage to the eye.

• Severe Respiratory Conditions

Some positions in yoga may trigger a flare-up of asthma. This means that yoga may need to be modified if you have asthma. It is recommended that you work with a certified instructor who has experience training those with asthma. Some studies indicate that those with COPD may benefit from yoga and pilates. However, poses that restrict breathing or involve diaphragmatic breathing may not be apt in some cases of moderate to severe lung disease.

Recent Surgeries and Acute Injuries

• Acute Injuries (Sprains, Strains, Muscle tear, Fractures)

Yoga can sometimes worsen existing pain or cause increased musculoskeletal pain, especially in the shoulders and arms, due to some poses like the downward dog pose. Exercises involving spinal flexion may not be suitable, particularly for people with spinal osteopenia or osteoporosis, who are at increased risk of vertebral compression fractures. Some injuries can arise from repetitive strain during yoga and overstretching. If not practiced with care, yoga can result in muscle tears and strains.

• Post-Surgical Considerations: It is best to avoid strenuous poses until cleared by a doctor.

For Women

• Pregnancy and the Postpartum Period
  • Modifications for Each Trimester: There are particular poses you should avoid depending on the trimester you are in. For instance, in the first and second trimesters, avoid inversions or forceful back or abdominal movements. During the second trimester, it is also important to avoid exercises that involve lying on your side or back. In the third trimester, besides the caution advised for the second trimester, it is recommended to avoid squats if prone to prolapse; otherwise, squats can be modified as required.
  • Avoid Hot Yoga and Hot Pilates: Women should avoid hot pilates or hot yoga exercises during pregnancy. These forms can induce maternal hyperthermia (overheating), which, particularly in early pregnancy, has been linked to the development of neural tube defects in the unborn child.
  • Postpartum Recovery: You need to wait a minimum of 6 weeks or longer before doing any exercise if you experience pregnancy-related complications. Gradually increase intensity and avoid strenuous poses, especially during the initial postpartum period. It is wise to avoid exercises that can exacerbate abdominal separation, also called diastasis recti.
  • Pre-eclampsia and Pilates: While low-intensity exercise may help prevent pre-eclampsia, moderate to strenuous exercise is not recommended if you have severe pre-eclampsia.

Special Conditions and Situations

• Chronic Illnesses:

Some illnesses, such as chronic fatigue syndrome and rheumatic diseases, may be aggravated by certain yoga poses. Hence, patients with rheumatic disease may need to modify them. It is advisable to consult with a rheumatologist before attempting yoga.

You should avoid strenuous activities and hot yoga if you have certain special conditions.

• Yoga in rheumatic diseases

Certain styles of yoga, such as Ashtanga, are not recommended if you have rheumatic disease.

• Chronic fatigue syndrome

Yoga can be problematic for some people with chronic fatigue syndrome, especially if they have orthostatic intolerance, which affects their balance. They may also experience significant exhaustion after the exercise.

• Diabetic retinopathy

​A person with diabetic retinopathy (a condition with abnormal blood vessel growth in the eye’s retina) should avoid doing certain pilates moves.

• Other chronic diseases or problems

In some cases, yoga can lead to muscle strain. Poor physical condition and chronic disease could increase the risk of injury during yoga classes.

• Vertigo and Balance Issues
  • There is a concern that yoga can lead to benign paroxysmal positional vertigo in some cases. Dizziness may also occur as an adverse effect of doing yoga. Furthermore, if you have problems with balance, modifications may be necessary.
• Neurological Conditions

Pilates can be modified for people who have multiple sclerosis (MS) or Parkinson’s disease. Pilates for people with MS should focus on building core strength.

• Mental Health Considerations
  • Intense Anxiety or Panic Attacks: Some yoga poses, particularly those that require deep breathing or stillness, may trigger anxiety or panic attacks in individuals with severe anxiety disorders.
  • Severe Depression: In cases of severe depression, physical activity might not be the primary focus, and people may have a tough time following complex techniques, which may aggravate the condition. Consulting with a mental health professional and engaging in therapies like cognitive-behavioral therapy (CBT) may be more beneficial than yoga alone, particularly in helping patients to sleep.

General Precautions

• Listen to Your Body:
  • Pay attention to pain and discomfort.
  • Rest when needed.
  • Yoga and pilates are best practiced when the mind and body are calm and receptive. Avoid these practices when exhausted (to prevent overexertion), unwell, rushed, or under acute stress.
• Consult a Healthcare Professional: Seek professional guidance before beginning a new exercise regimen, particularly if you have existing health conditions.
• Choose a Qualified Instructor: Ensure you team up with a skilled instructor who can suggest modifications for your specific needs.
• Start Slowly and Gradually Increase Intensity: Avoid pushing yourself too hard, especially as a beginner.
• Proper Form and Alignment: Maintain correct alignment to prevent injuries.
• Hydration: Stay hydrated before, during, and after practice.

• Avoid certain poses if necessary: As discussed above, if you have specific health conditions, avoid poses that may exacerbate symptoms. You may need to modify your routine and choice of poses to prevent further injury.
• Do not exercise immediately after a meal. Wait 2 to 3 hours after a large meal.
• Do not shower, drink water, or eat food for 30 minutes after doing yoga.
• Do not perform yoga or pilates in extreme weather conditions, such as too hot, cold, or humid weather conditions.

Yoga and Pilates Props

Props are sometimes used in both pilates and yoga. These can be helpful in providing support and safety.

Various equipment is used for yoga. Generally, the following props are needed and used:

• Yoga mats - Important for safety when performing poses.
• Yoga strap - Helps with alignment and deeper stretches.
• Yoga block - Helps make poses more accessible and also aids alignment.
• Yoga bolsters - Supports the body during times when you are doing restorative poses.
• Eye pillows - Helps when meditating.
• Yoga blankets - Useful for certain poses and in savasana yoga.
• Meditation cushions - Provide comfort when you are sitting for a long time.
• Sandbags - Help to provide stability by adding support in some poses.

Disabled indivdulas can benefit from props like blocks and straps as they provide extra support.

For pilates, equipment includes:

• Pilates mat - This mat is of greater thickness than a yoga mat and provides more support, which is sometimes needed in pilates.
• Pilates ring - A resistance prop.
• Pilates reformed - A fairly large piece of equipment used to help stabilize the spine, strengthen the abdominal muscles, and promote better balance.
• Foam roller - A foam tube is used for exercise and massage.
• Ladder barrel - Helps with spine alignment.
• Pilates band - A resistance band that helps you build strength.
• Pilates chair/Wunda chair - Useful when recovering from injury.

Conclusion

Yoga and pilates are two activities that can be beneficial for many people. However, these exercises are not one-size-fits-all, and you should be aware that although there can be health benefits, individuals with certain health conditions may need to be cautious. Particular poses or exercises done in yoga and pilates may not be suitable for everyone. Exercises may need to be modified or avoided altogether, depending on your condition.

It is advisable to work with a certified yoga/pilates instructor when incorporating pilates or yoga. Understand your physical limits, pay attention to your body's signals, and always consult a healthcare professional before beginning or changing any exercise program.

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