OPERATING PROCEDURE OP  30b					BRITISH WHEEL, OF YOGA
	Safety Statement		Section		Sheet Number	Date of Issue: June 1993
	Operating Guidelines		01			Revised: Sept 1995
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		Y O G A :  S A F E T Y   A N D   E X E R C I S E     © B.W.Y.
		There is ample evidence that most people who exercise feel better for it and those who exercise regularly feel less depression, fatigue and aggression(1). All regular exercise has a "training" effect and with regular exercise physiological changes occur in the muscles and cardiovascular system. It should be realised that classes usually last between 90-120 minutes and some classes are quite strenuous depending on whether the class is aimed at experienced students, beginners or special needs. The fact that most yoga is taught in a group situation imposes a certain level of discipline for the teacher. In any class situation there will usually be a cross section of the general public w.r.t fitness, age, height weight and flexibility.
		It is important that Yoga teachers are trained to produce programmes in which the safety of the individual in each class situation is recognised as the key issue.
		Basic areas have to be considered:
			PREPARATION USE OF AIDS AND MODIFICATIONS LIMITATIONS OF INDIVIDUALS LIMITATION OF JOINTS INTERACTION OF JOINTS AND MUSCLES THE MAIN MUSCLES/JOINTS INVOLVED IN INDIVIDUAL POSTURES.
		With any form of exercise there can be risks even to apparently healthy individuals with unrecognised medical conditions such as cardiac disease, changes to joints, muscles, etc. The high incidence of wear-and-tear arthritis, now more commonly called Degenerative Arthrosis, demonstrates that we create problems for ourselves by misuse of the structure of the body. Statistically all x-rays of the spine for Westerners over the age of 40 show degenerative changes(4). Poor use or injuries can produce changes in the soft tissue structure around joints, i.e., muscles, tendons, ligaments and cartilage.
		Most people only take an interest in the body structure when it breaks down. If we allow factors such as poor posture, poor muscle tone, emotional tensions, etc, to go on unchecked, they take a hold. We need to become aware of our individual weaknesses and limitations. Yoga has the ability to increase this awareness and is unsurpassed in its approach to body mechanics ..... providing you have a good teacher(4).
		A sensible approach to physical activity is the most realistic safeguard available. Previously sedentary individuals of mature years who wish to increase their recreational activity should always be advised to take things slowly.
		Sudden explosive exercise with the accompanying release of adrenaline and nor-adrenaline and the mobilisation of fatty acids, etc. can be harmful to some individuals not used to exertion. Any immediate cardiovascular problem relating to physical activity can be mitigated by preliminary warming-up exercises. The latter reduces the tendency to post exercise hypotension which can be a problem in the elderly(2).
		All students should be warned to heed such symptoms as chest pains, and awareness of cardiac irregularity, faintness or exercise dyspnoea. It should also be realised that although exercise increases wellbeing, muscle tone and the strength of bone and supporting structures, excessive exercise may result in temporary or permanent damage. Injuries during exercise may not only be brought about by over-exertion but by wrong technique(3). One should never physically push people into movement.
		To teach posture or movement adequately, the instructor must have a basic knowledge of anatomy and physiology which should include the simple assessment of an individual's limitations based on the quality of movement, body structure, movement capability. They should have a basic understanding of the muscle groups. There should be some knowledge of the potential weak areas of the body and what common medical conditions may make certain exercises contra-indicated. Some movements such as straight leg lifts are not considered safe for Yoga classes.
		The movements or basic exercises in Yoga fall into the following general groups:
		Balancing, Seated, Lateral Flexion, Forward and Backward bends, Inverted and Twisting postures.
		It is not easy to give 100% guidance in all areas as there too many posture variations to consider, but the following should be taken as general guidance.
		B A L A N C I N G / S T A N D I N G.
		The ability to perform simple posture balances may depend on a number of factors and essentially it is a complex interaction of the central nervous system and the musculo-skeletal system that gives you your balance. You need reasonably strong ankles. For most people to maintain a good physical balance you need a good efficient postural reflex mechanism especially in directing the position and movement of the head in space as well as a degree of concentration/co-ordination visual distractions often cause problems.
		Many things can effect balance - the effect of medication, etc.(9), anxiety, excessive high or low muscle tone, excessive body sway, abnormal reflex activity, poor tactile appreciation as well as problems associated with the vestibular system of the ears.(6).
		Build will also effect balance and a tall slender person is in a position of greater instability that a stocky, short-legged person(10). Regarding age, we tend to have best control of our physical balance as young adults and up to middle age(10). In the latter years the ability to balance may become more difficult, especially if degeneration of the upper back occurs and then people will take a wider stance and usually splay out the feet more.
			TADASANA   UTTHITA TRIKONASANA VIRABHADRASANA VRKASANA   CHANDRASANA   NATARAJASANA GARUDHASANA SURYA NAMASKAR   UTKATASANA		Mountain pose Lateral Triangle Pose Warrior Pose Tree Balance Moon Pose Dancer Pose Eagle Pose Sun sequence  Squat
		Contra indications:
		Clearly people with any of the above problems must approach balancing postures with some caution. Modifications are essential either to the posture itself or in some cases by ensuring that the student is supported by a wall, etc. There are a number of physiotherapy exercises that can assist people to achieve better balance(6,7,8,).
		SEATED
		There are many seated postures which will range from the simplest seated postures to those involving forward bends, rotation, etc. The commonest are listed below:
			PASCIMOTTANASANA    JANU SIRSASANA SUKHASANA VAJRASANA VIRASANA PADMASANA  GOMUKHASANA  BHADRASANA  SIMBHASANA    NAVASANA		Forward bend    "      "  + 1 foot against thigh Easy pose Diamond pose Hero pose Lotus Cow face pose Soles of feet together Lion pose Boat (also a balance)
		There are many others, M.J.Smith's book from the Krishnamacharya Institute lists fifty seven.  Most are variations on three basic themes and can, for brevity, be sub-divided into three groups.
		There are the classical postures such as Siddhasana, Padmasana, Brahmasana,etc, where to sit correctly one needs a good degree of flexibility in the hip joints that allows good lateral rotation combined with abduction and flexion. There are also seated postures where the thighs are relatively parallel, ie,; Vajrasana, Gomukhasana, Virasana, etc, which require a reasonable amount of looseness in the quadriceps, knees and ankles and there are a wide range of seated postures that broaden out the category into stretches, twists and balances, ie,; Pascimotanasana, Navasana, Ardha Matsyendrasana, etc.
		Virtually all seated postures require good mobility of the hip joint.  They also require some flexion of the knee and this joint is one of the most vulnerable joints in the body. It is often the case that once damaged it will always have a tendency to weakness. Students with a history of knee problems should always be advised to avoid postures such as Padmasana and until they can improve on their hip flexibility to achieve their individual potential, it is advisable that postures should be modified.
		As with all physical activities some people have a natural flexibility due to inherited characteristics. It is easier for people with "loose" hips and longer shins that fall into the ecto-mesomorph category to become competent in the classical postures such as Siddhasana or Padmasana, than someone who is not as flexible and has a heavier build where bulk can often get in the way.
		For people with limited flexibility it can help to sit on a folded blanket/foam block. By the use of a block in seated postures, slightly better flexion on the knee can occur which allows the distance between the hamstring muscles to reduce and therefore would be a better approach  for people whose flexibility is limited. The natural lowering of the knees to below the hip level encourages a better attitude in the pelvis/lumbar area as well as offering better abduction on the hips. The above is true also in seated postures involving flexion of the trunk where a raised position helps to promote stretching out of the hamstrings.
		Teachers should by observation be aware of the students in the class who have some restriction in the hips. Simple postures like Sukhasana and Bhadrasana(Baddha Konasana) will usually establish, in a class situation, a wide variety in the range of movement in students.
		Contra indications :
		Knee problems such as damaged cartilage or the ligaments associated with the knee joint must be treated with caution. The two common weaknesses are the medial meniscus and the medial collateral ligament. Arthritic conditions of the knee vary depending on the extent of the problem and should be treated with caution.
		In seated postures such as Vajrasana, students with limited  movement may experience discomfort in the knee due to poor extension of the quadriceps or discomfort in the ankles in the region of the dorsal tendons of the ankle. In such cases the use of folded blanket(s), blocks or gaitan stool will allow the student to  be seated in a higher position and thereby reduce the pressure on such areas. Knee problems such as prepatellar bursa or other knee problems that give rise to tenderness will benefit from padding from a folded blanket, but if it is a real problem avoid pressure from postures such as Vajrasana. People suffering from varicose veins are advised not to continue with postures such as Vajrasana if an adverse reaction occurs.
		F L E X I O N .
		A number of conditions can reduce the flexibility in forward bends. In a healthy individual with no problems with intervertebral discs, the commonest limitation for forward bend postures are tight hamstrings. This is essentially an hereditary problem although any regular repetitive exercise that encourages development of the body's fast twitch muscles will reduce flexion. With correct stretching exercises some improvement can be made but if a student has tight hamstrings they will always have some limitation on forward bends.
		Scoliosis may appear to limit forward movement but is all it does and does not usually create discomfort.
			PASCIMOTTANASANA JANU SIRSASANA UTTANASANA   PADAHASTASANA PADANGUSTASANA		Forward bend Forward bend + 1 foot against thigh Standing forward bend(hands by side of feet) Hands holding feet Fingers around big toes
		The comments made for modification by the use of folded blankets or blocks for assisting in the basic seated postures also apply for postures such as Pascimottanasana, Janu Sirsasana, etc. In seated postures the main ligaments in the hips take on a different mode of operation than when the body is in a standing pose. By the use of a block in seated postures, slightly better flexion on the knee can occur and therefore would be a better approach  for people whose flexibility is limited and it will also promote stretching out of the hamstrings.
		Bending the knees slightly is a modification that allows greater movement in the lower spine and in the case of tight hamstrings may be encouraged.
		Contra indications:
		Extreme caution is necessary with students that have problems with any form of prolapsed intervertebral discs in the lumbar region, sciatica, annulus fibrosis, ankylosing spondylitis and most degenerative  conditions of the lower spine or the sacro-iliac joint. Straight leg lifts, which come into the flexion category, are not considered a safe practice for most students and are not recommended for the majority of Yoga classes
		E X T E N S I O N .
		Back bends can be sub divided into two main groups as extension may be essentially with the spine or it may include utilisation of the hips. The commonest backbends are:
			BHUJANGASANA   SALABHASANA   DHANURASANA   CHAKRASANA       USTRASANA       SVANASANA(Adhomukha & Urdvha Mukha)		Cobra  Locust  Bow  Wheel  Camel Dog
		There are also postures such as Natarajasana, Virabhadrasana, which also bring in extension of the back.
		Contra indications:
		In evaluating backbends there are two critical areas of the spine, the lumbar and the cervical which are the areas of the spine that allow extension. There is little extension in children in the thoracic area and past adolescence there is no extension in this part of the spine.
		Students that show a degree of kyphosis are not advised to take the head back in postures such as Bhujangasana as this can create excessive strain on the cervical spine which will already exhibit some degeneration.
		Arthritic conditions, spondylitis, will usually give problems unless the posture is limited or modified.
		Students who have hands/wrists problems such as carpal tunnel syndrome should be advised to only hold the posture for very short periods to avoid problems or be given modifications that reduce any pressure on the wrists.
		L A T E R A L   E X T E N S I O N .
		Lateral extensions or twists will effect primarily the back/spine. All areas of the healthy spine, lumbar, thoracic and cervical areas will allow lateral extension of between  20-30o.
			UTTHITA TRIKONASANA  CHANDRASANA  UTTHITA PARSVA KONASANA		Lateral Triangle Pose            Moon Pose Flank Stretch
		The commonest limitations on lateral movement will be from obesity, degenerative orthosis of the facet joints of the vertebrae, possibly prolapsed disc.
		It is also the case that in postures such as Trikonasana, the possible strain  on the knees should be taken into account. There are variations/modifications to Trikonasana that will limit strain on the knee joint, although essentially applying pressure to the back foot will reduce any excessive pressure being applied to the knee. Another approach would be to have the feet parallel which will also alters the curve of the lumbar/thoracic area.
		R O T A T I O N
		The commonest postures involving rotation are:
			JATHARA PARAVRTTI ARDHA MATSYENDRASANA   PARAVRTTI TRIKONASANA		Lying twist  Half spinal twist Reversed Triangle
		Each movement of the body is directly related to the efficiency of its central core, the spinal column. The spine is particularly vulnerable to the force of compression, and this tendency is exaggerated even more when the spinal muscles shorten. A well-balanced spine is never rigid; as structures change it lengthens spontaneously, its mechanism becoming strain-free and more efficient.
		Postures which rotate the spine, like lateral bends will facilitate spinal flexibility whilst strengthening the support afforded to the spine by the muscle structure. Care must be taken to ensure precise movement and placement of the body. The spine should maintain an upright attitude, particularly when practising seated postures.
		Natural flexibility as well as the trunk/limb ratios will affect the degree of rotation. In adults there is little or no rotation in the area of the lumbar region and virtually all movement comes from the thoracic area. In postures such as Ardha Matsyendrasana and its modifications where flexibility of the hips or lateral movement of the lumbar region may be lacking, support for the buttocks is essential. Foam blocks or a folded blanked will support the trunk and allow the spine to lengthen in a vertical plane to allow the optimum rotation of the spine. Where trunk length /arm ratio limit the degree of leverage, support for the arms by use of a block, wall, chair or similar support is advised.
		Rotation usually involves pressure on first one side of the abdomen, then the other. In some cases, eg, pregnancy this is inadvisable and postures are modified accordingly.
		I N V E R T E D
		There are several definitions of what constitutes inverted postures but the generally accepted definition is one where the waist is above the head. Typical inverted postures, including hand balances are:
			SIRSASANA  SARVANGASANA HALASANA   KUKASANA MAYURASANA  ADHOMUKHA SVANASANA         UTTANASANA		Headstand Shoulderstand Plough Bird Pose Peacock Pose  Downward facing Dog                   Standing Forward Bend
		It is generally accepted that people suffering from High Blood pressure, over 160 mm.Hg. mean level, should not do inverted postures. They can increase pressure within the eye, which is dangerous for people with such eye problems as glaucoma and macular degeneration and may lead to a detached retina. This is particularly so in postures such as Sirshasana(Headstand)(5).
		In postures such as Sarvangasana (Shoulderstand), it is advisable to use a folded blanket under the shoulders to encourage the neck to lengthen and protect the cervical vertebrae, particularly in the area of C5, 6&7. The use of such support enables the body weight to be distributed across the shoulders and through the trunk. The ability to go into and come out of the posture smoothly is of paramount importance. It is also important that students who have insufficient strength, or who are carrying too much weight should not attempt to force themselves up into an inverted position.
		Contra-indications
		As mentioned above, students must be advised that if they have high blood pressure they should not do the extreme inverted postures. There are also conditions such as degenerative kyphosis, osteoporosis, or anyone with a severe arthritic neck condition, etc; which puts postures like these in the prohibition category.
		P A I R  W O R K
		All teachers will be called on to help and adjust/modify posture work when dealing with students. It is essential that all teachers realise their limitations in understanding, when working with students. Pair work, like individual work has obvious advantages and disadvantages. For example , in seated positions, using the back-to-back approach, under the directions of a teacher, students can experience encouragement and support, both mentally as well as physically. Using a partner to inform you of an incorrect movement, which you are unable to see yourself , can be useful. It can enable students to develop a greater awareness of respiratory action. Although some teachers incorporate "pair work" into classes, using methods such as P.N.F., S.A.S.S., etc., as a means of improving students flexibility and awareness, it has to be emphasised that this requires a high degree of skill and understanding. The problem is that teachers may not be aware of students' structural weakness that may have developed due to trauma, age or illness. Serious problems could also arise through disparity in size and/or strength of partner, which may not always be apparent. It is not, therefore, a practice we would encourage in any extreme or dynamic form and should only be reserved for advanced students or teacher training  and certainly not for beginners.
		YOGA AND BREATHING
		Breathing is given great prominence in most Yoga lessons.  This can range from simply teaching students to direct the breath into the lower part of their lungs, to quite complicated techniques. Provided the following guidelines are followed, there should be no problems.
		The progression in teaching breathing techniques should be a very gradual one, students always carefully monitored, allowing plenty of time for each stage to be assimilated. Before learning the more advanced breath control techniques (Pranayama), students should have a thorough grounding in "basic breathing".  This includes breath awareness, lengthening the breath, using the lungs fully, and synchronising breath with movement. Once students are very familiar with the above, they can go on to learn alternate nostril breathing and other techniques like Ujjayi. In advanced techniques, the breath is often held.  Holding the breath for longer than four seconds, because this tends to raise the blood pressure, is not advisable for  people whose blood pressure is already high, nor during pregnancy, nor for those with heart or chest problems.
		Rapid breathing techniques (Kapalabhati and Bhastrika) should be taught gradually, and taking into account the individual student's capacity.
		CLASSES / STUDENT NUMBERS
		Some Local Education Authorities / Activity Centres have tried to equate Yoga with large group activities such as aerobics, keep fit, etc. Yoga does not fall into this category. There has to be a trade off between the economic viability of larger class numbers and the level at which Safety and the Quality of Teaching are compromised. We believe that a maximum number would be between 15-25 and from a professional viewpoint, in terms of quality and safety, we would not recommend going above the latter figure.
		CONCLUSIONS
		All postures have a psychological and physiological effect on the body and it is difficult to judge the effects on individuals - the fitness of individuals  -  the feelings of individuals. Each teaching session will be different from the last one and classes and individuals change. It is important that Yoga teachers produce programmes in which the safety of the individual in each class situation is recognised as of extreme importance.
		It is not always easy for a tutor to judge the progress of students in terms of fitness, well being and other benefits.  This calls for a keen sense of observation and a responsibility for continuous learning in all aspects of safe teaching as well as keeping up to date with health/ medical developments. To this end In-Service Training and self development are actively encouraged through National and Regional activities.
		References:
		(1). Martinson                                          (2). Royal College of Physicians.               (3). Dr.M.Read.  (4). John L.Stirk.  (5). The Guardian.                                   (6)  M.R.Dix                                             (7)  M.R.Dix                             (8)  M.R.Dix  (9)  Overstal, et al                                   (10) P.M.Galley	Brit.Journ.of Hosp. Medic.1990 . 43 . 194-199. Report on the Medical Aspects of Exercise. May 1992. Sports Injuries  1989.    Structural Fitness. 1988 California School of Public Health - (Wellness Letter). All from Physiotherapy: Treatment of Vertigo. Vol 60 380-384. The Mechanics of the Upright Posture  Vol 55 398-404. Treatment of Balance Problems.Vol 55  415-420 BMJ Vol.1 1977  pp261-284 Human Movement ..   1982.
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