Practicalities of Iyengar Yoga

Therapy For Serious Conditions

BY LOIS STEINBERG, PH.D.

T
here are a broad range of therapeutic …the development and oversight of
applications of Iyengar Yoga. All CIYTs should specialized sequences is merely a
know how to use Iyengar Yoga to address
so-called “minor” ailments and conditions—
more intense and focused application
routine knee, hip, neck/shoulder, low back problems, of the same skills and practices that
and normal menses and pregnancy. CIYTs can include all CIYTs must develop to meet the
students with these conditions in regular classes
and give these students alternative poses whenever needs of their students.
appropriate. All CIYTs can also conduct specialized
classes devoted to addressing one or more of these OUR EXTRAORDINARY BASE OF KNOWLEDGE
“minor” ailments or conditions. A teacher should not consider using any posture
therapeutically—either for herself or for others—unless
More qualified CIYTs are authorized to use Iyengar Yoga the teacher has understood and experienced the
therapeutically to address more serious conditions that elements and effects of the relevant stage of that asana.
prevent the students from taking a regular yoga class.
For these students, it is common to have either a one- In Light on Yoga, B.K.S. Iyengar (Guruji) thus describes
to-one private session or a group class with a unique the elements and effects of each asana. For example, he
sequence personalized to his/her condition. The latter is says the following about Tadasana:
essentially a RIMYI-style therapy class.1
“People do not pay attention to the correct method of
In this column, I will discuss the practical issues and standing. Some stand with the body weight thrown only
challenges that arise when specialized sequences are on one leg, or with one leg turned completely sideways.
developed for serious conditions. However, as will be Others bear all the weight on the heels, or on the inner or
apparent, the development and oversight of specialized outer edges of the feet. This can be noticed by watching
sequences is merely a more intense and focused where the soles and heels of the shoes wear out. Owing
application of the same skills and practices that all to our faulty method of standing and not distributing
CIYTs must develop to meet the needs of their students. the body weight evenly on the feet, we acquire specific
There is no set formula for any therapeutical application deformities which hamper spinal elasticity. Even if the
of Iyengar Yoga. There is no one sequence for all, and feet are kept apart, it is better to keep the heel and toe
there is no one pose that is done in the same way, even in a line parallel to the median plane and not at an angle.
for the same condition. All therapeutic applications By this method the hips are contracted, the abdomen
of Iyengar Yoga require a deep understanding of the is pulled in and the chest is brought forward. One feels
effects of a classical pose (or stage of a classical light in the body and the mind acquires agility. If we
pose) on the specific conditions unique to a student’s stand with the body weight thrown only on the heels,
body. All therapeutic applications of Iyengar Yoga are we feel the gravity changing; the hips become loose, the
fundamentally experiential and experimental. Serious abdomen protrudes, the body hangs back and the spine
ailments present greater challenges because of their feels the strain and consequently we soon feel fatigued
complexity and because of the greater difficulty of and the mind becomes dull. It is therefore essential to
understanding the conditions unique to the student. master the art of standing correctly.”2

1 Interestingly, RIMYI has now developed a combination of a common ailments class and a personalized group class. In one of RIMYI’s three weekly “therapy” classes,
the class begins with every student in the same pose, such as Supta Baddha Konasana or Bharadvajasana I. The class is then divided into three groups, with some
students doing personalized sequences on the side and the other students jointly doing sequences to address particular “minor” ailments.
2 Light on Yoga,page 64.

The Light | Spring – Summer 2021 13

PRACTICALITIES OF IYANGER YOGA CONTINUED

Light on Yoga is likewise one of many Iyengar Yoga

To help our students with what
texts that provides guidance on postures that benefit ails them, we thus must deeply
students with various ailments. See Light on Yoga’s understand their physical condition
Appendix, Curative Asanas for Various Diseases.
Based on his experience during his first 25 years as and its associated emotional and
a teacher, Guruji gave “groups of asanas for different psychological qualities.
functional and organic ailments and diseases.” Over
the last 55 years, the Iyengars and others have refined understand their physical condition and its associated
and expanded upon these teachings, and Iyengar Yoga emotional and psychological qualities. In my experience,
teachers today have a toolkit to help ourselves and an effective first step for CIYTs is to have each student
others with a broad array of ailments, injuries, and fill out a Student Information Health and Lifestyle
other health conditions. This toolkit provides invaluable Questionnaire.3
guidance for the ways in which the actions in asanas can
benefit specific health conditions. The teacher can then use the results of the questionnaire
to conduct an in-person assessment interview. The teacher
UNDERSTANDING THE STUDENT’S CONDITION asks the student open-ended questions regarding their
AND ITS EVOLUTION health issues they revealed on the survey. Open-ended
But the application of these principles requires a deep questions are questions that cannot be answered with a
understanding of the physical and psychological conditions simple ‘yes’ or ‘no.’ This type of question lets the student
facing each student. There are many techniques CIYTs give a free-form answer that could reveal a lot. For example,
can use to gain this understanding, and I ultimately rely on if the student checked on the survey that they have
questionnaires and in-person interviews. anxiety, you can ask them: Tell me about your anxiety. Then
listen and get the student’s perspective in their own words.
But in some respects, the experience of the CIYT can You can ask them to tell you more if you feel they may not
aid this understanding. Individual CIYTs can face the full have revealed everything, are vague or ambiguous. You can
array of health challenges that befall our students, and probe further by asking, How did the anxiety start? It is not
CIYTs can and do use Iyengar Yoga to help themselves that you never ask a close-ended question. Those types of
heal. When we do so, we can also learn to understand questions can be used to clarify a response. The drawback
how to help others. However, we must exercise extreme to open-ended questions is that they can be time
caution. Our bodies can differ from our students’ bodies, consuming and give you information that is not relevant.
and what works for us is not necessarily going to work
for someone else. With practice and experience, you can become a
skilled interviewer and direct the student to pertinent
Likewise, to help our students, we must develop the information. I often schedule an interview for 15 minutes
ability to imagine health conditions that we have never and can complete the interview within this period.
had and that are otherwise unique to our students. This However, if you are new, plan for the interview to take
requires that CIYTs refine the observational skills we up to 40 minutes. Many students have a long list of
routinely use when we teach general classes. In these problems that I ask about one-by-one. I will ask them
classes, we learn to put ourselves in our students’ bodies to prioritize what is the most important condition for
and to experience their pain or their potential to harm them to address in the yoga practice. I also consider
themselves from doing a pose incorrectly. Whether or depression, anxiety, and respiratory conditions as having
not we have experienced conditions that our students a higher priority over other conditions as these could be
have, we need to develop an intuitive ability to imagine life threatening, fatal illnesses.
the restrictions and pain they experience and the
actions that can improve their conditions. The interview is also an opportunity for detailed
observation of the student’s body. It should include:
Yet much more is required than merely employing evaluation of the front, sides, and back of the
observational skills, because many effects of ailments student’s relaxed standing position; body carriage;
will not be immediately apparent to a CIYT. To help our observation of walking; and the Adam’s forward bend
students with what ails them, we thus must deeply test (when possible).

3 The Student Information Health and Lifestyle Questionnaire was developed by Gwendolyn Derk, PhD, CIYT, C-IAYT and contains patient reported outcomes that are
validated by the National Institute of Health (NIH). Contact the IYNAUS research chair to start collecting data on your students.

14 Yoga Samachar Spring | Summer 2019

 Based on the initial assessment
Finally, at the end of the interview, I try to prepare the
student for the personalized group therapy class (or
interview, I craft a 1.5-hour unique
private) by describing what I expect of them and what program of ten or more postures for
they can expect from us or my assistants. The more the student.
information a new student has about the class, the
more comfortable they will feel. Students who have therapy class sequence to include all the categories of
never come to an Iyengar Yoga therapy class may be poses, with detailed instructions of how to adapt each
overwhelmed by it. At the end of the interview, I show pose for the student’s needs. These students sometimes
them the props and let them know we will help them to “graduate” to a regular yoga class. Others may do both
set up, and that ultimately, if they are able, they should the weekly therapy class and a regular yoga class before
set up their supports on their own. I also let them know ultimately doing only regular classes.
they should speak up and get our attention when they
need it. Conversely, some students may temporarily regress and
return to a previous phase when warranted.
Yet the questionnaire and interview merely provide
information about the student’s condition before they To determine the initial length of the complete rest
begin attending my therapy class. I also require each period, I consider the abilities of the student. If the
student to fill out a Progress Note Form before and after student has no prior history of Iyengar Yoga, this
each class session. The pre-form includes: length of time phase can last two to three months. Students with
and number of days of home practice; new significant grave or terminal conditions continue this program
health/life events between sessions; and the student’s for the duration of their lives to ease their pain and
current physical and emotional status on a seven-point discomfort. The periods of complete rest may be
scale (0 being extremely good, 3 neutral, 7 extremely shorter if the student has a history of attending yoga
bad). I require the student to present the pre-Progress class and responds well. Alternatively, I may shorten the
Note Form to me before each class, and I then either duration of the resting poses or include more complex/
authorize the student to continue the regular program challenging adaptations of the resting poses.
or make any necessary changes to it. In the post-class
form, the student addresses whether any new health On the one hand, depending on his or her health
condition was resolved, their physical and emotional condition, a self-motivated, long-term, proficient
status after the practice, and how easy/difficult the practitioner may need to have a lengthy resting phase
sequence was—all on a seven-point scale.4 initially, but may transition to the rest|active|rest phases
earlier than a beginner. On the other hand, it may be
THE PERSONALIZED SEQUENCES difficult for this “seasoned” practitioner to rest and the
Based on the initial assessment interview, I craft a teacher may have to prolong the period of this “yoga
1.5-hour unique program of ten or more postures for rest.” Table 1 lists one example of a general sequence for
the student. I also create alternative sequences for resting poses.
students whose conditions fluctuate from day to day.
The sequences are all subject to change based on THE BENEFITS OF THE REST PHASE
the progress or backsliding of the student—and the The rest phase is crucial. Ill-health creates fatigue. It also
responses to the Progress Note Form. When possible, I can trigger the flight-or-fight reflex and other aspects
encourage the student to practice at home. of the sympathetic nervous system. That can also lead
to muscular gripping or otherwise create or enhance
The personalized sequence of postures is divided into pain. The rest phase creates an environment in which
thirds. Each third will represent either a “resting” or the student can relax, activate the parasympathetic
an “active” phase of practice. A new student starts nervous system, feel whole and calm, and reduce or
with three resting phases: rest|rest|rest. When suspend the mental fatigue of ill-health. This also gives
there is improvement, the phases are modified to the student confidence in the beneficial effects of yoga
rest|active|rest. Upon further progress, the student’s and enhances trust in the instructor.
phases are modified to active|active|rest—similar to a
standard yoga practice. Over time, I will also modify the Through these resting poses, the student also can

4 Go to www.loissteinberg.com to download the Progress Note Form.

The Light | Spring – Summer 2021 15

PRACTICALITIES OF IYANGER YOGA CONTINUED

I am not suggesting that the nervous system. The extension of the abdominal cavity
also helps move the spinal column from the back to
instructor should routinely lecture
the front, from posterior towards the anterior body. By
students during their practice. In fact, extending the spinal column and moving it inwards, these
it is better to let them be quiet in the poses balance and improve the functioning of important
components of the brain-cerebellum, hypothalamus,
poses to get immersed. thalamus, pituitary and pineal glands, amygdala, and
experience their body on more subtle levels and hippocampus. This aids in controlling and stabilizing all the
can develop greater understanding, awareness, and vital functions of the body.
knowledge of anatomy, physiology, psychology, and
respiratory and other bodily systems. This awareness In all these poses, precise positioning of the head and
can help them overcome or minimize structural extension of the neck are critical. It not only contributes
musculoskeletal imbalances and pelvic and shoulder to balancing the brain, but also benefits the thyroid
girdle stiffness. It can cause their postural alignment gland, sinuses, and the ears.
and body carriage to improve and lead to improved
circulation, especially to stagnant areas. I will include The resting poses cause students to go inward—to move
adaptations of inverted poses when possible, as these from the periphery of the body to its core. By containing
poses bring circulation and balance to all the systems of the student’s body, these poses conserve the student’s
the body.5 energy, which is limited when bodies are injured or
diseased. When space and containment is created, internal
I find it can be helpful to educate the student on how the alignment is facilitated, and the mind can quiet and be
yoga poses act on the organic body and why particular present, instead of projecting into the future, ruminating
poses are important for them to practice because they about the past, or otherwise engaging in destructive
stretch the muscle tissue in the heart, digestive organs, worries/thinking. When the body is calm and quiet, the
and blood vessels or target abdominal cavity organs breathing naturally relaxes. This is the gateway to the
(e.g., kidneys, adrenals, gallbladder, pancreas, lungs, breathing practices of pranayama, which begins with
spleen, stomach, and the primary lymphatic organ of focusing on letting the breath be relaxed and normal.
the thymus gland). The secondary lymphatic system
organs, the lymph nodes, located throughout the body In this regard, an important function of the instructor
in the neck, armpits, groins, and gut can also be affected is to observe where the student holds tension in the
beneficially by the poses. When students have disorders body. During the resting phase, the instructor guides
and conditions characterized by chronic inflammation the student and helps the student focus on releasing
(e.g., diabetes, inflammatory bowel diseases, asthma, body tensions, particularly the abdomen and diaphragm
arthritis, cancer, obesity, and long Covid), I sometimes will during normal exhalations. The response of the
likewise explain how the postures address these conditions parasympathetic nervous system is enhanced and the
by improving the functioning of the immune system. mind will be further quieted by the correct positioning of
the student’s head and neck, the centering and quieting
However, I am not suggesting that the instructor should of the student’s eyes, and the relaxation of the student's
routinely lecture students during their practice. In facial muscles and mouth cavity.
fact, it is better to let them be quiet in the poses to get
immersed. But a brief explanation from time-to-time can IYENGAR YOGA THERAPY IS EXPERIENTIAL
be helpful for students to understand why they are doing AND EXPERIMENTAL
certain practices. Devising a personalized sequence of yoga postures
is an ongoing, complex, and dynamic process for the
The resting poses produce other benefits. Many of these instructor. The sequence of postures is experimental.
poses stretch and extend the abdominal cavity. The The effects have to be continually evaluated, and
abdomen and intestines have myriad neural connections changes must be made whenever necessary or
to the brain: e.g., the vagus nerve interfaces with the appropriate, with adaptations made to some postures,
parasympathetic control of the heart, lungs, and digestive with the elimination of other postures, and/or the
tract and the brain. These poses thus help balance the addition of new postures.

5 It is always good to read and re-read the Sirsasana and Sarvangasana sections that describe the effects of these poses in Light on Yoga.

16 The Light | Spring – Summer 2021

 In yoga therapy, the poses are headache is related to hormonal changes, the student
could do modified forward bends.
adapted with an array of accessories
to support the pose. If the cause of the headache remains a mystery, the
student could begin the practice with forward bends;
The instructor must also consider new health conditions if that reduces the headache, then the student would
that were not part of the original ailment(s) but that continue this category of poses. If the headache does
arise or become apparent after the program was not go away or returns upon movement, then supine
established. For example, when a student arrives for poses could be performed/selected. If all are ineffective,
class with a headache that was not a symptom of their then the Samaashrayi and Upaashrayi (L-shape)
primary complaint, I will often change their sequence poses can be implemented. Additionally, the student
to focus on resolving the active headache. This requires can wrap his/her head, a supported variation of Shan
that I first do “detective” work to determine what Mukhi Mudra, with the head wrap adjusted based on
caused the headache and what part of the head is the location of the headache. Of course, the head wrap
affected. If the student does not know why he/she has would be unraveled if it becomes irritating.
the headache, the teacher must inquire further. Are
they dehydrated, constipated, or have they been overly During their time in my therapy classes, students
stressed, and for women, are they premenstrual or become more adept. They often understand what poses
menopausal? they need and will suggest poses that they should
practice. Ideally, my role steadily diminishes, and the
Indeed, the range of responses to a headache illustrates student learns to be more and more independent and,
the breadth of the Iyengar Yoga toolkit. If the likely hopefully, be consistent with a home practice. When
cause is dehydration, the student would obviously possible, all the categories of poses will be included
drink water until they feel adequately hydrated. If the in the student’s practice, especially when he/she
student is constipated, supine poses could be used. If progresses to the active|active|rest phase.
the headache is from stress, the student might be asked
to do Viparita Karani Sarvangasana as a first pose USE OF PROPS TO ENHANCE THE EFFECTS
(it typically is an ending pose), and if the headache is OF THE POSE
resolved by this pose, the student can commence his In yoga therapy, the poses are adapted with an array
or her regular program. If there is neck and shoulder of accessories to support the pose. The support is not
tension, the student could be told to do adaptations of necessarily to make the pose accessible or easier, but to
Bharadvajasana and Utthita Marichyasana 3 using a target areas that need enhancement. Ultimately, it may
wall (with the forehead supported on the wall or turned be possible to lessen the use of support.
opposite to the torso with the ears parallel to the wall).
Following the twists, supine poses are included that For example, Figures 1-5, shows how Cross Bolsters
specifically target and relax/align the musculoskeletal (a combination of Dwi Pada Viparita Dandasana and
area of the upper body to release tension. If the Setu Bandha Sarvangasana) can be adapted to meet

Figure 1 Figure 2

The Light | Spring – Summer 2021 17

PRACTICALITIES OF IYANGER YOGA CONTINUED

enhance the return of the blood back to the heart. Figure

4 shows a Chumbal (a rolled washcloth can work) to
support and lift the back chest (in the region of the base
of the esophagus) for hyperacidity. The weight of the
body is more in the direction of the legs and the chest is
supported higher to reduce heartburn, throat irritation,
and abdominal distention (Figure 5). In all these cases
the body type, ability, and comfort of the student is
considered so that the supports are not going to irritate
in any way.

Assistants can help students place the props correctly

to permit the desired actions in the pose. If the students
Figure 3
are able, they are taught to set up the props themselves,
and how to correctly get into and out of the poses,
the needs of students with various conditions. (The so as to become independent. They are taught to
model6 does not have these conditions.) Figure 1 depicts observe which parts of the body work excessively and
a support for a man who has recovered from surgery which parts need to be accessed. The teacher and or
to remove a testicle due to cancer. The hips are higher assistants improve the student’s poses by observing
to bring circulation to the pelvis and prevent or break the various reactions of the students. Some important
up adhesions from the surgery. The upper thighs are things to observe are changes in pallor, tautness of the
belted with a block between them to contain the area skin, breathing, tension in the face/head/neck, even
traumatized by the surgery. Later, the legs can gradually corners of the student’s eye. The poses are done with
open wider to Upavistha Konasana in Cross Bolsters accuracy and precision. Yet, the teacher should not be
(Figure 2) to further improve circulation and reduce obsessed with the evenness of the body, as we tend to
any scar tissue. Unless there is a contraindication (e.g., do. What is ultimately important is whether the quality
neck issues, high blood pressure, thyroid problem), of the student’s pose shows an alignment inside the
the head is extended back to lift the student’s spirits. body that shines forth and manifests a change in the
Figure 3 shows support for a person with high blood student’s well-being. It can take a long time for us to
pressure that is being treated with medications that are reach this level of observation. Certainly, we will never
not working effectively. In this case, the pose is done reach the genius that was Guruji’s as he astounded us
more like Setu Bandha Sarvangasana with the back of with awesome observations of the students that we
the head and neck extended to increase the circulation would never have seen on our own.
to the head, to reduce the feeling of lightheadedness
and to induce relaxation. The feet are also elevated to

Figure 4 Figure 5

6 Thanks to Jerry Chiprin (CIYT, Level 2) for modeling the poses.

18 The Light | Spring – Summer 2021

THE ART OF SEQUENCING AND Table 1. Salamba Asanas –
DETERMINING TIMINGS With Support Poses (Resting Sequence)
Sequencing the poses and determining the length of
time that each pose is held presents another set of 1. *Setu Bandha Sarvangasana/Dwi Pada
issues that require great knowledge and expertise. Each Viparita Dandasana – Bridge Pose/Two Footed
sequence is crafted so that poses of a similar nature Reverse Staff Pose combination (aka Cross-
are organized together, often to reduce the time spent bolsters)
transitioning from the floor-level poses to upright poses.
But this is not a hard and fast rule, and the particular 2. *Salamba Purvottanasana – Supported Intense
health condition could require a different result. For Stretch of the Front Body Pose
example, when a student has renal calculi (kidney
stones), the forward, backward, inverted, and twisting 3. *Dwi Pada Viparita Dandasana – Two Footed
poses are alternated to encourage the movement of the Reverse Staff Pose
passage of the stones. Similarly, some mental health
conditions require movement, such as extending only 4. Samaashrayi Upavistha Konasana/Baddha
the toes and fingers to bring the consciousness to the Konasana/Dandasana – Upright Seated Angle/
periphery (to help the student to become embodied) while Bound Angle/Staff Pose
moving through Prasarita Padottanasana between sides in
Parsvottanasana, without attention to details. 5. *Upaashrayi Upavistha Konasana/Baddha
Konasana/Dandasana – Reclined Seated
The poses are maintained from one to five minutes; Angle/Bound Angle/Staff Pose
shorter time in the pose is indicated when a student is
restless. According to the capacity of the student, the 6. Rope Adho Mukha Svanasana –
longer the time held in the poses results in more time for Downward Facing Dog Pose
the circulation to increase to targeted areas.
7. Rope Salamba Sirsasana –
I hope this article will help teachers to put into Supported Head Pose
perspective how to think, process, and use the tools
of assessing, evaluating, and creating practices for 8. Chair Salamba Sarvangasana –
students who need to use Iyengar Yoga therapeutically to Supported All Limb Pose
live with, and perhaps recover from, their health issues.
Often, I tell my student teachers to be confident about 9. Chair Salamba Halasana –
what they have learned in their studies and to see what Supported Plough Pose
works, and what does not, as they help others to heal
and ultimately practice yoga for the love of yoga. 10. Bench or Bolster Setu Bandha Sarvangasana –
Bridge All Limb Pose

11. Viparita Karani Sarvangasana –

Gratitude to David Carpenter, CIYT, C-IAYT for editing Going to Reverse All Limb Pose
this article.
* Supta Swastikasana, Supta Baddha Konasana,
© Lois Steinberg, Ph.D., CIYT, C-IAYT Supta Virasana may be substituted for those
who need a very gentle approach. Additionally,
Lois Steinberg (Ph.D., CIYT, Level 4, C-IAYT) has four these poses may be added in when the student
decades of extensive studentship with the Iyengars at has become proficient and has more time for
the Ramamani Iyengar Memorial Yoga Institute in Pune. additional poses. For those with back pain
Lois is the director of Iyengar Yoga Champaign-Urbana in when extending backwards, these poses are
Illinois. She is the author of numerous books and articles. contraindicated until the back pain has resolved.
She served on the IYNAUS board and the Assessment Various Adho Mukha and Salamba Savasana,
Committee (formerly Certification Committee) and Downward Facing and Supine supported Corpse
continues to serve as an assessor. poses, may be substituted.

The Light | Spring – Summer 2021 19