Welcome to today’s blog where I’m going to address a common question—what does chronic illness-informed yoga look like?

If you look at a typical yoga studio’s offerings, you might see a lot of things with mystifying titles, especially if you’re new to the yoga world. Vinyasa. Hatha. Bikram. Hot yoga. Mixed Levels. Chair. Iyengar. These, and many, many more, are common listings that may not come with clear explanations of what they entail. So how do you, someone with a chronic illness, find something that at least has a good chance of being effective for you?

A little disclaimer here: I am a registered yoga teacher trained primarily in the vinyasa and yin styles, but I’m not familiar with every single teacher’s way of doing things. I’m not “demonizing” or completely discouraging different styles or types of yoga. There are students who will find a lot of benefits from these styles, and that may include people with chronic illness. However, in my experience and research, I have found that most people with chronic illnesses and fibromyalgia tend to do better in specific types of classes. Ergo, think of these as guidelines, not set-in-stone rules, and again work with your medical team and your own body when trying yoga.

So to begin with, let’s start narrowing down our focus by exploring common types of yoga that may not be the best fit for you. Bikram, yoga scuplt, and hot yoga are usually types that I advise beginners to either avoid or wait until their skills and health levels have improved before exploring. Many of these classes are taught at a high intensity, which can be problematic, and don’t always include variations or modifications for people with different body types, abilities, injuries, or stamina. Hot yoga can be very rewarding for many, but unless you are a person who is very self-aware of what your body’s normal limitations are with stretching and movement, it can be potentially dangerous for you. The high temperatures don’t just put you at risk for passing out if you’re not properly hydrated or listening to body cues, but they will also allow connective tissue and muscles to move further than normal. If you are not very aware of just how far past your normal abilities you are moving, you can end up pulling, tearing, and otherwise damaging your body. Many brand-new yoga students do not have this self-awareness, and I highly encourage developing it before exploring more intense yoga classes.

So what are some key words to look for in class titles? Hatha, Vinyasa, some Yin, or Iyengar are good places to start, as they tend to be more gentle, really incorporate breathwork, and have a lot of variations and modifications possible. This doesn’t guarantee that the teacher will be trained in dealing with students with chronic illnesses, however. Classes that are labeled “accessible,” “gentle,” or “modified” will usually have a more informed teacher who can give you a lot of customized support in your practice. “Mixed levels” usually indicates that the class is tiered, with options given with each pose or “flow” (a series of poses linked together) so you can pick the level of challenge that is appropriate for you. Yoga Nidra is a special kind of class that focuses on deep relaxation and can be amazingly beneficial for those with fibromyalgia or other chronic illnesses. It’s one of my favorite classes to teach, and a field of yoga that I’m quite passionate about, so be prepared for other podcast episodes to come on this class type. 😊

More important than the class title or description, however, is the teacher. People with chronic illnesses like fibromyalgia often have to be their own advocates, so be open to asking questions before you enroll in a class.

Here are key questions to ask of a teacher:

1. Do you offer modifications/variations to poses in class? This should be one of your first questions, as it will immediately reveal whether the teacher is flexible (pun intended) and able to customize the class to you. Many people with chronic illnesses will require adaptation, and if the teacher is not willing or able to provide options, it could lead to discouragement at best or injury at worst. Whether the teacher just naturally gives these options throughout the class or only upon request can vary, so you may need to advocate for yourself and speak up if you need help or something doesn’t feel right. A good teacher will be watching students, but they cannot know everything that is happening in your body all of the time.

2. What kind of training do you have, and have you ever studied accessible or chronic illness-informed yoga? Most yoga teacher programs are classified by the number of hours in study and practice. A 200-hour certification is similar to a Bachelor’s degree, a 500-hour certification (often a 300-hour program taken after the initial 200-hour program) operates like a Master’s degree, and any number above that usually indicates a post-secondary or even close to PhD-level experience and knowledge. Some teachers will state that they are “experienced” at their level, which indicates that they have taught for years and usually have at least a thousand hours of teaching experience, although these numbers can vary according to their certification level and what guidelines the teacher is following. One teacher training program, Yoga Fit, doesn’t use the hours system and can be a little more complicated to understand just how much training a teacher has, although asking what “level” they are at can give you some indication. The variance in certifications and levels is primarily due to there not being a formal accreditation or licensing body in the U.S. for yoga teachers, at least not yet. A few optional ones exist, like Yoga Alliance and Yoga Unity. There are pros and cons to these organizations, and some teachers will not associate with any regulating body. This doesn’t necessarily mean that they will be poor teachers, but it does signal that there was no outside party ensuring appropriate rigor and depth to the training before teachers were allowed to instruct students. There are also some training programs that are criticized for not including accessibility or adaptation in their curriculum—and as this is something you are very likely to need, it’s best to know what experience or resources the teacher has. Keep in mind that you may find a very effective teacher even without them having specific training or having a chronic illness themselves. This being said, a teacher who has sought out reliable training in accessibility, chronic illnesses, or similar fields is more likely to be successful to you, and you may feel more confident in their classes. Also note that you might find a very well-trained teacher, but their style may not be to your liking. Some teachers are very quiet, others use a sense of humor in class, some are more hands-on with adjustments provided you consent, and others will only use their words to correct you. Be aware that it may take a few tries with different teachers to find one that works really well with your needs and personality.

3. I have _____ condition. Have you ever worked with someone with this condition? How do/would you modify class to accommodate someone like me? If you’re not comfortable revealing your exact medical diagnosis, you are NOT required to disclose it per the Americans with Disabilities Act—but for your own safety, it’s best to at least give the teacher an idea of what may need to be prepared for, like accommodating a wheelchair, providing options that avoid an injured hip, etc. Remember, the teacher is not liable for any injuries or poor results that occur because you didn’t appropriately disclose these things—and most teachers and studios will have you sign a liability release waiver before coming to class anyway. As a teacher, I would feel horrible if I led a student into a pose that hurt them because I didn’t know of a counter-indicated condition, and I always want to be as prepared as possible. How you balance your privacy with your safety is up to you, but know that this can have an impact on the teacher and your success in the class. To note here is not so much if the teacher has extensive experience with your particular condition, although that is always a plus, but rather if the teacher is dedicated to accommodating you, researching options that are appropriate, and willing to learn alongside you. Those are the kinds of teachers that will often be the best fit for you.

4. What materials am I required to bring to class? Does the class provide additional props if I need them? Not all studios and teachers have extra props or materials, or they may have a limited number available. Some will rent equipment to students or sell them older materials at a discount. Any teacher or studio should be able to guide you to places to find the materials you want and need, and explain what qualities are recommended or address cost concerns. Most teachers will have preferred brands (like most of us do with about anything we purchase) and some will also have distributor or other selling accounts with certain brands. This can, of course, indicate a strong bias and you may need to do your own research on alternative brands, or it may be a way for you to get reliable, ecologically-friendly materials, and sometimes at a discount. (This may vary more widely during the pandemic, so it’s important to ask. If you’re going to need extra options to find the best version of the pose for your body, you want to be prepared and not feel left out or discouraged because it’s not accessible to you at that time). For those taking virtual courses, teachers should also be able to advise on non yoga-specific options in most homes that can replace props, such as using the sash from a bathrobe instead of a yoga strap. I’ll also have a podcast later on this topic, exploring a wide variety of options while also addressing safety concerns.

5. What costs are there for classes, and what types of classes and programs do you offer? Some teachers offer a per-class price or discounts for monthly/annual memberships or class packages. Some teachers will offer regular or occasional donation-based classes. The prices will vary greatly according to the expertise of the teacher, the location of the studio, the area of the country, and perhaps if the class is offered virtually instead of in-person. Make sure you understand what all of your options are, and if there are any current or upcoming promotions that you may want to take advantage of.

6. What are your absentee/late cancel policies for classes? This can be very important for those with chronic illnesses, as sometimes we will have very bad days that will keep us at home or restrict us from safe driving with little or no notice. You need to be aware if there is a grace policy for people with these conditions, charges after a certain number of incidents, or a flat price for a series of classes whether the student attends or not. If you have typically stronger symptoms during certain times of the year, this may make a big impact on what classes you choose to take and what packages would be best for you. If you are also concerned about weather and road conditions, asking about winter policies would be wise, as well as how notifications are sent out and if charges are still made if the teacher cancels class due to emergencies, weather conditions, or other situations.

7. How should I dress for class? Normally this isn’t a question I’d recommend, as you would typically wear something that you are appropriately covered and can move freely in and others should respect your choice of clothing. Sometimes, though, there may be more regulations. For example, during the pandemic, masks are often required during practice and many students have to provide their own. Additionally, some classes may be also trauma-informed and request clothing that is less revealing, does not have writing or symbols that could be offensive or troubling, or that all students must wear shirts (in lieu of sports bras or muscle tanks). It is absolutely your choice to avoid classes that have stricter dress codes, but if you do choose to attend these classes, please respect the rules provided as they are nearly always instituted to ensure the safety and comfort of all students and teachers.

Most teachers and studios will have contact information where you can call or write to the teacher to ask these and any other questions you may have, therefore allowing you to be fully informed before class. That doesn’t mean, however, that you have to do all this research before a class, especially if you have a recommendation from another student. Some of us have more concerns, doubts, and worries than others, so this list should address most of those and give you the confidence you need to begin a yoga practice. Some yoga teachers will have a one-on-one consultation option where you can meet in person and discuss these things as well as get a functional assessment of your abilities completed so the teacher can understand how best to guide you. This may be free, a part of the price of a program, or be billed as a private session (often more costly that group/public classes but can be very much worth the expense to have the individualized and customized attention).