Are In Person Classes Better for Your Poses? A Physical Therapist Weighs In.

Recently I read a social media post of someone who wrote that they were having pain while practicing yoga asana. Specifically, that the pain came on while he was doing downward facing dog pose.

The post sparked a lively discussion in the comments. 

What surprised me was that the vast majority of commenters recommended that the person stop practicing yoga at home through online classes, and instead attend in person yoga classes. 

A few others recommended private yoga lessons.

These responses puzzled me because they seemed to assume things that were not based in reality.

Before diving into the main subject of this post, know that in-person social connections are crucial for human health and well-being. In person yoga classes, for some, play a vital role in reducing feelings of loneliness and social isolation, which have been amplified in recent years. Yoga studios can be powerful community spaces. None of what is written below erases these facts or downplays the value of in person classes. 

Pain is the Physical Therapy purview 

As a physical therapist, the first thought that pops into my head when someone has movement or position related pain, is “see a physical therapist”. 

Orthopedic physical therapists are true movement experts. They have years of training and experience (as well as a license) in addressing pain and dysfunction in movement and position.

I may have a pro-physio bias, but I’m not unfounded in this take. If you visit a primary care physician for an issue like the one described above, you will more likely than not walk out of that appointment with a referral to physical therapy. 

The Flawed Logic Behind “In-Person Will Fix It”

But what flummoxed me in the comments was more than just the oversight of not considering physical therapy.

• What if the person actually enjoyed their online yoga practice and didn’t want to change? 
• What if the online teacher gave impeccable cues? 
• Some yoga practitioners live in rural areas or have busy lives, making online classes the only way they can stay consistent in a guided practice.

Most importantly, there’s are fundamental flaw in the assumption that if a yoga pose hurts during an online class, attending an in-person class or taking private lessons will automatically solve the problem.  

The Qualifications of Yoga Teachers 

In this case, the student is experiencing pain. Are yoga teachers the best trained in understanding the root cause of pain? Generally, no. 

Yoga teachers most commonly have 200 hours of formal training, none of which is required to be in evidence-based tissue dynamics, pain, biomechanics or injury. 

Only 30 hours is the total time required for all anatomy and physiology training within a 200 hour registered yoga teacher training program, and that includes “subtle anatomy”, like chakras. Source: https://yogaalliance.org/rys-overview/

But there are highly educated yoga teachers out there. Let’s say a student finds a highly skilled yoga teacher with years of teaching experience and hundreds of hours of advanced training, possibly even massage therapy qualifications.

While that teacher may have a deeper understanding of bodywork, massage therapy training doesn’t typically cover movement analysis in dynamic, moving positions, which is what we need for addressing pain during yoga. Physical therapists are not trained to assess entire groups. Medical doctors have limited movement analysis skills as well.

Even if you do find a highly skilled yoga teacher, other flaws in the logic remain. 

Observational Time Divided by Number of Students

As massive as lack of training is, lack of time is also a huge factor. 

In my work as a physical therapist, I observe and assess patients’ movements in a methodical way. But when I was teaching in-person group classes, even with years of practice behind me as a physio / physical therapist, I could not have enough information just from watching students in classes to help a student in pain. That act would be doubly difficult during the act of teaching.

If there are 10 people in a class, the teacher has the ability to focus on each student theoretically only 10% of the time.

In a 60 minute class with 5 minutes of gentle warm up and 10 minutes of savasana, that leaves about 45 minutes to view how someone is moving. 

If the teacher can only give each student 105 OF THEIR TIME, that’s 4.5 minutes of observation time per person.

Which leads to the next point. 

If you are not assessing, you are just guessing

As I discussed in a video last year, ”if you are not assessing, you are just guessing.”

A few divided minutes of observation is not enough time to assess or evaluate someone’s pain. 

Moreover, watching people move through Warrior 1 or a vinyasa does not isolate movement to figure out where a problem is originating.

A proper assessment or evaluation should use validated tests and measures, not casual glances. 

The Misconceptions of “fixing” alignment

Alignment is a big subject, and the idea of “fixing” alignment is problematic

At Yoga Anatomy Academy, we have taught, written and spoken about this in-depth previously:

There is No Such Thing As Universal Alignment  https://yogaanatomyacademy.com/there-is-no-universal-alignment-in-yoga/

How Our Obsession with Alignment Misses the Point: https://yogaanatomyacademy.com/how-our-obsession-with-yoga-alignment-misses-the-point/

And this podcast episode:

https://www.francescacervero.com/podcast/alignment-ariele-foster

There is a widely held belief that “perfect alignment” can fix an issue such as pain in a downward facing dog pose, but this is also a flawed argument. 

The Perfect Posture Doesn’t Exist

Nearly every style of yoga, if not every teacher of yoga asana, has a different approach to alignment. No one singular way of practicing Warrior I exists. So which way is the most “aligned”? There is no answer. 

Even if styles of yoga were all the same in their approach to asana, there is no evidence that “good posture” correlates with lack of pain, and we can extract from that that “good poses” will not have a relationship to whether someone is in pain. 

This is a bold statement, but it is what the evidence bears out:  

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1250-1

https://www.sciencedirect.com/science/article/abs/pii/S0021929017303135

The Guardian also did a nice summary of this topic: https://www.theguardian.com/lifeandstyle/2022/aug/18/good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it

We even have evidence that pain-free, healthy people tend to sit in a slump, which really blows concepts of perfecting posture out of the water: https://www.sciencedirect.com/science/article/abs/pii/S0003687015300788 

The best posture, the best pose. 

The best posture seems to be the one that changes frequently. The healthiest moving humans have the most options for movement, the most versatile “vocabulary” of movement. To put it another way, it’s actually healthy to move differently day to day. 

A clinician’s goal should be to help you move with greater versatility, not just to fix a single posture or pose. 

On the yoga mat, I interpret that to mean that it is healthy to have multiple variations and ways to practice any single pose. 

So a poorly qualified instructor “correcting” the way someone is holding a pose (or moving into or out of a pose) with only minutes of observation beforehand, is unlikely to correlate with the yoga student feeling less pain during practice.

In-person Yoga Classes Aren’t A Cure-All 

In summary, there are many holes in the assumption that in person classes will prevent or fix pain.

It’s an unfair burden to place on a yoga teacher to solve someone’s pain. This is especially true with a group class setting with limited time and attention per student.

In person group classes are not likely to “solve” a pain puzzle, and private lessons face all of the same flawed logic — with the exception of time. 

Private lessons, while offering more individualized attention, still face many of the same limitations as group classes, with the added challenge of possibly focusing too much on perfecting poses rather than addressing the underlying issues causing pain.

Private Lessons: Lovely but Not a Panacea

Spending 60 minutes one on one with almost any yoga teacher is going to have many of the same limitations as described above for group class experiences. 

The teacher will most likely lack formal training in movement analysis, physical examination and pain management. 

They may approach your pain by focusing on “alignment”, or aesthetically perfecting yoga poses, which as we’ve discussed, doesn’t necessarily correlate with pain relief.

Many people have been injured from straining to achieve unrealistic and non-biological “alignment” cues in yoga. The idea that there is a universal alignment for various yoga poses is ableist and problematic. 

Additionally, hands-on adjustments in private lessons can cause injury or exacerbate pain. It is possible that a yoga teacher would issue more hands on adjustments during a private session because they have the time and focus. 

I have many patients who come to me after well-meaning yoga adjustments gone wrong.

Private lessons, while amazing in their own right, are also not typically an answer to pain. (However, you can book private lessons with a physical therapist who is also a yoga teacher, such as myself.)

What should you do?

If you are in pain while practicing yoga asana, especially if you are also experiencing that pain in your day to day life, why not see someone who has the training to decipher the *source* of the problem? 

Why not find someone who has the proper training, keeps up with the latest evidence-based research, and is able to genuinely help you get to the root cause? 

There are many skilled rehabilitation professionals who do this, including physical therapists, exercise and movement oriented chiropractors, and more. 

As a yoga community, we’ll be stronger when we recognize the natural of our scope of practice, and work with skilled healthcare professionals, rather than trying to replace them. 

While asana can be a helpful tool for many people to manage or alleviate pain, it’s not a one-size-fits-all solution nor is it always the solution at all times. This is especially true when pain arises on the mat.