yogabook / tips & tricks in case of restrictions

This is a collection of tips and tricks on how postures can still be performed in the case of certain complaints / disorders / limitations or how they can be replaced by other postures with a similar effect. This is not about the curative treatment of disorders, see the individual pathology pages and their sections „Asana practice and movement therapy“ and „Asanas“.

In the following, the tricks are broken down by affected areas/body parts/joints:

Finger. Hand. Wrist. Forearm. Elbow joint. Upper arm. Shoulder joint. Scapulothoracic gliding bearing. Trunk. Hip. Knee. Ankle joint. Foot

Fingers

Sprain, dislocation, rupture of the palmar plate, fracture, pressure-sensitive injuries, pressure-sensitive inflammation

Restrictions: do not strain, do not bend

Posture: downface dog
Modify: Place the affected hand on shoulder plates so that the fingers are free

Posture: upface dog
Modify: Place the forearms instead of the hand. Instead of switching to dog head down, switch to dog elbow stand. Measure the distance from the elbows to the feet after dog head down

Posture: Handstand
Modify: Perform the elbow stand instead of the handstand

Posture: Bhujangasana
Modify: The character of Bhujangasaana as a strengthening of the arm extensors, the triceps cannot be maintained, but the forearms can be placed on top instead, which shifts the arms towards the shoulders and autochthonous back muscles

Posture: Back extension
Modify: Instead of pressing the hand against the wall with dorsiflexion of the wrist, place the outer edges of the hand on a window sill, with an appropriate elevation underneath if necessary

Posture: Headstand
Modify: Do not cross your fingers, but keep them extended

Hand

Isolated pressure sensitivity of the carcass

Restrictions: Protection from pressure exposure

Posture: downface dog, upface dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana
Modify: If pressing down harder on the base of the fingers does not help, patches or shoulder stands can be used as a softening agent. If only a small area of the body is affected, this can be left out of the patches. In principle, these postures can also be performed on fists or fingertips.

Isolated pressure sensitivity of the hamulus

Restrictions: Protection from pressure exposure

Posture: downface dog, upface dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana
Modify: In these postures, the hamulus can be left out using two patches.

Isolated pressure sensitivity in the metacarpophalangeal joint area

Restrictions: Protection from pressure exposure

Posture:
Modify: Occasionally, often quite suddenly, an isolated pressure soreness occurs in the area of the palmarplate/palmar joint capsule, which can only be avoided by complete relief. In this case, use patches to protect this area from pressure on the ground.

Greater pressure sensitivity due to injury, inflammation, burns

Supports: Protection from pressure exposure

Posture: downface dog, upface dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana
Modify: If the palm is sensitive to pressure over a large area, some postures can alternatively be performed on fists or fingertips

Posture: Back extension
Modify: Instead of pressing the hand against the wall with dorsiflexion of the wrist, place the outer edges of the hand on a window sill, with an appropriate elevation underneath if necessary

Posture: Headstand
Modify: Do not cross your fingers, but keep them extended

Posture: Three-point headstand
Modify: It may not be possible to perform the three-point headstand. It is not advisable to perform it on fists or fingertips because the relatively finely adjustable exertion of force on the palmar flexors of the wrist is an important part of balancing in the three-point headstand and is not possible on fists or fingertips.

Malperception due to missing carpal bone

Restrictions: Rest before the pain-inducing movement / position

Posture:
Modify: Depending on the affected bone and the direction of the unphysiological translation, it may be sufficient to relieve the affected area (bone and overlying muscles). However, it may also be necessary to vary, e.g. by performing the posture on the edge of the hand, such as the back extension, or on fists, such as the two dog positions head up and head down and many other postures, or, if the strength and body awareness are sufficient, also on fingertips.

Injuries to the thumb or thumb joints

Restrictions: Rest before the pain-inducing movement / pressure exposure

Posture: head up dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana, tolasana, back stretch and others
Modify: In the postures indicated, the thumb or its joints must be unloaded, which is most easily accomplished when it is completely unloaded, such as the rest of the hand resting on a support on the floor. To achieve a symmetrical posture, the other hand should be placed in the same way. The back extension can also be performed in such a way that instead of pressing the hands on the wall and using supports to keep the thumbs out of the way as described, the edges of the hands are placed on an appropriately high object such as a windowsill, possibly with some shoulder support plates on top.

Wrist

Restriction of dorsiflexion of the wrist due to ganglion, injury

Restrictions: Rest before the pain-inducing movement / position

Posture: head up dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana, tolasana, back extension
Modify: In the postures indicated, the wrist must be able to assume about 90° dorsiflexion. If pain occurs or if a therapist instructs you to avoid this angle, the body can be placed on an elevation, such as a few patches, for moderate angular relief. As the patches are loaded here with approximately vertical pressure, they should not tend to slip under each other.

Restriction of dorsiflexion of the wrist due to extreme stiffness of the palmar flexors of the wrist and finger flexors

Restrictions: Protect against excessive stretching and tensing of the antagonists

Posture: head up dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana, tolasana, back stretch
Modify: In the indicated postures, the wrist must be able to assume about 90° dorsiflexion. The extrinsic finger flexors in particular prove to be limiting, mostly in people who are active in sports or manual work. There are two useful approaches, depending on how much relief is required: If only a small amount of relief is needed, a small number (one to three) of patches can be placed under the carpus, with the metacarpophalangeal joints still pressing on the floor, so that angular relief in the direction of dorsiflexion results. If the required relief is greater, the patches may begin to slide against each other. It then makes more sense to place the palm of the hand on a shoulder support plate, on which a patch is placed as a friction mediator, so that the fingers are not supported and can bend. The resulting relief of the superficial finger flexors and profound finger flexors usually allows sufficient dorsiflexion. If, contrary to expectations, this is not the case, the monoarticular palmar flexors of the wrist are the ones that set the restriction and sufficient patches under the carpus must be used (see above).

Instabilität

Restrictions: Protection from movements that could further damage the insufficient ligaments, i.e. from utilizing the translatory or rotatory movement and forces that act in this non-physiological direction.

Posture: (various)
Modify: Depending on the type of instability (in the palmar-dorsal or radial-ulnar direction), care must be taken to use the muscles that can be acquired in this direction to stabilize the wrist, preferably both agonists and antagonists. If this is not possible or only possible to a limited extent, consideration can be given to varying the posture so that the wrist is only loaded axially and held extended, or so that the load acts on the wrist in a different direction. For example, a wrist that is unstable in the dorsal-palmar direction and cannot be adequately stabilized muscularly would be loaded in the ulnar-radial direction, taking into account that the load capacity is lower in this direction. Alternating between pushing and pulling should also be avoided as far as possible. A sequence of dog position head down with changes to dog position head up has a similar direction of thrust, in the sense that in the dog position head up the force of the frontal abductors of the shoulder joint causes a translatory force of the forearm as punctum mobile in relation to the hand as punctum fixum in the dorsal direction of the wrist. In the downward dog position, the force is much less with good shoulder flexibility, but certainly not the opposite. On the other hand, the upward dog position with inverted feet produces an opposing thrust in the wrist, which must not be combined with the standard version of the upward dog position or the downward dog position if the wrist is unstable in the dorsal-palmar direction. If the dog positions were performed on fists instead, the frontal abductors of the shoulder joint would always exert a translatory force in the same direction, namely pushing the forearm ulnarly in relation to the hand.

Forearm

Golf elbow

Restrictions: Rest before exerting force that triggers the pain.
Curative: see golfer’s elbow
Posture: downface dog, upface dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana, back extension, and various forward bends with grip to the outer edge of the foot
Modify: The golf elbow must be differentiated by type: the forearm pronated golfer’s elbow is less noticeable in the asanas, if then when eliminating the „mouse holes“ by consciously pressing down forcefully on the base joints of the index fingers in postures with the upper arm turned out overhead and the forearm pronated, in which the hand is placed on the floor(downface dog, upface dog, right-angled handstand, handstand, vasisthasana, ardha vasisthasana) or on the wall(back stretch). The exact angle of dorsiflexion differs in the postures, for example between downface dog and upface dog, but both types of posture can trigger the pain. The other two types of golfer’s elbow, finger flexion golfer’s elbow and wristpalmar flexion golfer’s elbow, may also react quite clearly to the elimination of the „mouse holes“, i.e. pressing down on the metacarpophalangeal joints of the index finger, but here not because of the pronation of the forearm but because of the palmar flexion of the wrist. In postures with a grip on the outside of the foot, which are often forward bends, a finger flexion golfer’s elbow quickly becomes noticeable. Alternatively, you can pull on a belt. In all three cases, the triggering of pain must be avoided. However, these postures can be beneficial until just before the pain is triggered. In the case of wristpalmarflexion golfer’s elbow, it should be possible to perform most of these postures on fists without pain, provided that the muscular control of the wrist is sufficiently pronounced. It can be checked whether the affected postures can be performed on fists. Of course, the fist should only be closed with sufficient force to avoid pain. In the case of a finger flexion golf elbow, these postures can also be performed on fists, but here too the fist closure must not be so firm that it triggers the known pain. Execution on fingertips is generally prohibited in the case of the finger flexion golf elbow. In postures in which the hand is pressed against the wall, it is advisable to place the edge of the hand on a raised surface, depending on the height, for example on a windowsill in the case of the back extension.

It is important to note the connection with the not uncommon cracking elbow, in which there is presumably a slight subluxation before the cracking occurs. In these cases, the elbow should of course be made to crack before loading, i.e. the subluxation should be eliminated (
reduction). However, it can also be observed that before reduction there may be increased pain in the sense of the golfer’s elbow (tense pain at rest and pain on movement or exertion) in the muscle origin affected by the golfer’s elbow.

Tennis elbow

Restrictions: rest before exerting force that triggers the pain.
Curative: see tennis elbow
Posture: trikonasana standing against the wall
Modify: In this pose, the aim is to use the strength of the supinator muscle to rotate the leg out from the foot. If the tennis elbow is of the forearm-supination tennis elbow type, the untwisting must be limited to a pain-free intensity.

Posture: (various postures on fists)
Modify: In the case of a wristdorsiflexiontennis elbow or finger extension tennis elbow, the fist closure and stabilization of the wrist by the forearm muscles must be limited to a pain-free intensity. If it is not possible to achieve a subjectively loadable wrist in view of the posture requirements, this variant cannot be performed.

Cubital tunnel syndrome (ulnar sulcus syndrome)

Restrictions: protect from pressure exposure

Posture: gomukhasana, maricyasana 1, maricyasana 3
Modify: If the elbow joint cannot tolerate a wide bend, the postures must be performed in such a way that the bend is limited to a pain-free extent, which usually requires the use of a belt. In gomukhasana this can affect both arms, in maricyasana 1 and maricyasana 3 usually only the arm that grasps the leg dorsally.

Posture: elbow stand, dog elbow stand, right-angled elbow stand, dvi pada viparita dandasana, eka pada viparita dandasana, generally all postures with the forearm resting on the floor
Modify: If the pressure on the forearm in the area of the ulnar sulcus causes discomfort, this area can be left out and the rest of the forearm can be placed on a shoulder support. A patch between the arm and shoulder support plate is usually recommended as a friction mediator.

Fracture of the forearm

Restrictions: Protection from traction, rotation and shear forces

Posture: (various postures in which the hands are supported)
Modify: The distal radius fracture is not only the most common fracture injury of the forearm, but also the most common fracture injury in humans. In this case, the instructions of the attending physician should of course be followed with regard to resting or partially weight-bearing the arm. This means that most postures that support body weight on the floor are generally contraindicated, but not only these, work with dumbbells held in the hand or resistance bands held in the hand is also out of the question until the appropriate release, as shearing forces occur in the fracture site. In the case of resistance bands, these can – depending on the type of fracture treatment – be held proximal to the fracture site. It is also normally possible to perform the upavista konasana with a block if this is held proximal to the fracture site.

Posture: Back extension
Modify : A purely axial load on the fracture site with shear would be the most tolerable, in contrast totraction. However, since shear forces in the fracture site due to the weight of the upper body, the head and the arm itself cannot be ruled out, a safe variant should be chosen by performing the back extension with the elbows resting on a window sill at an angle.

Posture: Shoulder opening on the chair
Modify: The shoulder opening on the chair can be performed if the forearms proximal to the fracture site are prevented from moving inwards with a block instead of the fingers pressing on each other, which of course corresponds to an end rotation of the upper arm in the shoulder joint.

Posture: gomukhasana, maricyasana 1, maricyasana 3
Modify: Using the finger flexors to prevent the hands from leaving the desired position or beyond to bring the wrists closer together creates a pulling force in the fracture site, which is why these postures are generally contraindicated.

Traumatic injury to the skin of the elbow

Restrictions: protect from pressure exposure

Posture: elbowstand, dog elbowstand, right-angled elbowstand, dvi pada viparita dandasana, eka pada viparita dandasana, generally all postures with the forearm resting on the floor
Modify: In these postures, the affected area can usually be left out by placing the unaffected part of the forearm on a shoulder stand. It is usually necessary to use a patch as a friction mediator. In order not to create an asymmetrical posture, it will also be necessary to support the other arm in most cases.

Posture: Shoulder opening on the chair
Modify: It is usually possible to avoid the affected area itself and only support part of the upper arm near the elbow.

Elbow joint

Instability

Restrictions: Protection from movements that could further damage the insufficient ligaments, i.e. from utilizing the translatory or rotatory movement and forces that act in this non-physiological direction.

Posture: (various)
Modify: There are different types of instability of the elbow joint, basically any of the three sub-joints can become unstable due to insufficient ligaments. If this is known, the elbow joint should be loaded as little as possible in the unstable direction and certainly not alternately.

Cracking elbow joints are fairly common, where there is probably a slight subluxation before the cracking occurs. In these cases, the elbow should be made to crack before loading, i.e. the subluxation should be eliminated. All postures can then be performed as usual. As far as the other types of instability are concerned, care must be taken to ensure that the muscles are used in such a way that, as far as possible, there is no switching back and forth between the two extremes that are possible with instability, but ideally an attempt is made to adopt and maintain a low-momentum, physiological position in between.

To illustrate this using the example of purvottanasana in the simple version with hands pointing backwards and feet up: For many people, the arms turned out in a wide retroversion can overstretch. This does not represent instability in the strict sense, but is usually within the tolerance range of the osseous flexibility of the elbow joint. After all, unless the biceps are significantly shortened, it is not the soft-elastic (muscular) or firm-elastic (ligamentous) limit of movement that is reached here, but the hard-elastic (osseous) limit. Overextension can easily be reduced or stopped by using the arm flexors. However, if the forearm deviates from the upper arm in the direction of the valgus position or varus position, i.e. outwards or inwards from the line connecting the wrist and shoulder joints, and if the degree of deviation is variable, this is usually a case of ligamentous insufficiency, i.e. genuine instability. No significant moments should occur in the joint or be caused by the performer that push in one direction or the other of the limit value of the unphysiological movement.

As the elbow joint is not covered by muscles that can move in these directions, an attempt must be made to bring the joint into a low-moment center position with the help of lateral adductor or lateral abductor muscles of the shoulder joint, i.e. by pushing the hands towards or away from each other. In principle, this correction could also come from the hands, which stand on the floor as a fixed point, but this is more difficult and also quite limited in terms of the force that can be achieved. This issue of joint instability affects not only, but frequently also the middle joints of the elbow and knee joints.

However, the principle explained in the example can be transferred to many postures and joints. In uttanasana or tadasana , for example, the legs can be pushed outwards from the hip joints in the case of a kinked foot; on the other hand, starting from the punctum fixum foot, the subtalar joints can be pronated in order to reduce the hindfoot valgus. The latter approach addresses the disorder directly, but is less easy for many people to implement. The former, on the other hand, can cause discomfort in the case of existing disorders of the medial knee, such as the medial meniscus. In this case, an attempt would be made to supplement the latter with the former, but only until the symptoms appear.

Bursitis olecrani / Bursitis informaticus olecrani / Student’s elbow

Restrictions: protect from pressure exposure
Posture: various postures with the forearm supported such as elbow stand, dog elbow stand, right-angled elbow stand, dvi pada viparita dandasana, eka pada viparita dandasana, variations of purvottanasana,
Modify: As the bursa (subcutanea) olecrani covers the olecranon, supporting it on the floor is contraindicated, as exposure to pressure is an important trigger for bursitis. In some postures, the area can then remain unsupported by placing the rest of the forearm on a shoulder support plate or on patches. Depending on the posture, this is more or less possible. If the body weight presses the upper arm approximately vertically downwards, as in the right-angled elbow stand or elbow stand, the area left unsupported should only be very small. If in doubt, you should also try to prevent the affected area from exerting pressure on the floor by applying a lot of force to the triceps.

Oberarm

Shoulder joint

Dislocation tendency

Restrictions: Be sure to rotate the arm in an overhead position (from 120°)
Curative: see shoulder dislocation
Posture: all postures with the arm in an overhead position
Modify: The vast majority of shoulder dislocations (95-97%) occur anteriorly, very frequently in the overhead position of the arm if it is rotated in or at least not rotated far out. The initial dislocation is often caused by trauma, but reluxations require less of a trigger than the initial event. Experience has shown that all asanas can be performed if strict attention is paid not only to the posture but also to ensuring that the arm is maximally dislocated at all times when entering and leaving the posture. Handstand and bridge are then also possible. However, it is easier to switch to postures which, by design, have a very widely extended arm, such as elbow stand or, as an equivalent to bridge, dvi pada viparita dandasana.

Skapulothorakales Gleitlager

Rumpf

Painful supine position with thoracic spine kyperkyphosis

Conditions:
Curative: see Hyperkyphosis

Posture: savasana, viparita karani, supta dandasana
Modify: in the above poses, the back lies passively on the floor. Supta dandasana differs slightly from the other postures in that the hip flexors have to hold the legs in a vertical position, which may require considerable effort if the flexibility of the hamstrings is restricted, which can lead to hyperlordosis of the lumbar spine. This in turn changes the force ratios in the entire back and can fundamentally increase hyperkyphosis of the thoracic spine. Depending on how pronounced the hyperkyphosis is and how soft the surface is, hyperkyphosis can be quite uncomfortable. It also often leads to secondary hyperlordosis of the lumbar and cervical spine. The former is noticeable in an unpleasant hollow back sensation, the latter in an unapproved head sinking into reclination, i.e. a hollow neck. To counteract the unpleasant sensation of pressure in the thoracic spine, softness mediators can be used on the one hand, and on the other hand more support can be provided caudally and cranially of the support area than directly under the maximum curvature. In the case of a secondary hollow back, a distinction must be made: if less mobile hip flexors pull the lumbar spine into hyperlordosis anyway, the knees can be supported somewhat. However, this should not be done too often and for too long, especially not during the night, because otherwise the hip flexors will shorten even more as they no longer receive a gentle stretching stimulus in the supine position. The only temporary remedy for hollow neck is to raise the head.

Painful supine position with lumbar spine hyperlordosis

Restrictions:

Posture: savasana, viparita karani, supta dandasana
Modify: As with the hyperkyphosis of the thoracic spine, a distinction must be made here: a less mobile hamstrings leads to a hollow back in supta dandasana, which goes beyond that caused by the shape of the spine or that forced by the restricted flexibility of the hip flexors. This effect does not occur in the other two postures. In viparita karani the hip flexors no longer play any role at all, so that a hollow back should not occur at all, especially as the antagonistic hip extensors pull the lumbar spine in the opposite direction. If a hollow back is nevertheless present, this must be examined more closely. savasana, on the other hand, is the typical case in which the hip flexors can pull the pelvis into hyperlordosis in the supine position due to the extended hip joints and the extended knee joints, and regularly do so in an uncomfortable way if there are corresponding restrictions in flexibility. The first possible measure is then to support the knee joints in a flexed state, which creates flexion in the hip joint and relieves the hip flexors so that the iliopsoas pulls the pelvis less cranially to the ventral side and the psoas major pulls the lumbar spine less ventrally.

Unpleasant hollow neck in supine position with cervical spine hyperlordosis

Restrictions:

Posture: savasana, viparita karani, supta dandasana
Modify : The hollow neck in the above-mentioned postures, i.e. excessive reclination that is perceived as uncomfortable, is usually the result of hyperkyphosis of the thoracic spine. In principle, this can occur with or without hyperlordosis of the lumbar spine, but it is not uncommon for it to occur at the base of the spine. Hyperlordosis of the cervical spine is rarely isolated; after all, the body tends to compensate for disorders, which often leads to secondary disorders. Regardless of how the hyperlordosis of the cervical spine has arisen, elevation of the head is the main symptomatic treatment.

Posture: jathara parivartanasana
Modify: In this case, a less flexible hamstrings can cause the back to round overall in the lumbar and thoracic spine if the legs are pulled in too far to avoid hyperlordosis of the lumbar spine. This often results in excessive reclination, as the head remains on the ground due to gravity. In these cases, there is no need to support the head, but rather a more precise parameterization of the flexion in the hip joint.

Intervertebral disc disease: Prohibition of lumbar spine kyphosis, lateral trunk flexion and spinal rotation

Restrictions: Do not do anything that increases the pressure of the prolapsed or bulging mass on the spinal nerve. This definitely applies to the acute phase, in which neuroradicular pain (pain radiating into the leg) occurs from time to time. It is difficult even for experts and with radiological follow-up to say with certainty when, after a longer period without symptoms, which movement can be performed again and to what extent in terms of intensity, duration and frequency.

Posture: all postures that kyphosis the lumbar spine, including all forward bends in the sense of hip flexion that do not explicitly stretch the back, seated such as pascimottanasana or standing such as uttanasana, but also postures that have a straight back in the ideal posture, but which become round in practice due to flexibility restrictions such as maricyasana 1 and maricyasana 3, see below.
Modify: In the case of disc disease, it is difficult to predict the level of convex curvature at which pain will occur. In practice, there are cases in which even a steeply curved back triggers the familiar neuroradicular pain. Furthermore, it remains unclear how much curvature is tolerable shortly before pain is triggered and for how long, or in other words, how long it is likely to cause the situation to deteriorate. A defensive approach should therefore be taken in these cases. All postures with hip flexion in which the upper body moves gravitationally towards the floor generally tend to round the back in the thoracic and lumbar spine. In the case of seated forward bends, the tendency to round and the resulting bending moments in the spinal segments are even greater, which is one reason why seated forward bends are not recommended for beginners with little flexibility. Which postures

Posture: maricyasana 1 and maricyasana 3
Modify: What both maricyasanasanas have in common is the tendency to tilt the pelvis backwards away from the legs in the straight leg due to the restricted flexibility of the hamstrings and in the bent, upright leg due to the short hip extensors, which results in a tendency towards a rounded back, as one shoulder must still be far enough forward to be able to reach around the upright leg. Unless both groups can be assumed to have very good flexibility, there will always be a more or less rounded back in the lumbar spine area, and very often beyond the level at which the pain associated with the intervertebral disc disease is triggered. These postures may then not be feasible. Before drawing this conclusion, however, an attempt can be made to place the buttocks on a moderate elevation. However, this will only work for people with suitable proportions; in the case of sitting giants, the arm gripping the raised leg will regularly slip over the knee.

Posture: uttanasana and its variations, prasarita padottanasana and its variations
Modify: Only the variations that consciously stretch the back against all the forces and bending moments that arise come into question here, in particular the table variation and the right-angled uttanasana. For the table variation, the fingertips often have to be placed on a corresponding elevation. Only the supported version of prasarita padottanasana should be performed.

Posture: seated forward bends
Modify: For the time being, seated forward bends should be categorically replaced by the above-mentioned variants of standing forward bends, which are not only less problematic with regard to intervertebral disc disease, but also offer better support for the flexion ability of the hip joints, which in turn benefits people with intervertebral disc disease in everyday life.

Posture: Twisting postures
Modify: Twisting postures are considered critical for intervertebral disc disorders. Ventrally, the oblique abdominal muscles and, to a lesser extent, the rectus abdominis pull the rib cage downwards, dorsally the oblique parts of the autochthonous back muscles. The simultaneity of both results in increased compression of the intervertebral discs, irrespective of whether the rotation does not in any case lead directly to the bulging or prolapsed mass pressing on a spinal nerve or whether the pressure already present becomes more intense. For the time being, the recommendation will be to refrain from rotational postures for an indefinite period of time.

Posture: Trunk side bends
Modify: Intervertebral disc disorders often react badly to lateral trunk flexions, so it is generally recommended to refrain from them for an indefinite period of time. As in the case of flexion of the spine, it is difficult to predict when, to what extent and for how long they can be performed again without damage. Once again, a defensive approach is recommended. At least some of the positive effects of trunk side bends can be approximated by other postures. The one-sided stretching of the latissimus dorsi achieved in the seated trunk side bend can be achieved just as well and safely with other postures with wide frontal abduction in the shoulder joint, and these postures generally tend to stretch rather than bend the spine. If hypertonicity of the oblique abdominal muscles is felt, the twisting postures, which also have a stretching effect, prove to be better tolerated in practice than trunk side bends. The most difficult case here is that of a perceived hypertonicity of parts of the autochthonous back muscles that have both an extending and rotating effect, in particular those that extend from the transverse processes to the spinous processes or those that originate from the iliac crest, such as the iliocostalis lumborum. Since both counter-movements to the direction of the muscle, i.e. flexion and contralateral rotation, are contraindicated in themselves, and even more so in combination, hypertonus can only be countered with work in the middle sarcomere length, not with genuine stretching.

Hip joint / hip region

Knee joint / Knee

ventral tenderness, often in the area of the patella, sometimes also at the tibial tuberosity due to various events such as trauma, retropatellar conditions, joint effusion, Osgood-Schlatter disease, Sinding-Larson-Johansson disease , sometimes also the distal form of patellar tendinopathy,

Restrictions: protection from pressure exposure
Curative: see Sinding-Larsen-Johansson disease, Baker’s cyst
Posture: virasana, supta virasana, krouncasana and their relatives,
Modify: In supta virasana, supta krouncasana and ardha supta krouncasana, most people have very little support, especially of the knee, but also of the tibial tuberosity, so that pain can usually be eliminated or sufficiently reduced with a softness mediator such as a blanket.

Posture: Postures in which the knee rests on the floor with a lot of weight, often large parts of the body weight, such as quadriceps stretch 1 on the wall, quadriceps stretch 2 on the wall, ustrasana.
Modify: In ustrasana and also with good flexibility in quadriceps stretch 1 on the wall, the thighs are approximately horizontal, which presses the femoral condyles onto the floor rather than the patella. This is not the case for less mobile people and quadriceps stretch 2 against the wall, where the patella presses on the floor with a lot of weight. Depending on what is happening, it may not be possible to perform these postures. Instead of a quadriceps stretch 1 on the wall, however, you can perform supta virasana or ardha supta krouncasana. The best substitute for quadriceps stretch 2 on the wall is supta krouncasana. Of the above-mentioned postures, ustrasana can prove to be the most difficult, as the pressure exerted by the knees on the floor is compounded by the retropatellar pressure when the pelvis is pressed against the wall with great force from the quadriceps. If this did not trigger or intensify the pain, the entire lower leg could be placed on a support with the foot in ustrasana so that the knees themselves are exposed, which would offer a possibility that does not exist for quadriceps stretch 1 against the wall, quadriceps stretch 2 against the wall.

Posture: Postures or variations in which the bent knee is pressed against the wall, e.g. 1st warrior stance with knee against a block on the wall.
Modify: The variations in which the bent knee is pressed against the wall include, for example, the 1st warrior stance with the knee against a block on the wall. This can be modified so that it is not the knee but the tibial tuberosity that presses on the wall distal to the knee. This should be feasible with the help of a softness mediator such as a patch or a shoulder support plate.

Restriction of flexion of the knee joint due to various conditions such as meniscus damage, osteoarthritis, rheumatism, joint effusion, more rarely also due to larger Baker’s cysts.

Restrictions:
Posture: various postures with very wide flexion of the knee joint such as virasana and postures that include a virasana leg such as tryangamukhaikapada pascimottanasana, supta virasana, krouncasana and its variations as well as quadriceps stretch 1 on the wall, baddha konasana and its variations, as well as postures with a leg similar to baddha konasana such as janu sirsasana, furthermore padmasana and its variations, respectively. Postures that include a padmasana-like leg such as ardha baddha padma pascimottanasana,
Modify: If corresponding disorders are present, the postures mentioned cannot tolerate as much flexion as the posture requires or induces. In some cases, the flexion of the knee joint in virasana, supta virasana can be limited with aids such as a block or a shoulder support plate under the buttocks to such an extent that no pain or adverse effects occur. This is not a problem for the effectiveness of supta virasana because instead of the widest possible flexion of the knee joint, the hip joints can simply be moved further in the direction of extension, i.e. the pelvis can be tilted. The effectiveness of virasana, on the other hand, as a stretch of only the monoarticular parts of the quadriceps, becomes less and less effective with each degree of less flexion of the knee joint, to the point of sheer ineffectiveness. Whether the required increase is still effective depends on the individual case.

In the case of quadriceps stretch 1 at the wall, you can try to perform quadriceps stretch 2 at the wall instead, which stretches the rectus femoris even better and also involves the iliopsoas.

The postures baddha konasana and its variations as well as padmasana and its variations represent a different case again, as the primary effect of the posture does not depend on the exact degree of flexion of the knee joint, but the posture is aimed at the adductors or the gluteal muscles and pelvitrochanteric muscles that restrict exorotation in the hip joint. Therefore, the last degree of flexion can usually be dispensed with without any great loss of effectiveness, and no means need to be used to limit flexion because this does not happen automatically after the posture is constructed, for example through the effect of gravity.

Ankle joint

„sprained ankles“ / supination trauma

Restrictions: protection from significant supination and possibly also pronation and wide plantar flexion, rarely also from dorsiflexion
Posture: various postures with wide supination, such as parsvakonasana, warrior 2 pose and the wide prasarita padottanasana, as well as all postures with a „lotus leg“, starting with the lotus position itself and including all its variations and postures that only have one leg in this position, such as ardha baddha padma pascimottanasana. A baddha konasana with low flexibility of the adductors must also be mentioned here. Postures that require adaptation also include those with wide dorsiflexion or plantar flexion in the ankle. This includes all postures with extended feet such as virasana, supta virasana, krouncasana and their variations as well as postures with wide dorsiflexion such as dog pose head down, parivrtta trikonasana, parsvottanasana, warrior 1.
Modify: The three movements mentioned above are often painful or even contraindicated in the case of these injuries. If such an injury has been diagnosed, the treating therapist will usually impose corresponding restrictions. A parsvakonasana or warrior 2 pose may then be just as difficult to perform due to the wide supination in the ankle joint as a lotus position and all postures that contain a „lotus leg“. A wide prasarita padottanasana is also one of the postures with a high degree of supination. In the case of the standing postures parsvakonasana or warrior 2 pose, the foot can be pushed into an edge of the room so that it is neutral in terms of supination and pronation, which avoids the problem. Patches may need to be used here as a softness mediator.

If the wide dorsiflexions are painful or contraindicated, ways can sometimes be found to perform the posture. In the head down dog position, for example, the heels can be placed on a block or other suitable support so that the dorsiflexion remains limited to a tolerable level. Instead of the normal dog position head up, the variation can be performed with inverted feet. If you switch between the two postures, the distance between the hands and the feet must of course always be adjusted, which must be significantly greater in the variant with the feet turned upsidedown.

If a reduced tolerance of plantar flexion has to be taken into account, the focus is on the fully extended feet of the postures virasana, supta virasana, krouncasana and their variations, where a workaround must be found. It is often possible to achieve complete relief with only the lower legs supported up to just before the ankle joint if the feet can tilt freely and according to gravity without exerting pressure on the floor. For a hip opener 5, on the other hand, a block would be placed under the forefoot to relieve the strain, which of course nullifies the effect of stretching the foot lifts, but under the given circumstances there is no way to achieve this without pain. Any flexibility lost or to be acquired at this point must then be worked up later.

Foot

Hallux valgus / hallux rigidus / hallux limitus

Restrictions: protection from dorsiflexion and plantar flexion in the metatarsophalangeal joint, less frequently protection from pressure exposure is also necessary
Curative: see hallux valgus
Posture: postures with dorsiflexion of the metatarsophalangeal joints such as upface dog, staff pose, bhujangasana, setu bandha sarvangasana against the wall, quadriceps stretch 1 against the wall, quadriceps stretch 2 against the wall and others
Modify: The above-mentioned dysfunctions prevent the metatarsophalangeal joint from being brought into significant dorsiflexion. Even a load on the joint in only slight dorsiflexion is often painful. Therefore, if possible, postures must be varied so that the metatarsophalangeal joints remain extended or are completely relieved. Instead of the head-up dog position, a variation with stretched feet can be used, which, however, requires constant adjustment of the distance between the hands and feet when changing from and to head-down dog. Extending the feet in the pole position also means not pushing the body backwards; the lost opportunity to strengthen the deltoids can be compensated for with various dips. The bhujangasana, which mainly relies on the use of the triceps, which remain undamaged when the feet are stretched, has fewer losses. In setu bandha sarvangasana, the variation against the wall is not only used to stretch the plantarflexor muscles of the metatarsophalangeal joints, which is of course clearly contraindicated here, but also to prevent the feet from slipping away when the quadriceps are used vigorously. A reasonably useful substitute is the variation in which the feet are placed on a hard shoulder stand plate without the heels and the heels are supported in front of the edge of the shoulder stand plate. Finally, in quadriceps stretches 1 and 2, the feet can be stretched if there is enough effectiveness left anyway. If this is not the case, the stretched feet must be pressed against the wall by means of two shoulder support plates, at least the one facing the back of the foot should be soft. Other metatarsophalangeal joints are rarely affected by these disorders.

Metatarsalgia

Restrictions: Protect from pressure exposure
Posture: handstand, elbow stand, headstand,
Modify: If both legs are not equally affected, the handstand or elbowstand upswing can be performed with the leg that is less affected as the swinging, extended leg. Leaving the posture is even more important than the upswing. Here too, the less affected leg should touch the floor again first. If you have strength, flexibility and body awareness, you should slowly swing up on both legs in the headstand; if not, proceed as for the handstand and elbow stand.

Posture: Head down dog pose, head up dog pose, staff pose, bhujangasana, hip opener 1 and other hip openings
Modify: In the postures mentioned, the metatarsophalangeal joints – with an uneven angle of the sole of the foot to the floor – are on the floor, which can cause pain in the case of metatarsalgia and should be avoided. In the dog position head down, as described above, the pressure on the balls of the feet can be significantly reduced by supporting the heel with a block, one or more shoulder support plates or other adequate support. In the other postures described above, the leg is approximately horizontal with good flexibility of the hip flexors. This makes it possible to rest the distal lower leg on one or more shoulder support plates so that the area of the ball of the foot is relieved. Of course, the postures can also be varied in the direction of extended feet with the familiar implications of the head-up dog position, i.e. the direction of pressure with the arms is changed and, if necessary, the distance between the hands and feet.

Posture: various standing postures
Modify: In standing postures, you can try to avoid the problem by using patches under the soles of the feet that avoid the area of the affected ball of the foot. However, as the toes should generally not exert any pressure on the ground, the problem can arise that only the heel and the bony outer foot are supported if all metatarsophalangeal joints and also the metatarsophalangeal joint area are affected by metatarsalgia. The medially hollow longitudinal arch of the foot can then result in massive instability in postures on one leg, making balancing work impossible. It may then be necessary to include the toes in the balancing work, which completely changes the character of the posture.

Injuries to the toes in general (inflammation, fracture, contusion, impact trauma…)

Restrictions: Protection from pressure exposure

Posture: various
Modify: If the toes need to be protected, postures with the undersides of the toes up at approx. 90° dorsiflexion in the metatarsophalangeal joints are often not possible due to pain or should be avoided. Postures such as head down dog, head up dog, pole pose, bhujangasana, hip opener 1 and other hip openings must then be varied. In those postures in which the legs are essentially horizontal, the distal lower legs can be placed on shoulder stands. Some parameters of the posture may need to be adjusted, as described for the variation with inverted feet.

In the dog pose head down, you can try to see whether a sufficient elevation under the heels (block or shoulder plates) takes as much pressure off the balls of the feet and toes as necessary. In postures such as virasana, supta virasana, krouncasana, in which the dorsal sides of the toes press on the floor or at least rest on the floor, it must be checked whether this is tolerable. If not, the lower legs can also be placed on a shoulder stand so that the feet can tilt freely and the toes rest on the floor with their own weight at best.

In many standing postures, the soles can be raised so that the toes are exposed; they should not usually be included in the posture anyway. Postures such as the quadriceps stretches on the wall can be performed with the feet stretched out, whereby shoulder plates may need to be used as spacers between the foot and the wall if the effectiveness of the posture is otherwise insufficient.

plantar or dorsal pressure sensitivity of the heel, for example due to plantar or dorsal heel spurs, Haglund’s heel and other, less specific complaints.

Restrictions: protection from pressure exposure
Curative: see heel spur
Posture: various standing postures (plantar heel spur) and postures in which the dorsal side of the calcaneus is supported (dorsal heel spur and Haglund heel)
Modify: In most standing postures, the plantar side of the heel bone(calcaneus) presses on the ground with a lot of weight. In the case of a plantar calcaneal spur, this typically causes discomfort, although not quite as intense as walking, for example, in which the plantar fascia and its insertion on the calcaneus as a passive tension belt of the foot is subjected to tension every time the foot is stepped on and even more so when rolling off. However, simply placing the foot on the ground and putting weight on it is generally sufficient to trigger pain, so that it also occurs in standing postures. The traction factor cannot be reduced when the foot is positioned and loaded, but the local pressure at the insertion can. Therefore, if it could be established that the heel bone placed without other parts of the sole of the foot (e.g. isolated on a block) causes more pain than just the ball of the foot placed with the heel raised, patches under the midfoot and forefoot and under the dorsal area of the heel bone could provide relief. If, on the other hand, the pain is mainly caused by the tensile load, this would probably be ineffective and relief would hardly be possible, as the forefoot would have to be almost completely relieved, which in most standing postures leads to indisputably low stability and probably also to cramping or at least hypertonicity of the dorsiflexors.

The case of dorsal heel spurs and Haglund’s heel is slightly different. The variations of purvottanasana with outstretched legs are affected here. No tension strapping plays a role here; it is all about local pressure exposure. Due to the comparatively low height of the calcaneus and its rounded contour in the transition from the dorsal side to the plantar side, it may be difficult to support this area so solidly that the area affected by the pain-causing event can remain unsupported and without pressure. Of course, it is not an option to exercise with only the unaffected leg on the floor, as this leads to one-sided strengthening of the hamstrings, among other things, and thus represents a possible factor in the genesis of pelvic torsion. If the area were so vulnerable that even savasana causes pain, the lower legs could be supported appropriately so that the calcaneus is completely free. The same applies to virapita karani, whereby the pressure of the calcaneus on the wall can be significantly less than in savasana, depending on the mass, shape and tone of the calf muscles, which also determine the pressure of the heels on the floor in savasana. If pain still occurs, the calf can be relined, which can reduce the pressure of the calcaneus to zero.

Lateral pressure sensitivity of the heel or outer edge of the foot.

Restrictions: protection from pressure exposure

Posture: baddha konasana and related postures, janu sirsasana, parivrtta janu sirsasana, hip opening at the edge of the mat, hip opener 3, as well as variations of standing postures in which the outer foot is pressed against the wall at the base of the metatarsal 5 or the outer heel is pressed against the wall.
Modify: This type of pressure sensitivity is not usually due to a specific illness, but is often caused by intensive or repeated exposure to pressure. Only protection from pressure exposure can help here. It must be checked whether another area can be placed on the floor or pressed against the wall in terms of the posture. In baddha konasana, for example, the outer ankle can be adequately supported and the heel can lie unsupported on the floor. For many less flexible people, this has the additional advantage that the supination required in the ankle is significantly reduced. This applies similarly to janu sirsasana, parivrtta janu sirsasana, hip opening at the edge of the mat, hip opener 3.

In the case of the standing posture variants, in which an outer foot is pressed against the wall, variations can often be made. As a rule, the area from the lateral calcaneus to the prominent base of the metatarsal 5 bone is pressed against the wall, but this is often not without alternative. For example, the angle of the foot to the other foot and to the wall can be changed so that only the outer heel presses against the wall if the base of the metatarsal 5 bone is painful, otherwise the heel can be left out and the area along the metatarsal 5 bone pressed against the wall if the lateral calcaneus was painful. If the thigh in question is very steep, a pressure-absorbing mass (shoulder support plate, patches, block or a combination of these) between the wall and the lateral malleolus could also be considered if this is not detrimental to the purpose of the exercise; after all, this mass will influence the necessary work with the ankle ’s pulley system and may impair the training effect.