Podcast: Ep #242: Healing & Synergy: Why Modifications Don’t Work in Yoga Therapy and What Does

From Pain to Possibility with Susi Hately | Healing & Synergy: Why Modifications Don't Work in Yoga Therapy and What Does

In this next part of the Healing & Synergy mini-series, we’re discussing the concept of modifications and how, while they may be useful in yoga teaching, they can be counterproductive in yoga therapy.

In yoga teaching, modifications are implemented when a patient invariably cannot achieve a pose due to certain issues. Trainees and graduates are then taught to simply “modify the exercise”. But that concept itself is compensatory and, therefore, doesn’t allow us professionals to address the underlying movement issue.

Tune in as I explain how such modifications limit the healing process during rehabilitation as well as the thinking required to move away from those workarounds to actually resolve a patient’s core movement issues.


If you're interested in improving your healing skills with a more guided approach, join my Yoga Therapy Certification. Click here to register.

Subscribe:   Apple Podcasts   |   Spotify  

What You'll Learn from this Episode:

  • The problem with movement modifications.

  • Why modifications are used in yoga teaching.

  • How to address a client’s underlying issue without implementing modifications.

Featured on the Show:

  • If you're interested in improving your healing skills with a more guided approach, join my Yoga Therapy Certification. Click here to register.
  • Join the next Therapeutic Yoga Intensive on April 20–25, 2024 by registering here.
  • Ready to learn to listen to your body? Email [email protected] for a customized learning path.

Full Episode Transcript:

Male Announcer: You’re listening to From Pain to Possibility with Susi Hately. You will hear Susi’s best ideas on how to reduce or even eradicate your pain and learn how to listen to your body when it whispers so you don’t have to hear it scream. And now here’s your host, Susi Hately.

Welcome and welcome back. I’m so glad that you’re here because I’m continuing my healing and synergy miniseries, which is a multi-episode series on the significant pieces that I have found to be important for helping clients to reduce and eradicate physical pain.

And this is really geared for the professional who wants to up their game and hone their craft. And I’m covering topics on anatomy and biomechanics, as well as helping clients gain awareness and listen to the whispers. As well as the business component pieces.

This is healing and synergy, right? So it’s the healing process as well as the synergy between mind and body and between business and technical skills because we’re helping people reduce and eradicate physical pain and we want to be able to earn a living at this, right?

Whether it's a part-time or a retirement living or whether it’s a full-time living, I want and support my trainees and my grads to really make that happen for them in a way that serves them, that honors their physiology and psychology, a way that helps them cultivate ease, predictability, consistency. Because it’s as much about nurturing themselves, the grad and the trainee, as it is about our client. Otherwise, it’s a very one-sided, burning out kind of experience.

So today, I want to get into a key concept that I see present in the yoga teaching world that often bleeds over into the therapy world that can really hamper somebody’s process and progress. Meaning the yoga teacher turning to the yoga therapist process. And I see this concept, which is the modifications that are often taught in the yoga teaching world, I see that

mindset of like, what’s the modification for this exercise? Or how can we modify this for somebody?

And the way of thinking around this modification, which started in the Yoga TT 200 world and is very, very prevalent in the yoga teaching world, actually hampers yoga therapist, trainee and graduates’ progress with clients. So a concept that’s used a lot in yoga teaching hampers the progress of a yoga therapy trainee or grad.

And it’s something I’ve seen over and over and over and over and over again. It’s been consistent throughout my entire training and my entire career really, seeing this. And it’s a piece that can be a hard won success for a trainee who breaks free of the modification paradigm and starts to see their person in a whole new way.

So with this episode, I want to play into what I see as being a problem with using modifications, where it actually limits progress, and part of what I think contributes to why we use modifications and how it leads to some massive doubt for yoga therapists to be and even grads who haven’t quite busted through that paradigm. And where I see my grads who are being super successful, how they’re utilizing a different idea and where I’d like to see things kind of evolve to if I could wave my magic wand.

So in the yoga teaching world, modifications are significant, right? It’s a big piece of what is taught in TT 200 and TT 500. And a major reason for the evolution of modifications is because multi-level classes became the norm, right? Lots of people in a class, one teacher at the front and maybe some assistants in the room, depending on the numbers, multiple levels, multiple issues in the room. People are coming for multiple reasons to the class.

So lots of multiple, multiple, multiple, layers and layers of stuff in a room. And there’s a plan that the teacher has, a sequence, a choreography, something that the teacher is following, moving and guiding their students through. And invariably, you will have people not being able to do a pose for any number of reasons. So then what do you do?

Because of the multi-level nature and you can’t meet every single person where they’re at, not in a big class, modifications really have evolved so that you can say to someone, you know, if you’ve got a wrist thing or if you’ve got a knee thing, then do this instead. Or if you’ve got a whatever, blah, blah, blah, blah, blah, blah, here’s the workaround to use instead.

Which is really terrific as an idea in a multi-level class, or really any yoga teaching class, any yoga class, like regular class, where for the most part the belief of why people are showing up is not really considered. It could be any number of reasons. It’s their time alone. It’s their time on their mat. It’s the time before their workday, after their workday. A time to move, a time to get fit, a time to breathe, a time to stretch. And that’s just like a handful of things coming out of my mouth right now.

But here’s the problem with modifications. The problem with modifications is they are a workaround, they’re actually a compensation. Yes, they are honoring a person where they are at, so that person can continue moving through the class, so the class can continue to move forward without much sort of an upset. But they don’t really address the movement piece that is correlated to the issue at hand.

So if someone has a wrist pain or an elbow pain and they’re given a workaround to do a movement in another way, that other way is not actually addressing the underlying movement issue. And truly, that’s not what modifications are for.

I see them as being terrific in a multi-level class where you have a sequence, as the teacher, that you’re moving the class through and you’re plopping in these workarounds as you go, so the class can kind of move through and the people are learning as they go. But because of this thinking, it can translate into a yoga therapy realm of, okay, well, if a person can’t do this exercise, then what do we do? How do we work around? What workaround do we provide a student? What’s the modification?

And if I just harken back to what I just said a moment ago, the thing with the workaround, the thing with the modification is that they’re not addressing the underlying movement pattern or the correlated movement pattern that’s contributing to the issue that we’re providing the modification for.

So if we take that idea, which is great in terms of its intention in the yoga teaching world, and we bring that into the yoga therapy world, we’re missing out on something so massive, in my mind anyway. We’re missing out on what’s the underlying movement pattern that’s contributing to the issue at hand? What’s the correlated movement patterns that are contributing to the issue at hand?

So if we’ve got a movement that, let’s say it’s been labeled as something for the back, but then someone is hurting their back or they just can’t fundamentally do it, a common question I’ll get in the early phases of my process with people is, well, what’s the modification?

And this is where I start my teaching process of there isn’t one. There isn’t a modification. To which there’s a what? And my response is, we don’t need to have a modification, we need to address the movement pattern that’s at issue here. We need to recognize what’s compensating, what’s contributing to the issue here.

If someone is unable to do the movement, someone is unable to do the movement. This is our opportunity to say, stop, stop, stop. Let’s look at actually what’s going on here, as opposed to providing the workaround, as opposed to providing the modification.

So this becomes really interesting in terms of my process, because when we are in a 200 or a 500 hour teacher training program, it’s only 200 hours plus an extra 300 to make it a 500. So when I say 200 or 500, I’m not calling it 700. 200 to 500 is 200 hours of initial training plus 300 hours, that’s not very much training.

And the focus isn’t on how to help people improve movement patterns. It’s not how to see movement patterns. It’s mostly about, here is the pose, here is the asana, here is what it’s supposed to look like. And if a person can’t get into what it’s meant to look like, here’s the modification.

We can take that same thinking into therapeutic exercise or therapeutic yoga or any therapeutic movement pattern. The movement pattern isn’t a noun, it’s a verb. So if someone is unable to do it, there’s a process of movement that they are struggling with.

So it’s not about finding the modification for said movement or the workaround for said movement. It’s taking a look at what is happening as they move. It’s moving the thought pattern from this being a noun, a thing to do, to a verb of how they are doing it. And this is what I like to say, and I’ve said it a number of times in this podcast and I say all of the time in my courses, which is, how is the person moving from point A to point B? What’s that movement? How are they moving through that trajectory?

Because you will see, as your eye is trained you will see what is happening between point A and point B. And that’s where part of the answer lies. Versus the person’s already gotten to point B, the noun, the pose looks weird or not right or there’s something that’s not right here, I don’t know what it is and the person can’t feel it. Am I really seeing what I’m seeing? I’m going to do this modification. They’ve already gone through the trajectory. They’re already through to the position. It’s too late at that point.

Do you see what’s happening here? There’s a lens that has been formed and evolved in yoga teacher training around modifications that doesn’t necessarily work over in yoga therapy. Because in yoga therapy, the way that I see it is we’re helping to resolve issues. So to resolve an issue, meaning we’re helping the client to resolve an issue and we’re looking at it from a movement perspective, we’re resolving a movement pattern.

So we need to address the movement pattern, which is different than providing a modification, because a modification or a workaround isn’t addressing the movement pattern. It’s just helping someone get into a pose in a different way.

So it becomes curious and also very interesting as a process because one would think that it would be simple to be able to learn how to see the movement piece in addition to why you might choose a modification. And the answer is that’s not necessarily the case. There’s a lot of doubt that I think the modification lens has inadvertently cultivated amongst many yoga teachers.

And I think that doubt arises because they see something that’s not quite right, but the student was able to get there. The client was able to get there, was able to get to the final pose, but they see that something’s not quite right. Intuitively they know. Visually they can see, but they can’t name it, in part because the client or the student is not quite aware of what they’re doing because compensatory strategies happen, most of the time, under our level of awareness.

So it becomes difficult as a teacher to be able to describe something they see for which the student is not able to feel, which then becomes difficult. It just becomes a difficult scenario. Not like difficult meaning there’s a relational difficulty. It just becomes difficult to share or teach something that a person isn’t aware of because you can’t really change what you’re not aware of. You can’t see what you’re not aware of. You can’t perceive what you’re not aware of.

So then the yoga teacher starts to doubt what they see because they’re not getting the clarity from the student. They’re not getting that validation. And I use that word loosely because it’s not like they’re seeking validation, but they’re not getting the thought that they’re having validated by feedback from the student. They don’t know how to. And so that circulates in this doubt.

So then the teacher says, well, if I just know more anatomy, then I’ll know what to do. But what they don’t change is this modification piece. So they learn the anatomy, they learn more about the glutes, they learn about the hamstrings, they learn about the core, they learn about the shoulder, and they’re still attempting to try and modify because they aren’t learning how that anatomy, that biomechanics, the kinesiology, how that moves through. How that actually expresses itself through the range of motion, through that trajectory.

They’re still only seeing it at the end range. They’re only seeing it at the end pose. So they’re still missing out on a huge piece of the puzzle, which is a piece that I teach.

It’s interesting because when I’m teaching, especially in the intensive, we get into a piece on the planes of movement. And most teachers have learned about the planes of movement being the sagittal, the transverse, and the frontal planes. But they’ve learned them in a very static way.

If you open up an anatomy book, you’ll see an image of a human being with three planes, one vertical, one like along the X, Y, and Z axis is what I’ll say. And the body is cut into these three axes, X, Y, and Z. And then those planes will be described. So here’s the sagittal plane, it cuts the body left and right. Here is the frontal plane, it cuts the body forward and back. Here’s the transverse plane, it cuts the body top and bottom.

But the problem here is that it doesn’t actually tell you anything about movement. So when we start to use the planes of movement in the therapeutic yoga intensive, eyes start to become really wide. And I’ll say, all right, how are you moving through the sagittal plane? Now we’ve got some action happening. The sagittal plane movement is a vertical plane. It is flexion and extension.

The frontal plane, that one that divides the body front and back, when you move through that plane, in that plane, now you’re moving into abduction and adduction. Arms move wide, think jumping jack, side bending as well. Transverse plane, that was the one that cut top and bottom. But when you move through that plane, you are moving in rotation.

So now you have a biomechanical sight on how a body is moving through these planes. Now you’ve got the ingredients for understanding movement. And does a person, when they move in that plane, is the movement, first of all meant to be in a certain plane? And does the person move in that plane?

So if the arm wants to go up overhead, that’s a sagittal plane movement. As you see the person taking the arm overhead, does the arm actually stay in the plane or not? Is there another plane that gets involved when it doesn’t need to? Is there a deviation in the plane? Is there something else that’s kind of bracing or holding or gripping in order to enable that smooth, fluid motion inside that plane or not?

So do you see here what starts to happen is we start to develop this really global eyesight for the planes and what movement is. Now you begin to see from point A to point B. And you begin to see, oh, there’s the compensatory strategy that led the person to be in that very awkward looking pose.

So where they would have modified at the end, where they might have adjusted at the end through verbal cueing, maybe with a finger or possibly with a hand, although that’s not done so much anymore, now they can catch it earlier. Provide cueing earlier, instruction earlier, help the client tune in earlier.

Now they’re applying that anatomy that they’ve learned in a very functional movement-oriented way. And they’re helping their students to feel and become aware of what they weren’t aware of and what’s likely contributing to the way that they’re feeling. Their client starts to feel better. They feel more coordinated, smoother, less tense. They’re breathing better because they’re bracing less. Their tissue is becoming more responsive and less braced, tense, tight.

The teacher starts to gain more words to describe what’s actually happening. They gain a language and some fluency and they’re able to teach their client that same fluency, but for themselves. So now there becomes this interaction between what they both can objectively see and perceive; are they moving in the plane or not? Is there a deviation or not? Is there gripping or not?

And there’s this amazing and beautiful integration with what the client or student feels, which is 100% subjective. It can only be felt on the inside. But when we combine that amazing subjective experience with the objective binary view of what’s happening, some amazing magic starts to happen. There’s connection, there’s integration, there’s a weaving of proprioceptive and interoceptive wisdom.

And that is where healing really takes off. And that is where as a teacher, your results really take off because you have started to really hone the craft of seeing, of seeing biomechanics in action and of helping your client feel it and perceive it for themselves proprioceptively and interoceptively.

It is fundamentally and profoundly simple. It makes the process of recovery just so much more straightforward. Simple building blocks, simple ways of helping a client connect, simple ways of teaching.

We might not ever really fully know what’s going on inside a body. There’s multiple, multiple, multiple reasons for why a body moves the way that it does. We know that when someone has disc protrusions or stenosis, facet joint deterioration, I mean, just list any condition that’s out there, but how it’s expressed in any given body for any given human is different.

So what’s really available to somebody with a condition is so wide ranging. That is why it’s so vital in our work as yoga therapists, so vital for you as a yoga teacher thinking about becoming a yoga therapist, for you as the PT thinking about integrating more of the yoga voice into your practice. The massage therapist who is wanting to integrate and maybe get off the table with their clientele. It’s so important for you to be able to see. To see objectively biomechanics in action.

I know that sounds like, well, aren’t you saying the same thing twice? Isn’t biomechanics about movement? Yes, I’m just making it for emphasis. And when you’re able to do that well, you enable an opportunity for your client to really feel what’s going on in themselves. And that is the greatest, greatest wisdom that any human being can learn and own for themselves.

If this has resonated with you and you are seeking the next level of training for you as a yoga teacher or a health professional seeking yoga therapy training, it would be an honor to work with you. You can learn more over at functionalsynergy.com/intensive, or you can email us directly at [email protected].

Enjoy the Show?