What is a Yoga Teacher's Scope of Practice?
This blog post was first sent to Jenni’s email list as an email newsletter. Sign up for the JRY email newsletter here!
In the yoga world, we often see yoga teachers wearing many different hats, so to speak. We generally expect yoga teachers to teach some combination of yoga-specific practices such as asana, pranayama, meditation, and/or yoga philosophy. But we also commonly see yoga teachers taking on other roles as well, including addressing their students’ pain and injuries, consulting students on psychological issues such as anxiety, stress, and depression, correcting students’ posture, offering nutritional advice, and more.
Do all of these practices fall within a yoga teacher’s scope of practice, or do only some of them?
My colleague Travis Pollen, PhD and I have been following this conversation for quite some time now. (As a yogi and Rehabilitation Scientist, Travis takes as natural an interest in this topic as I do.)
It turns out that because yoga teaching is a largely unregulated, unlicensed field, what constitutes a yoga teacher’s scope of practice is in some regards relatively open to interpretation. (You’re probably aware of the organization called Yoga Alliance. Yoga Alliance is a non-profit registry system with a global membership, but it is not a governing body that regulates the yoga industry.)
Because of this lack of a single governing authority, questions about a yoga teacher’s scope of practice don’t always have clearly-defined answers. This can be a confusing environment for yoga teachers to operate within, especially those interested in “staying within their lane” in their yoga teaching role.
In order to offer some insight and guidance on this subject, we interviewed a selection of five informed and experienced members of the yoga community:
Shelly Prosko and Celest Pereira are yoga teachers who are also physical therapists, and they bring their perspectives as health professionals to this topic.
Rocky Heron and Trina Altman are long-time yoga teachers with many years of experience training other yoga teachers.
Larry Payne is a pioneer in the field of yoga therapy and founding president of the International Association of Yoga Therapists (IAYT). He studied directly under T.K.V. Desikachar in India, among many other seminal yoga teachers.
As you read through this diverse collection of responses side-by-side, we hope you gain some new insights on this topic, particularly vis-à-vis the ways the responses resemble and differ from one another.
1) What’s your definition of a yoga teacher’s scope of practice?
ROCKY HERON: While there are many nuances and contexts that inform the scope of my practice as a yoga teacher, at its basis I see it as the designing, teaching, and facilitating of sequences and techniques that can promote general health and well-being for my students.
Trina Altman
TRINA ALTMAN: Scope of practice will vary for each yoga teacher depending on their level of education and any other licenses that they might hold. For instance, it will be in the scope of practice for a yoga teacher who is also a physical therapist to provide manual adjustments in a private session. However, it might be out of the scope of practice for a yoga teacher to apply adjustments, even if they learned them in their teacher training, if the state requires that they have a license to touch.
With this in mind, I define scope of practice to be honoring the limitations of the education that you have received, while also respecting state and federal laws around what a yoga teacher is allowed to do within their scope.
LARRY PAYNE: Based on your training, helping people physically, mentally and spiritually that are not in acute physical or emotional pain. The average time with an HMO doctor is about eight minutes. When you see a yoga teacher it is usually for an hour, so people will bond with you and try to get you to fix everything in their life. So you have to set up boundaries.
SHELLY PROSKO: I will try to keep my description of the scope broad to attempt to be inclusive of many paths or types of yoga:
I think a yoga teacher’s scope of practice is to share the principles and practices of yoga with the general population to help promote overall physical, mental, spiritual, and social health and wellness without the intent to act as medical treatment or therapy (physical, psychological, or spiritual). Yoga teachers should not offer medical or therapeutic advice or provide a therapeutic or medical diagnosis. The teacher has a responsibility to refer the student to a licensed healthcare professional for any undiagnosed or unmanaged medical (physical or psychological) conditions or issues. I think it is within scope and responsibility of the yoga teacher to ensure a safe space is created physiologically, psychologically, socially, and spiritually, as they guide students to cultivate awareness, exploration, and self-reflection so students can gain deeper insight into their own experiences during the class and develop discernment that promotes their own safety, health, and wellness. I also think yoga teacher scope of practice could be informed and guided by the yamas and niyamas.
CELEST PEREIRA: A yoga teacher's scope of practice lies within the realm of movement, philosophy, and meditation. However, this definition is often difficult to maintain as the yoga teacher is faced with a complex individual who has multiple issues in their body. Clients often see their yoga teacher more frequently and for longer periods of time than their healthcare provider. As a result, they are extremely valuable in helping to gain deeper insight into each client's range of symptoms, enabling them to refer people to the relevant professional when the person's needs fall outside their scope.
2) Do you feel that the Western yoga world would widely agree with the definition you provided above? Or do you feel that a yoga teacher’s scope is defined differently in different realms?
ROCKY HERON: Generally speaking, yes. I do feel, however, that the Western world often confuses what it means to be a teacher of movement and asana, with being a teacher of yoga, and all of its associated practices and areas of study. Depending on one’s area of expertise and understanding, the scope of practice may change.
Celest Pereira
TRINA ALTMAN: I think that it’s unlikely that the Western yoga world will agree particularly when it comes to scope of practice and adjustments. Adjustments are still taught in many yoga teacher training programs. However, many states have laws requiring that you have a license to touch (e.g., a massage therapy or medical license) to perform any type of adjustment. In those situations, even if you have education around how to perform adjustments and you have the consent of the student, you may still be outside of your scope. With this in mind, I think it’s important to be educated on your state’s specific laws and to understand that not everything we learn about is always within our scope of practice. The same could be true for certain statements surrounding injuries, diagnoses, and mental health.
LARRY PAYNE: I believe any US yoga teacher working in an integrative team would widely agree with what I had to say. But there are always people out there that do things the way they want to, and lawsuits on yoga teachers in the US are on the rise. India is quite different. I know that my teacher, Desikachar, had a yoga therapy clinic that was sponsored by the government of Southern India and would refer any modality including people in acute pain. And there are very few lawsuits on yoga teachers in Southern India. It’s quite different in the USA.
SHELLY PROSKO: I don’t know if the Western yoga world would widely agree with the definition I provided above. A yoga teacher’s scope is going to be different depending on the path of yoga they have been trained in, other education or licenses they may have received, and any specific regulations of their jurisdiction in which they live. But perhaps my attempt at describing a scope was broad enough that it might be able to be applied across several paths.
CELEST PEREIRA: I think one of the overarching issues we face in the movement world is the lack of standardised definitions for this and so many other facets of what we do. We don't have measurable and replicable language to guide our decision-making processes.
3) Are there any practices you see yoga teachers commonly perform that you believe are out of scope? If so, what are these practices?
ROCKY HERON: Yes. I see many teachers offering nutritional and dietary advice to students; diagnosing physical, psychological, or metaphysical injuries and attempting to prescribe practices to treat them; and offering manual adjustments to manipulate students joint positions and ranges of motion, both with and without consent – all of which I believe to be outside of the scope of a yoga teacher’s practice.
As a result, I am often asked by students to offer guidance, diagnosis, treatment, and adjustments, assuming that these are areas in which I must be qualified. Further, I have commonly had students sign up for a teacher training with me expecting that they will be learning how to likewise offer these services. I also often interact with teachers who feel inadequate in their teaching and knowledge because they don’t feel qualified to offer these services that are not within their scope of practice. So I do find it to be important and necessary that teachers, and students, are aware of what they are qualified to offer and expect from a yoga teacher.
TRINA ALTMAN: Oftentimes, our students will ask us questions about how asana, breathing, or meditation practice can help their mental health or a specific injury. As yoga teachers, it is beyond our scope to diagnose or treat mental health disorders or people’s pain. In these situations, it is important for a teacher to refer the student to a medical professional for diagnosis and treatment.
Rocky Heron
SHELLY PROSKO: I believe the practice of language and cueing that offers therapeutic advice is out of scope. Language recommendations and specific advice for certain conditions or issues like: ‘this pose is good for sciatica’; ‘this breath practice will help your anxiety’; ‘this bandha practice will help your incontinence’; ‘this meditation is to help heal your trauma’; or ‘this alignment stabilizes your joint instability’ and ‘this alignment is bad for your osteoarthritis’ are claims that (1) aren’t true or validated for everyone and (2) imply the teacher has a level of expertise that they may not have training in. And even if they did, the teacher would still need to assess each individual student and explore to see if the practice would be indicated for that particular person and their issue or condition.
The practice of hands-on ‘adjustments’ I think are also out of scope unless the teacher has training from another certified or regulated profession that includes touching or hands on practices as part of its scope of practice. I don’t think this means, though, that the teacher is absolutely prohibited from touching all students in all cases, and deserves a more nuanced discussion around consent, intent, and common sense.
CELEST PEREIRA: The most common and harmful habit is when yoga teachers diagnose students based off of a superficial set of symptoms. Sometimes labels such as "family trauma" or "passed life karma" are brought into the conversation. Whilst I realise science is unable to disprove these concepts, a label can and often does shape a person's actions significantly.
I think the impact of our words is often not fully understood. Of course, even highly trained medical professionals misdiagnose, but what these practitioners are relying on is experience in clinical reasoning and critical thinking to make their conclusions. These are skills that are often not championed in the yoga world currently.
4) Have you always held your current view on a yoga teacher’s scope, or has your view changed over time? If it has changed over time, how?
ROCKY HERON: No. Because this was not a topic I was explicitly taught in the beginning of my teaching, I assumed that what I saw other more experienced teachers doing was not only within the scope of my practice, but also expected to be a part of my offering as a teacher. I spent many years attempting to learn as much as I could in the above areas so that I could be the teacher / body wizard / nutritionist / therapist / spiritual master I thought I was expected to be.
There were several moments throughout my teaching that awakened me to the error of my assumptions, and I have found it to be quite liberating to refocus and boundary what I offer within its appropriate scope. Further, if my goal is to actually be of value to my students, referring them to the appropriate places where they can receive care and guidance by experts that are qualified in these areas is far more effective than me pretending to be one.
TRINA ALTMAN: As a beginner teacher, I thought that there were more simplistic solutions for what students described as tightness or pain. However, as I learned more, I realized how complicated these things were and that I didn’t know enough to comment. Now, I believe that my students are best served if I refer them to someone with more education than me who is more qualified to help them.
Today, I work with students who sometimes have pain. However, they are seeing me in addition to a physical therapist or they have completed physical therapy. I am teaching them movement, which may help them feel better as a byproduct. However, I am not diagnosing or treating a specific condition or promising a specific outcome.
LARRY PAYNE: Yes, it has changed over time. In the early days, going back 40 years ago, touching was much more acceptable and was actually expected from my students. However, in India with the exception of the Iyengar system, touching or hands on was not encouraged. I remember in the early on with Desikachar there was a group of us meeting with him in India that were the original charter members of Viniyoga America. He said, “There is no reason to ever touch a student. Just give me one reason?” I said, “Sir, I am from California. Some people just like to be touched.” He got very upset with me and one of the middle-aged women in the group said, “By a virile young man?“ It was an awkward moment I will never forget.
Then when I became a certified yoga therapist and worked with people that had conditions that would not normally fit in a regular yoga class, I had to learn more about the principles of practice that are stated and sometimes updated at the IAYT website.
Shelly Prosko
SHELLY PROSKO: I was a yoga teacher before I was a physiotherapist. I hadn’t learned or been informed about scope of practice nor even heard of the term prior to being a physiotherapist; so I hadn’t thought of it for yoga teachers and never held a view of a yoga teacher’s scope of practice until I was familiar with the term, after being a PT. Yes, it’s evolved a bit over time. I used to think yoga teachers were more just like fitness instructors and only had to be concerned about the physical domain, but now acknowledge the wider scope of all domains. I also used to think that safety in yoga classes could only be obtained by yoga teachers telling people specifically what to do and not to do, but now I understand it differently.
CELEST PEREIRA: It has expanded dramatically. Whilst I still feel that yoga teachers are primarily movement specialists, their deep connection to their students gives them a crucial role in the well-being of their community. As I mentioned above, students spend more time with their yoga teachers than their healthcare providers. If I had a magic wand, I'd incorporate yoga teachers into the multidisciplinary team, where they can learn about what action each diagnosis requires, empowering them with the tools to support their students' recovery processes.
5) Is there a difference in scope between a yoga teacher and a yoga therapist? If so, how do they differ?
ROCKY HERON: Somewhat. I am clear that the same areas that are beyond the scope of a yoga teacher’s practice also apply to that of a yoga therapist. They cannot diagnose, prescribe, manually adjust, or change their clients’ diet or lifestyle. Due to the additional hours of training and potential clinical experience, however, I believe a yoga therapist is more qualified to work with individuals one-on-one who may have more specific ailments, needs, disabilities, etc. that can be addressed through yoga techniques. A yoga therapist inevitably has more specified training that can qualify them to develop therapeutic plans that are informed by a deeper understanding of human physiology and psychology.
LARRY PAYNE: Yes, a yoga therapist works with people that for whatever reason, physically, mentally or emotionally don’t fit in a group class. Our Yoga Therapy Rx program at Loyola Marymount University in Los Angeles has now graduated close to 1,000 yoga therapists over a period of 17 years. One key issue though for yoga teachers or yoga therapists is that “we do not work with people in acute pain.” I have had many people call me and say, “Hi, Dr. Larry. I am crawling around on the floor in acute pain. I cannot wait to see you.” To which I say, “Don’t see me… First see your chiropractor or physical therapist until you are out of acute pain, and then I will see you.” If they ask, I will also refer them to a HP that I trust.
Trina Altman
SHELLY PROSKO: Like yoga, yoga therapy promotes and empowers people to progress towards improved health and wellness and does not treat diagnoses. However, yoga therapy is more contextual as it equips the yoga therapist to provide professional guidance and support to an individual to help them learn how to live their life with their specific issue or condition.
It is within a yoga therapist’s scope of practice to assess each individual using a whole-person, biopsychosocial-spiritual assessment, based on the pancha maya kosha model of health. Then, to be able to individualize and plan a program where yoga principles and practices are implemented that address the client’s valued needs and goals, which are co-created during the assessment process, and may continue to evolve during the therapeutic process. The yoga therapist is trained to practice within their scope and is required to take responsibility to refer to a licensed healthcare professional as needed.
6) What are the risks for yoga teachers and/or yoga students of operating outside scope of practice?
ROCKY HERON: Physical and/or psychological harm, misunderstanding and misinformation, legal consequences, and prolonging the process of the student finding qualified care and guidance surrounding their needs.
TRINA ALTMAN: There can be both physical and emotional ramifications if a teacher operates outside of their scope and it goes poorly. There can also be legal consequences on the state level, but this will depend on the state that you live in.
Celest Pereira
LARRY PAYNE: In the US there are definitely legal issues.
SHELLY PROSKO: It might lead to unintended injury or harm physically, psychologically, emotionally, and/or spiritually. I think some of the harm could be subtle and could go relatively unnoticed for periods of time, leading to more prominent problems later on. Keep in mind, harm may also be elicited by sending implicit or explicit messages to students that they are fragile or can only trust the teacher’s instructions, which may perpetuate experiences like pain or may be limiting their potential to build resilience, self-worth, self-efficacy, or self-confidence. If we are not honouring yoga principles of non-harming or truthfulness, I believe we are not acting within scope of practice.
I also think there is a possibility of discrediting the value and potential contributions of yoga and yoga professionals. As with any profession, if we are commonly breaching our scope, not only could we potentially be bringing harm to our communities, but it may also create a sense of disrespect and distrust towards yoga and yoga teachers among other professionals and the public. We are trying to build bridges, work together interprofessionally, and integrate yoga into health, wellness, and rehab care. It is important to acknowledge and respect scope and learn how we complement one another’s professions and where we share commonalities including shared missions and visions.
CELEST PEREIRA: Delaying the student’s ability to access real medical care can lead to serious ramifications for the person in question. That is why it is so important that we learn to refer our students to the appropriate healthcare provider. I've been a qualified physio since 2009, and I still refer my students to practitioners with more experience.
7) What are some strategies yoga teachers can adopt when a student's needs fall outside their scope?
ROCKY HERON: Inform them of any misunderstandings they may have surrounding your scope of practice, offer compassion, and, if appropriate, refer them to a professional whose scope of practice qualifies them to address the needs of the student.
TRINA ALTMAN: You can tell the student that what they need is outside of your scope of practice, but you can refer them to the appropriate medical provider.
LARRY PAYNE: It helps to have a referral system. When people come to me for private sessions or yoga therapy, they fill out a form. One of the questions is, “Who are the health professionals in this town that have helped you the most?” I make an effort to reach out to the health professionals that are often mentioned and make a connection. This often leads to cross referrals. One category of health professionals that is often neglected is a physiatrist or doctor of physical medicine. In many cases, they can approve yoga in their office depending on the state, approved by many insurance companies.
SHELLY PROSKO:
Create and hold a safe space to first listen to their needs. You will be better able to navigate next steps to take if you take a bit of time to listen.
Recommend the student see a relevant licensed healthcare professional. First ask if the student has their own preference. (If so, refer them to their own physician, spiritual counsellor, psychologist, etc., that they already have in place.) If the person doesn’t have anyone in mind, have a list of contact information to different healthcare professionals in your community that you can refer students to: social workers, physical therapists, occupational therapists, clinical psychologists, psychotherapists, dieticians, etc. If you have a list of licensed healthcare professionals who also serve as yoga professionals, this can be an added bonus for the individual interested in yoga.
Shelly Prosko
Recommend a yoga therapist. Keep in mind that yoga therapy is not a regulated or licensed healthcare profession. However, it is within a yoga therapist’s scope of practice to assess each individual and then apply yoga principles and practices that will suit their valued needs. This may be particularly helpful, as it can help the student who is already interested in yoga (because they are coming to your class) learn more about how they can use yoga in their life to help manage their specific issue or condition. The yoga therapist is trained to practice within their scope and takes responsibility to refer to a licensed healthcare professional as needed.
Be mindful, but not fearful. Most scenarios are not life-threatening. Be aware and educated about red flags or medical emergencies where students should be immediately referred to a medical professional before they return to your class. But the majority of the time, there is a lot you can do as a yoga teacher to help people adapt their yoga practice and navigate any complaints they may have during practice, alongside any therapy or medical treatment they may be exploring or receiving or that you may suggest. For example, if a student comes to you after class asking about pain they’re experiencing in the sole of their foot during standing poses, or hip pain during asymmetrical poses and one-leg standing poses, or anxiety with a certain breath practice, it is not within scope for a yoga teacher to say what you think their problem is. But there is a lot you can do as a yoga teacher to cue and guide them to explore ways they might be able to influence their anxiety or pain experience during yoga practice. The type of language used and guidance you offer can safely cue the person to enhance awareness, explore modifications, discern how much to modify, and promote safety through autonomy rather than providing external rules that are beyond scope.
Cultivating relationships with a variety of professionals in your community can be a great way to network, gain awareness and respect of yoga and your services, and cross-refer students or clients. Professionals will learn more about what you offer as a yoga teacher and will feel more comfortable recommending yoga to their patients and clients. You can learn more about what they offer and what their passions and expertise may be and better understand when a referral is indicated. It’s a beautiful way to build relationships and better serve the community.
CELEST PEREIRA: REFERRAL! Beyond that, I encourage all yoga teachers to develop a relationship with their local medical care workers so that they can gain deeper insights into the complexities of the human body. The old phrase "the more you learn, the more you realise you know nothing," is actually a deeply humbling place from which to serve people. But the ability to learn more also empowers people to spot red flags early, support the rehabilitation process, and adapt teaching styles to suit the unique needs of each individual.
Related: Yoga Meets Movement Science podcast episode: What is a Yoga Teacher’s Scope of Practice?
If you’re interested in exploring the perspectives and work of any of the yoga teachers featured here further, you can learn more from them here:
Trina Altman – Website / Instagram / Facebook
Rocky Heron – Website / Instagram
Larry Payne – Loyola Marymount University / Website (Samata International)
Celest Pereira – Website / Instagram
Shelly Prosko – Website
You Might Also Like…
