Yoga for Chronic Illness & Pelvic Health
By Sasha Sigel
For yoga teachers rethinking their approach—or students navigating illness, injury, or recovery—this post shares how my practice of asana evolved through injury, chronic pain, and learning the hard way.
When I finished my 200-hour Yoga Teacher Training in 2017, I could do a lot of fancy asana (postures) and show others how to do them. I could teach five classes a day and bicycle between studios. I demonstrated asana that required immense flexibility and strength without warming up. And it cost me dearly.
The Hidden Costs of “Performing” Yoga
The West’s appropriation of yoga focuses on asana, and pushing our bodies into specific shapes, and often stems from a culture of hierarchy and abuse. As students and teachers, we need to deeply investigate ableist beliefs and practices we’ve been taught.
For a stomach-churning expose into Ashtanga yoga's history of abuse and cultish dynamics, read Surviving Modern Yoga. While my personal experience never got to the level described in the book, subtle elements were replicated in my training—and leaked into the classes I taught myself.
Yoga teachers have the opportunity to change the current culture and create the conditions for growth and connection. It starts with examining our own conditioning. We know that yoga is much more than asana, but this post will focus on that limb specifically.
The Injury That Changed My Teaching
I can still remember going into a demonstration of Eka Pada Rajakapotasana I (mermaid pose) and feeling a ripple of “pops” go from my glutes to my low back. Gingerly coming out of the pose, I didn’t immediately feel pain, but I did think…
“Uh oh.”
A few days later, I could barely walk. Sitting upright was so painful, I found myself crying on the subway. After frantically subbing out my classes, I made an appointment with a PT and started my recovery.
Over time, my quadratus lumborum (QL), piriformis, and glutes began to heal. But truthfully, they’ve never been the same—I get pain flares exacerbated by common asana, particularly with external hip rotation.
Injury and Illness as a Teacher
During that recovery, I began to consider the yoga studio norms that (partially) led to my injury. In the years to come, I would contend with more injuries (like spraining both elbows at the same time– yikes) and chronic illness (like endometriosis, migraine, recurrent staph infections, and OCD). How could I adapt my classes to meet my own body’s needs, and to become more skillful in supporting my students?
While I would never choose to repeat those injuries or sign up for these illnesses, my practice and teaching of asana have deepened because of them.
Questions I Ask Myself Now: Who, Why, and How
1. Who is in the room?
Thankfully, I almost always work in private sessions or teach small groups—I prefer a maximum of 8 students for in-person classes. I love working with students and clients over a span of several years, so I get to know their bodies, injuries, and illnesses quite well.
Based on this, I tailor both what we do and how we do it. For example:
Does someone with hypermobility really need an extended hold in Paschimottanasana (seated forward fold)?
Probably not.
I might skip this pose or offer specific cues:
Placing a rolled blanket under the knees to prevent hyperextension
Keep an active flex of the feet
Private clients and small group classes aren’t always possible for teachers—especially when starting out. But we can still hold these adaptive practices in mind for larger group classes.
2. Why are we doing this asana?
Let’s get specific about the purpose of this asana. Maybe we’re doing it for a physical benefit—creating circulation in the pelvis, or strengthening the ankles and feet. Maybe we’re building awareness of our own patterns—how we enter and exit a pose, or noticing the inner monologue during balancing poses. Figure out the why.
Once there’s an intention, we can get creative with sequencing.
Let’s say a student wants to focus on stability and balance—both physically and mentally.
One option could be Vrksasana (tree pose.) We can build strength in the feet and ankles, practice drishti (gazing at a focal point,) and find continuous breath during a challenging physical experience.
What if the student uses a wheelchair or needs to be seated for this practice of stability and balance?
We could place a foam block on the student’s flattened palm, and have them slowly move the block up and down, and side to side. The drishti and breath practices still apply.
We’re still working with the same intention, but we’ve found a practice to better serve our purpose.
Note: This is not about deeming poses “good” or “bad.” It’s about fully assessing purpose, benefits, and contradictions—for each person.
3. How can I lead by example?
Over time, I’ve been able to let go of what a yoga teacher “should” be able to do, and focus on showing up with authenticity and honesty. It can feel vulnerable to say:
“I won’t join you in this asana because I’m having a pain flare today.”
“I’ll be keeping my knee quite bent because I tend to overstretch my hamstrings.”
But that vulnerability can be powerful for students to witness. We don’t often see yoga teachers taking care of their own body in a group setting. It models this as a real practice– right here and now. By listening and responding to our bodies, we help create a culture where that is the norm.
Other Tools I Use as a Teacher
Our bodies are not our only teaching tools! Especially with online classes, we have more access to teaching tools than ever before.
Images, videos, and powerpoints
I use photos or videos with varied body types, genders, and ethnicities demonstrating multiple ways to approach a pose, rather than only showing the way my body works.
Powerpoints can be a great visual aid for understanding information.
Note: I avoid using photos of thin white women with extreme flexibility– that’s not the standard I want to set
Anatomy and biomechanics education
Do students know what “adduction” means or where their “triceps” are located? Anatomy and biomechanics (the mechanics of movement) can empower people to more intimately understand their bodies.
Over time, body literacy can help students find adjustments on their own. It can encourage safer, more purposeful movement.
Group discussion and journaling
We can create time for students to process and making meaning out of their experiences individually and within community.
Rather than implying that we simply “feel good” after yoga, we can make space for a whole range of experiences to learn from.
My Practice Today
Gone are my days of teaching Power Hour and fitness-style classes (eye roll at myself)—and I don’t miss it at all.
Today, my teaching focuses on:
Trauma recovery
Chronic illness support
Pelvic health
For example, I run a 6-month Endometriosis Yoga Circle, teach 5-week series like Yoga for Pelvic Pain, and work 1:1 with clients with chronic illnesses like EDS (Ehlers-Danlos Syndrome,) POTS, and scoliosis.
I find so much meaning in working slowly, creatively, and intentionally. I love learning and sharing about the myriad ways yoga can support us through all chapters of life– including injury and illness.