Ep 72: When to Refer Out: Recognizing the Limits of Your Scope

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One of the most critical, yet often overlooked skills for yoga teachers is knowing when a student's needs exceed our expertise. While yoga can be therapeutic, it is not a substitute for medical or rehabilitative care. Pushing beyond the boundaries of your scope can delay healing or even worsen injuries. In this episode, we'll chat about how to identify. When you should refer a student to a healthcare professional. Get your journals and let's get started. Welcome to the Essential Conversations for Yoga Teachers Podcast with me. I'm Monica Bright and I've been teaching yoga and running my yoga business for over a decade. This is the podcast for you. If you are a yoga teacher, you're looking for support. You love to be in conversation, and you're a lifelong student. In this podcast, I'll share with you. My life as a yoga teacher, the lessons I've learned, my process for building my business and helpful ideas, tools, strategies and systems I use and you can use so that your business thrives. We'll cover a diverse range of topics that will help you, whether you're just starting out or you've got years under your belt and you wanna dive deep and set yourself up for success. I am so glad you're here. Listen, I don't take myself too seriously, so expect to hear some laughs along the way. Now let's do this together. Welcome back to the podcast. I'm Monica, and I am so glad to have you in on these conversations I've published quite a few episodes on pain injuries. The nervous system and how you might go about feeling more comfortable teaching students with injuries. Scroll back and have a look at the episodes so far. I guarantee you there will be plenty of topics that will grab your attention and as you listen, you'll start putting the puzzle pieces together and you'll realize that all of these conversations go hand in hand with one another. While we talk about all of these topics and integrate the knowledge into your teaching, you get to a point where it still begs the question, when and how do I refer out? I mean, you could just say, go to a doctor or a physical therapist and get a diagnosis, or you could come to this conversation with your students with a more layered approach, which still positions you as the expert yoga teacher. So let's get into it. First, what are the signs that a student needs a referral? Here are three things that you could look for. The first is red flags in movement. Is your student experiencing sharp shooting or electrical type pain, especially radiating down their limbs? This is possible nerve compression Like sciatica and it needs to be diagnosed by a doctor. Next is joint instability. Are any of your students experiencing shoulder subluxations or buckling in their knee joint? This might indicate ligament laxity or tendon tears. And finally, are any students having persistent inflammation? For instance, is there any swelling or lingering pain? 24 hours plus after practice. This could be an indication of tendinosis or autoimmune flareups. The next indicator that tells you you should refer out is if a student is having pain that doesn't fit the usual pattern. Are they having pain when they're at rest or even at night, for example, are they having shoulder pain while they're sleeping? This is common in rotator cuff and bicep tendon tears, frozen shoulder. Bursitis or arthritis. Ask them if they have pain that worsens with basic movements. Simply walking aggravates their hip pain. They may need imaging to look for a possible labral tear or stress fracture. I. And finally be aware of any medical history warnings. Have they had any recent surgeries? You should know if they've had any joint replacements or spinal fusions, and know that after surgery they should have a clearance from a physical therapist or a surgeon to practice. If not, you should tell them that they need to go get clearance. Do they have any current diagnosed conditions like osteoporosis, herniated discs, LERs, Danlos syndrome? Knowing this will help you help them in your classes. They might also need tailored practices via private sessions with you. Are there any students with neurological symptoms? Numbness, tingling, loss of balance. If you know this, you're less likely to teach balance poses and say, just keep practicing and you'll get it eventually. Honestly, we need to stop saying that because that's not always true, and it can lead to students feeling less than because they just can't seem to get it. So let's talk about some common yoga scenarios requiring a referral. The first is chronic shoulder or elbow pain in Chaturanga. If you've already tried modifying alignment, either elbows hugged in, or allowing them to flare out a little bit. Hands placed differently and progressive alternatives have already been practiced, like knees down, holding plank to build strength or lowering to the belly slowly. If these options aren't helpful or pain continues to persist beyond class, They likely need a referral. Likely issues include rotator cuff tear impingement, or maybe even tennis elbow. If your student has persistent low grade pain or pain that radiates to the buttock leg or forward folds, consistently aggravated, then they need to go see someone. These issues could include disc herniation, SI joint dysfunction, or facet joint irritation. Do you teach lunges or lotus pose? And do your students have knee pain in these poses? Full transparency here. I don't teach Lotus pose anymore. It requires too much hip and knee joint rotation, and most students either don't have it or they're forcing themselves. Into these shapes if their pain is deep in the joint, not muscular and accompanied by clicking or swelling. Not all clicking is bad, but when it also involves pain and swelling, it is a problem. This could be a meniscus tear, patella tracking disorder, or arthritis. A gait analysis might be extremely helpful for understanding if everyday movements are also contributing to their pain. what if a student has dizziness or blackout, say in inversion? If it happens repeatedly, even with proper hydration, alignment and class pacing, it could be a problem of blood pressure dysregulation or vestibular dysfunction. They should see a cardiologist or a neurologist and talk with them about what they're experiencing. So how do you refer out without overstepping boundaries? Here's some examples of what to say and what not to say. You could say what you're describing sounds beyond my scope. Have you seen your doctor or physical therapist? Or you could say, I know a great physical therapist who specializes in, say, for example, shoulders, Would you like their information? Resist saying, I think you have a torn rotator cuff as diagnosing is outside our role. Or just do these stretches and you'll be fine. You could be dismissing serious symptoms. You could suggest a few things that it sounds like to you. For example, I've had torn rotator cuff and frozen shoulder. I personally know the difference in pain, sensation and location and how movement limitations may appear in the body. So I might suggest that they ask their doctor about these specific conditions. My goal is not to diagnose, but to educate them and help them have really good conversations with their medical professionals, like a back and forth conversation. Instead of only receiving information, it actually gives them more power when it comes to these conversations and the treatment plan they're going to receive from their doctors. I suggest that you build a referral network, connect with physical therapists, chiropractors, if you like chiropractors or they want a chiropractor and sports medicine doctors in your area have a list of trauma-informed practitioners for students with PTSD or chronic pain Because having this network helps you help your students if they don't know who to go see. You could suggest people that you've worked with in the past and that you trust Now, what can you do? While they're seeking care? You could offer gentle movement options. For example, chair yoga, breath work practices, or even restorative classes Suggest that they see you for private classes as opposed to group yoga classes. This way you can support their needs and work with their healthcare provider in their recovery. I can't stress how important this is and how helpful it is for students with. Injuries to continue to practice, but make it tailored to their needs. You should also avoid loading the affected area, skip weightbearing poses for acute injuries, and find a starting point that students can handle and work from there. I always encourage pain journaling. Tracking what aggravates or eases symptoms will help you and your students realize what helps and what doesn't. In this journaling, I ask them to include as much information as possible. For example, how are you sleeping? What are you eating? What's your activity level on a specific day, what's their movement been like So that they can begin to see a trend. For example, I didn't sleep well last night and my pain symptoms are heightened today looking for clues in their journaling. It's so helpful and it gets the information out of their head and onto paper so they can see it. Let me end with this reminder. Referring is responsible. Teaching a referral isn't a failure. It's ethical practice, but you were never taught how to do this. Neither was I, but I've learned how, and I want that for you too. The best yoga teachers know their limits and prioritize student safety over retaining clients and trying to fill group classes. Understanding anatomy and how it might change the way you teach might feel overwhelming at the start, but there are ways to make understanding it a little less complex. I teach anatomy as it relates to teaching yoga, so you aren't learning random bones and muscles, but understanding how these parts of the body are incorporated into the yoga practice. I believe with all my heart that yoga teachers are movement educators, and we must understand the human body and its movements in order to be effective in our teaching. It is so important for us to have this conversation and sometimes teaching can feel lonely, which is another reason why I started this podcast. So you have a place to go to ask questions and get answers if you haven't already. Download the ebook sequencing for different injuries. The link is in the show notes below. I promise you, it will help you form a foundation for teaching students with injuries and aging bodies. The information will also help you understand how to accommodate students of different abilities, and it'll be a great resource for you to return to again and again. When you download the ebook, you'll be joining my newsletter. That's just for yoga teachers. I've got more exciting teachings coming soon, so I wanna tell you all about them. The link is in the show notes below, and I would love for you to join it so we could always stay connected. If you love this episode, let me know. I've added a link in the show notes for you to send me a quick text message about your thoughts on this episode. I won't know your phone number. It's just a neat addition to the platform I use that allows for this new and super easy way for you to communicate with me. Once you click on it, it'll take you to your messages, but don't delete the code. That's how your message will get to me, and I would love to know your thoughts. Subscribe to the podcast so you're always in the know when a new episode drops and share it with another yoga teacher. Who you think would love to be in on these conversations. Thank you for helping to spread the word about this podcast and if you've been taking notes in your journal as you listen to these episodes, I'm so glad you are and I would love to hear about it. Alright, that's it for now. Bye.