When you think of the physical shape of Downward Facing Dog, what comes to mind? Do you think of a long upside-down V with the heels touching the ground and knees straight? That might be the way the shape looks on some people, but for many folks, downward dog can take many different forms - all of which are still accomplishing the same energetic purpose of this inversion posture.
Using the language customizing instead of modifying might help some patients realize they are not “doing less” by not being able to comfortably attain the physical shape of what they think they should be able to do. In fact, it is an opportunity to be rewarded for listening to one’s inner wisdom about how the body wants to move in that particular moment. We are not robots, and our bodies’ energy and pliability can change greatly during the day and from week to week, especially for people experiencing hormonally influenced persistent pain.
From a clinical perspective, customization emphasizes patient empowerment. For example, patients with pelvic pain often present with increased muscle guarding in the pelvic floor, hips, or abdominals. Asking them to force their heels to the floor or straighten their knees in Downward Facing Dog can increase tension and exacerbate symptoms. Instead, inviting them to bend their knees, widen their stance, or elevate their hands on blocks or a chair creates a version of the pose that is supportive and therapeutic. This allows patients to access the benefits of the posture - inversion, elongation, breath awareness—without reinforcing pain patterns.
This shift in perspective also serves the nervous system. Persistent pelvic pain frequently involves central sensitization and heightened protective responses. When patients hear that creating the shape of a posture that serves them is not only allowed but encouraged, the perceived threat decreases, and there may be less fear-avoidance. Clinicians can use language such as, “Notice how your body feels with the knees bent,” or “Try widening your stance and see there is less neural tension.” These cues guide patients toward building interoceptive awareness, giving them tools for self-regulation that extend beyond the clinic.
Customization also highlights the principle that yoga is not one-size-fits-all. Each patient comes with a unique history - postpartum recovery, endometriosis, hip impingement, abdominal surgery, hypermobility, etc. The physical shape of a posture that is accessible for one person may be provocative for another. By offering variations and inviting exploration, clinicians can encourage self-efficacy and reduce fear-avoidance behaviors. This builds confidence in movement and often translates into improved participation in daily activities outside of therapy.
For rehab professionals, integrating yoga in this way reinforces biopsychosocial care. By blending mindful movement with therapeutic exercise, you can help patients reframe movement as safe, adaptable, and nourishing. Consider weaving in reflective questions during sessions: “How do you know this version feels better for you?” or “What would make this position feel even more supported?” These simple prompts deepen the patient’s awareness and reinforce the therapeutic alliance.
Ultimately, customizing yoga postures is not about diluting the practice but about making it clinically relevant. When patients learn that the value of a pose lies not in how closely it matches a picture in a yoga text but in how it supports their body and nervous system in that moment, the practice becomes inclusive and sustainable. For people with pelvic pain, this can be a turning point: shifting from frustration with limitations to curiosity, agency, and resilience in movement.
Clinician Takeaways: Customizing Yoga for Pelvic Pain
- Use empowering language: Swap out “modification” for “customization” to reduce stigma and emphasize patient agency.
- Prioritize nervous system safety: Encourage patients to notice what feels supportive rather than pushing into shapes that increase tension or pain.
- Offer accessible variations: For Downward Dog, consider bent knees, wide stance, hands on blocks, or using a wall/chair.
- Cue interoception: Ask reflective questions like, “What do you notice in your body?” or “Can you breathe with more ease here?”
- Honor individuality: Recognize that each patient’s pelvic health journey is unique; customize postures according to surgical history, musculoskeletal patterns, and pain triggers.
- Blend yoga with rehab principles: Use posture customization to reinforce body awareness, reduce fear-avoidance, and build resilience in movement.
Want to deepen your understanding of how yoga can support patients with pelvic pain? Join Yoga for Pelvic Pain with Dustienne Miller, PT, MS, WCS, CYT on September 13–14, 2025. This remote course offers practical, evidence-informed strategies to integrate yoga into pelvic health care. Register here.
AUTHOR BIO
Dustienne Miller MSPT, WCS, CYT
Dustienne Miller MSPT, WCS, CYT (she/her) is the creator of the two-day course, Yoga for Pelvic Pain, and an instructor for Pelvic Function Level 1. Born out of an interest in creating yoga home programs for her patients, she developed a pelvic health yoga video series called Your Pace Yoga in 2012. She is a contributing author in two books about the integration of pelvic health and yoga, Yoga Mama: The Practitioner’s Guide to Prenatal Yoga (Shambhala Publications, 2016) and Healing in Urology (World Scientific). Prior conference and workshop engagements include APTA's CSM, International Pelvic Pain Society, Woman on Fire, Wound Ostomy and Continence Society, and the American Academy of Physical Medicine and Rehabilitation Annual Assembly.
Her clinical practice, Flourish Physical Therapy, is located in Boston's Back Bay. She is a board-certified women's health clinical specialist recognized by the American Board of Physical Therapy Specialties. Dustienne weaves yoga, mindfulness, and breathwork into her clinical practice, having received her yoga teacher certification through the Kripalu Center for Yoga and Health in 2005.
Dustienne's love of movement carried over into her physical therapy and yoga practice, stemming from her previous career as a professional dancer. She danced professionally in New York City for several years, most notably with the national tour of Fosse. She bridged her dance and physical therapy backgrounds, working for Physioarts, who contracted her to work backstage at various Broadway shows and for Radio City Christmas Spectacular. She is currently an assistant professor of jazz dance at Boston Conservatory at Berklee.
Dustienne passionately believes in the integration of physical therapy and yoga within a holistic model of care. Her course aims to provide therapists and patients with an additional resource centered on supporting the nervous system and enhancing patient self-efficacy.