Essential Prayer Guidelines for the Sick in Islam

Excerpted from the book “Bīmār kī Namāz” by Umm 'Abd Munīb

✦ Inability to Stand in Prayer​

Narrated by ʿImrān bin Ḥuṣayn رضي الله عنه:


صَلِّ قَائِمًا فَإِنْ لَمْ تَسْتَطِعْ فَقَاعِدًا، فَإِنْ لَمْ تَسْتَطِعْ فَعَلَى جَنْبٍ
“Pray while standing; if you are unable, then sitting; if you are still unable, then on your side.”

Reference: Bukhārī, Kitāb al-Ṣalāh: 7; Abū Dāwūd: 952; al-Tirmidhī; al-Nasāʾī; Ibn Mājah: 1223; Musnad Aḥmad: 4/426

This shows that if one is unable to stand, then performing the prayer while sitting is permissible.

✦ Method of Sitting While Praying​

• Sit as one does during tashahhud.
• Say the opening takbīr (Takbīr al-Taḥrīmah), raise the hands to the ears, then fold them over the chest.
• Place the hands on the floor, perform sajdah (prostration), then jalsah, then sajdah again, and complete the prayer.
• If the patient is unable to sit in the tashahhud position, then they may sit in any way comfortable.
  
  Reference: Fiqh ʿala al-Madhāhib al-Arbaʿah

✦ Reciting While Partly Sitting and Partly Standing​

Narrated by Mother of the Believers ʿĀ’ishah رضي الله عنها:


The Prophet ﷺ never prayed the night prayer (Tahajjud) sitting until he became old. Then he would recite sitting, and when he intended to bow, he would stand and recite 30–40 verses, then perform rukūʿ.

Reference: Bukhārī, Kitāb al-Ṣalāh: 118; Muslim: 1702; Abū Dāwūd: 1954; al-Tirmidhī: 374; al-Nasāʾī: 1647

This proves that a weak or elderly person who cannot remain standing for the entire prayer may perform part of it while sitting.

• Standing (Qiyām) is obligatory; therefore, one should try to stand as much as possible.
• If support is needed to stand, it should be used.
  
  Reference: Fatāwā Barā'e Khawātīn Islām, p. 22

Narrated:


When the Messenger of Allah ﷺ became old, he would lean on a pillar while performing night prayer.

Reference: Abū Dāwūd: 938; al-Silsilah al-Aḥādīth al-Ṣaḥīḥah: 319

Statement of Ḥasan al-Baṣrī:
A sick person may pray two rakʿāt sitting and two standing.

Reference: Bukhārī, Adab Bāb, as cited: 1118

✦ Reward of Praying While Sitting​

Narrated by ʿImrān bin Ḥuṣayn رضي الله عنه:


مَنْ صَلَّى قَائِمًا فَهُوَ أَفْضَلُ، وَمَنْ صَلَّى قَاعِدًا فَلَهُ نِصْفُ أَجْرِ الْقَائِمِ، وَمَنْ صَلَّى نَائِمًا فَلَهُ نِصْفُ أَجْرِ الْقَاعِدِ
“Whoever prays standing gets full reward, and whoever prays sitting gets half the reward of one standing. And the one who prays lying down gets half the reward of the one who sits.”

Reference: Bukhārī, Kitāb al-Ṣalāh: 1916; Abū Dāwūd: 951; Ibn Mājah: 1231; Musnad Aḥmad: 4/426

This indicates that while it is permissible for a sick person to pray in any way possible, the reward decreases with less physical effort. However, Allah is All-Knowing and Forgiving regarding genuine excuses.

✦ The Prophet ﷺ Praying Sitting Due to Illness​

Narrated by ʿĀ’ishah رضي الله عنها:


The Prophet ﷺ was ill and led the prayer while sitting. Some people prayed behind him standing, so he gestured to them to sit down. After the prayer, he said:
إِنَّمَا جُعِلَ الإِمَامُ لِيُؤْتَمَّ بِهِ، فَإِذَا رَكَعَ فَارْكَعُوا، وَإِذَا رَفَعَ فَارْفَعُوا
“The Imām is appointed to be followed. When he bows, you should bow, and when he rises, you should rise.”

Reference: Bukhārī, Kitāb al-Ṣalāh: 1113

Also narrated:


The Prophet ﷺ used to pray standing for a long time, then would sit for much of the night. If he stood, he would bow from standing; and if he sat, he would bow from sitting.

Reference: Abū Dāwūd: 955; Muslim: 730; Ibn Mājah: 1328

✦ If Unable to Perform Rukūʿ (Bowing)​

If someone can stand and perform sajdah but cannot bow, they should:

• Stand fully during qiyām.
• Indicate bowing with as much bending as possible.
• Then proceed to sajdah.

✦ If Unable to Perform Sajdah (Prostration)​

The Prophet ﷺ saw a sick person placing a pillow in front of him to prostrate upon. He ﷺ threw it away. Then the man used a wooden board; the Prophet ﷺ removed that too and said:


صَلِّ عَلَى الْأَرْضِ إِنِ اسْتَطَعْتَ، وَإِلَّا فَأَوْمِئْ إِلَى الْأَرْضِ، وَاجْعَلْ سُجُودَكَ أَخْفَضَ مِنْ رُكُوعِكَ
“If you can, then pray on the ground. Otherwise, indicate (gesturally) towards it, and let your prostration be lower than your bowing.”

Reference: al-Silsilah al-Aḥādīth al-Ṣaḥīḥah: 323; Ṣifat Ṣalāt al-Nabī

Thus, it is not valid to place the head on pillows, tables, or raised objects for sajdah.

• If unable to perform sajdah but can perform rukūʿ, then sit in tashahhud position and indicate sajdah by bowing the head lower than rukūʿ.
  
  Reference: Fiqh ʿala al-Madhāhib al-Arbaʿah

✦ Praying Cross-Legged (Chār Zānū)​

It is permissible to pray sitting cross-legged if needed. However, jalsah, qiyām, and sajdah should still be done in the tashahhud sitting posture.


Narrated by ʿĀ’ishah رضي الله عنها:


I saw the Prophet ﷺ praying cross-legged when he became old.

Reference: al-Nasāʾī; al-Ḥākim (Ṣaḥīḥ); Ibn Khuzaymah 1/2/107; Ṣifat Ṣalāt al-Nabī

✦ If Unable to Bow and Prostrate​

One who can stand but cannot bow or prostrate may:

• Perform qiyām.
• For rukūʿ: bow head slightly.
• For sajdah: sit and bow further down than rukūʿ.

✦ If Unable to Stand, Bow, or Prostrate​

If someone cannot perform qiyām, rukūʿ, or sajdah, they should:

• Sit in any manner comfortable.
• Use head gestures for rukūʿ and sajdah—sajdah lower than rukūʿ.
  
  Reference: Fiqh ʿala al-Madhāhib al-Arbaʿah

✦ If Only Able to Stand​

A person who:

• Cannot sit, bow, or prostrate
• But can stand, should:

→ Pray standing and use gestures for rukūʿ and sajdah, ensuring sajdah is lower.

Reference: Fiqh ʿala al-Madhāhib al-Arbaʿah

✦ If Unable to Stand or Sit​

Lie on the right side, face towards the qiblah, and gesture for all prayer actions. This is the preferred method.

Reference: Bukhārī: 1116; Abū Dāwūd: 951; Fatāwā Barā’e Khawātīn Islām, p. 122

If unable to lie on the right side, lie on the left side facing the qiblah.
If not even that, lie on the back, slightly raising the head using a pillow to face the qiblah. Feet soles and knees should also be facing qiblah.

✦ If Unable to Move the Head​

Such a person should:

• Gesture with the eyelids for rukūʿ and sajdah.
• Let the sajdah gesture be lower than rukūʿ.
  
  Reference: Fiqh ʿala al-Madhāhib al-Arbaʿah, p. 614

✦ If Unable to Perform Any Physical Act​

If conscious, but physically unable:

• Visualize the actions and words of prayer in the heart.
• Or silently move the lips.

✦ If Unable to Move Lips or Tongue​

If due to a medical condition one cannot speak, then repeat the words in the heart.

✦ Prayer Location Preference​

• Best: Standing on the ground.
• If sitting: sit like tashahhud.
• If ground sitting is impossible: sit on a chair or bed, but do qiyām on ground if possible.
  
  Reference: Fatāwā Barā’e Khawātīn Islām, p. 122

✦ If Unable to Face the Qiblah​

According to ʿAṭā’ bin Abī Rabāḥ:


If one cannot face the qiblah, then pray facing whatever direction is possible.

Reference: Bukhārī, Kitāb al-Ṣalāh: 1117

✦ Coughing, Sneezing, and Spitting During Prayer​

If sneezing occurs, one must not say alḥamdulillāh during ṣalāh.


Narrated: A man sneezed and said alḥamdulillāh, then another replied yarḥamuk Allāh during prayer. Afterward, the Prophet ﷺ said:


إِنَّ هَذِهِ الصَّلَاةَ لَا يَصْلُحُ فِيهَا شَيْءٌ مِنْ كَلَامِ النَّاسِ، إِنَّمَا هِيَ التَّسْبِيحُ وَالتَّكْبِيرُ وَقِرَاءَةُ الْقُرْآنِ
“This prayer is not suitable for the speech of people; it is only for glorification, takbīr, and Qur’anic recitation.”

Reference: Muslim

• Coughing with sound does not break the prayer.
• If one coughs during recitation, one may proceed to rukūʿ.

Narrated:


The Prophet ﷺ was leading Fajr and reciting Sūrah al-Muʾminūn. When he reached the verse mentioning ʿĪsā عليه السلام, he coughed and went into rukūʿ.

Reference: Ibn Mājah: 820; Muslim: 455; Bukhārī (prior to 220)

• If one needs to blow the nose due to flu, do so using cloth/tissue.
• Phlegm or saliva may be spat on own clothing or under the left foot.
• Use a handkerchief or spittoon if needed, on the left side.

Narrated:


When one is in prayer, Allah is in front of him. Therefore, do not spit in front of or to the right; spit to the left or beneath your left foot.

Reference: Bukhārī: 611, 107, 394

✦ Eye Pain and Discomfort​

• During prayer, the eyes should remain open and fixed on the place of prostration. However, if there is pain or discomfort, it is permissible to close the eyes.
• If discharge or tears come out during ṣalāh, they may be cleaned using a tissue or handkerchief.
• If due to eye pain one is unable to lower the head, then rukūʿ and sajdah may be done by gesturing, but not by prostrating on raised objects like pillows or tables.

✦ Pain in Hands or Arms​

• During Takbīr al-Taḥrīmah, if pain prevents raising the hands fully, then raise them as much as possible.
• If it is impossible to raise the hands at all, then visualize the posture of Takbīr in the heart.
• If pain prevents placing both hands on the chest, then tie one hand only, or move hands toward the chest or stomach as far as possible.
• If movement is severely restricted, then place the hands wherever feasible during standing.
• In sajdah, if one cannot raise or separate the arms from the body, keep them in any way possible.
• In rukūʿ, if one cannot grasp the knees, place the hands wherever feasible and bow the body if possible.
• In qaʿdah (sitting), place the hands in any position the body allows.

✦ Turning the Head for Salām​

• If one is unable to turn the head due to stiffness or pain, then gesture using head movement to the right and left.
• If even head movement is not possible, then gesture with the eyes is sufficient.

✦ Labor Pains and Childbirth​

• If labor begins but no blood appears, prayer must still be performed.
• If part of the child emerges but is not yet born, prayer is obligatory.
• If blood is flowing but the child has not been delivered, then prayer is not required.
• If bleeding begins before 80 days of pregnancy, it is not considered ḥayḍ or nifās, but irregular bleeding (istiḥāḍah), and prayer must be offered.
• If labor pain is intense, perform prayer sitting, standing, or lying, in whatever way possible.
• If miscarriage occurs after more than 80 days of pregnancy, this is considered nifās, and prayer should not be offered until the bleeding stops.

(For further details, refer to rulings on physical purity.)

✦ Being Bitten by a Poisonous Creature During Prayer​

• If stung or bitten by a poisonous creature and urgent treatment is needed, then the prayer may be broken to prevent spread of venom.
• If a snake, scorpion, or dangerous predator appears during prayer, and one is able to kill or prevent harm, then breaking the prayer is permissible. It should be made up later.

اقْتُلُوا الْأَسْوَدَيْنِ فِي الصَّلَاةِ: الْحَيَّةَ وَالْعَقْرَبَ
“Kill the two black (creatures) during the prayer – the snake and the scorpion.”

Reference: Abū Dāwūd: 921; al-Tirmidhī: 390; Ibn Mājah: 1345

• If the sting does not pose danger or intense pain, complete the prayer.

✦ Unconsciousness Due to Medication​

• If a person needs to take medicine or injections that cause sleepiness or high fever, they should, if possible, pray before taking them, especially when prayer time is near.
• If the effects are prolonged, combining two prayers is allowed.
• For surgeries, exercises, or tests that cause missing prayer time, one should pray beforehand, if possible.

✦ General Unconsciousness​

• Unconsciousness breaks wuḍūʾ. Upon regaining consciousness, the person must make wuḍūʾ again.
• Missed prayers must be made up in chronological order, even if several prayers are missed over days. There is no sin or expiation, as such a person is likened to one who sleeps through prayer.

مَنْ نَسِيَ صَلَاةً أَوْ نَامَ عَنْهَا، فَكَفَّارَتُهَا أَنْ يُصَلِّيَهَا إِذَا ذَكَرَهَا
“Whoever forgets a prayer or sleeps through it, its expiation is to offer it when he remembers.”

Reference: Muslim, Kitāb al-Masājid, Bāb Qaḍāʾ al-Ṣalāh al-Fāʾitah: 684

(Also see: Fiqh al-Sunnah by ʿĀṣim al-Ḥaddād)

✦ Prolonged Unconsciousness​

• If unconscious for more than three days, due to illness or treatment, the person is regarded as insane.
• Upon regaining proper consciousness, they will resume regular prayer without needing to make up the missed ones.

رُفِعَ الْقَلَمُ عَنْ ثَلَاثَةٍ: عَنِ النَّائِمِ حَتَّى يَسْتَيْقِظَ، وَعَنِ الْمَجْنُونِ حَتَّى يُفِيقَ، وَعَنِ الصَّبِيِّ حَتَّى يَبْلُغَ
“The pen is lifted from three: the sleeping person until he wakes, the insane until he regains sanity, and the child until he reaches puberty.”

Reference: Abū Dāwūd: 4398; Fiqh al-Madhāhib al-Arbaʿah

✦ Combining Two Prayers Due to Illness​

If the illness is such that:

• Repeated wuḍūʾ or postures are difficult, two prayers may be combined:
  
  • Ẓuhr (end time) + ʿAṣr (beginning time) in one session.
  • Maghrib (end time) + ʿIshāʾ (beginning time) in one session.

Though not explicitly stated in ḥadīth, Imām Aḥmad and Imām Mālik allow this, as illness is a greater hardship than rain, which allows for joining prayers. Imām Nawawī agreed.

Reference: Fiqh ʿala al-Madhāhib al-Arbaʿah

✦ Making up Missed Prayers Due to Illness​

• If prayers are missed due to sickness, one should make up as many as possible daily, in chronological order.

Reference: Fatāwā Barā’e Khawātīn Islām, p. 138

• Even if few prayers were missed, perform all missed ones before the current prayer.

(For more, see: Qaḍāʾ Prayer and Qaḍāʾ ʿUmrī)

✦ Memory Loss and Forgetfulness​

• If one forgets the number of rakʿāt, they should focus and complete the prayer based on strongest estimation.
• After completing tashahhud, perform two sajdah of forgetfulness (sajdat al-sahw) before salām, without repeating tashahhud.
• If forgotten before salām, they can still be offered after salām, with the following method:
  
  • Say Allāhu Akbar, go to sajdah.
  • Sit briefly (jalsah istirāḥah), then perform second sajdah.
  • Rise and complete salām.

(See details under Sajdat al-Sahw)

✦ Severe Mental Deterioration​

Some people, especially the elderly, may lose mental clarity to such a degree that they:

• Lose track of prayer times, tahārah, or direction of qiblah.
• Mix up prayer postures or recitations.

Such individuals are legally excused due to mental incapacity, and are not held accountable.

لَا يُكَلِّفُ اللَّهُ نَفْسًا إِلَّا وُسْعَهَا
“Allah does not burden a soul beyond its capacity.”
[Qur’ān 2:286]

✦ Sick Individuals and Congregational Prayer​

Jumuʿah is obligatory upon every Muslim except four categories: slaves, women, children, and the sick.

Reference: Abū Dāwūd

• Congregational prayer is obligatory for men, but sick people are exempt. However, if possible, they should still attend, even if sitting.

Narrated by ʿĀ’ishah رضي الله عنها:

In the final days of illness, the Prophet ﷺ came for prayer leaning on two men, and his feet dragged on the ground.

Reference: Bukhārī, Kitāb al-Ṣalāh, Bāb Ḥadd al-Marīḍ an Yashhad al-Jamāʿah: 198–199; Muslim: 940; Ibn Mājah: 1332

Narrated by Ibn Umm Maktūm رضي الله عنه:

“O Messenger of Allah, I am blind, my house is far, and I have no guide. May I pray at home?”
The Prophet ﷺ said:
هَلْ تَسْمَعُ النِّدَاءَ بِالصَّلَاةِ؟
“Do you hear the call to prayer?”
He replied, “Yes.”
The Prophet ﷺ said:
لَا أَجِدُ لَكَ رُخْصَةً
“I find no concession for you.”

Reference: Abū Dāwūd: 552

Narrated by ʿAbdullāh bin Masʿūd رضي الله عنه:

Only a munāfiq (hypocrite) would miss the congregation. Even a sick man would be brought by two others supporting him, and placed in the row.

Reference: Abū Dāwūd: 550

• These narrations prove that the sick should strive to attend the masjid, even if they must pray sitting.
• The Prophet ﷺ also commanded Imāms to shorten the prayer, due to the presence of elderly, weak, sick, and children behind them.

Reference: Ibn Mājah: 984; Bukhārī: 702, 704, 715, 90; Muslim: 466

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Conclusion:​

Prayer (ṣalāh) remains an obligation upon every Muslim, regardless of health, and Islam has offered merciful concessions for those suffering from illness, disability, or hardship. The following are the key takeaways:

① Standing is obligatory if possible. If not, sitting or lying down is permitted, based on ability.

② If one is unable to perform rukūʿ or sajdah, then gestures may be used—ensuring that sajdah is lower than rukūʿ.

③ No substitute like pillows, tables, or objects should be used for prostration—gesture only if ground contact is not possible.

④ A sick person may combine two prayers at one time if their condition makes it difficult to perform each on time.

⑤ In cases of unconsciousness, missed prayers should be made up if the person regains awareness within three days.

⑥ Those with severe memory loss or mental decline are excused by the Sharīʿah and not held accountable.

⑦ Congregational prayer is still highly encouraged, even for the sick, if physically possible, even if performed sitting.

⑧ Islam emphasizes flexibility without compromising obligation: perform ṣalāh in any posture, even with eye or eyelid gestures, if that's all one can do.

⑨ There is no sin or blame upon those who fall short due to genuine incapacity, as Allah ﷻ says:

لَا يُكَلِّفُ اللَّهُ نَفْسًا إِلَّا وُسْعَهَا
“Allah does not burden a soul beyond its capacity.”
[Surah al-Baqarah: 286]

May Allah ﷻ grant ease, healing, and steadfastness to all those who struggle with illness, and accept their prayers in whatever form they are able to offer them. آمين يا رب العالمين.