Upside Downside?


By Timothy McCall, M.D.  |  

Last year, after developing a nerve blockage in the chest called thoracic outlet syndrome, I stopped doing Sirsasana (Headstand). In the months prior, I’d worked up to holding the pose for 10 minutes, and I’m now convinced that the resulting compression of my chest led to the nerve problem. Shortly after stopping Headstand, the intermittent tingling in my arm went away.

Looking at the faces of people doing Headstand, I often see little of the ease, or sukha, that Patanjali stresses should be part of every asana. Some people appear to be straining or breathing erratically, and many students look like they can’t wait for the teacher to tell them to come down and rest.

Even though the pose was never comfortable for me either, I had stayed with it because of the purported benefits. T. Krishnamacharya, the guru of K. Pattabhi Jois, B.K.S. Iyengar, and T.K.V. Desikachar, called Headstand the king of the asanas, and practicing regularly is stressed in Iyengar Yoga, the main style I’ve studied. Headstand is believed to calm the nervous system and promote a yogic mind (that is, foster equanimity), and has numerous physiological effects, including reducing the breathing and heart rates, slowing brain waves, and enhancing the drainage of lymph from areas below the heart. It also induces reductions in norepinephrine, aldosterone, and antidiuretic hormone levels, and so tends to lower blood pressure.

Interestingly, the pose is rarely taught by Desikachar and his followers, due to safety concerns, including neck problems such as herniated disks and arthritis in the cervical vertebrae (bones of the neck). Of greater significance is the potentially heightened risk of stroke in people with inadequately controlled high blood pressure and of retinal bleeding or detachment in those with some types of eye disease. For people with glaucoma, Headstand may further increase pressure in the eyes, contributing to loss of vision.

So, should you dare to go up? I tend to view the question in light of my own medical training. Doctors are used to weighing the risks and benefits of any intervention before deciding what to do, and I suggest you do the same when contemplating potentially risky poses. For a certain group of yoga students, I have little doubt that Headstand can be safe and of great value. These students have enough openness and strength to be able to lift out of the shoulders and thoracic spine and skillfully use their legs to bring further elevation. They are also able to maintain good alignment of the arms, head, and neck and to keep their feet directly over their heads. When the feet drift, it can generate an unhealthy torque on the cervical vertebrae.

Given how tiny and fragile these vertebrae are, I wonder if it is advisable to teach this pose in open classes, in which students of varying levels may be participating. In a class setting, some people may end up doing what isn’t safe for them or what does not feel good.The desire to persevere with a pose that your body is indicating is not right (or not yet right) for you ought to elicit some serious self-study, or svadhyaya. You might ask yourself why you are doing yoga and what you hope to gain from it. In this light, putting off or forgoing a pose you’d like to do can be an opportunity for growth and greater self-knowledge.


If you have no strong contraindications but alignment is a problem, using a mirror, wall, or corner to give proper support can help. If they are available, wall ropes and props, such as two chairs, can provide excellent alternatives for those with neck or thoracic spine problems (see “Everybody Upside Down). If maintaining alignment is an issue, come down as soon as you lose sukha, then slowly build up gradually. More time on preparatory poses is also advisable. For those with poorly controlled high blood pressure, glaucoma, or retinal problems, however, Headstand may simply be too risky in any form.

Luckily, there are many alternatives that can give you a wonderful yogic experience even if the pose isn’t right for you. Ask your teacher for recommendations.

Timothy McCall, M.D., is Yoga Journal’s medical editor. His Web site is www.drmccall.com.