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Upside Downside?

Headstand can have just as many risks as benefits. Here are a few things to consider before going up.

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.

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Reader Comments

sara

I'm not sure how old this article is but I recently got diagnosed with TOS. I am starting to do some yoga and think it will help. Some other things that have helped are acupuncture and deep tissue massage. I am also athletic and abstaining from exercises I used to do is very hard. I like the Bikram idea, that's a great workout.

Nancy

Hi Katrina, First off, so very sorry to hear you have TOS.. I have been living with TOS for ten years now and I do understand the frustration and pain. In the beginning I used the Peter Edgelow therapy kit and was a good start. It just wasn't a life long therapy I wanted to do. The "pinky ball" helped to pinpoint and use direct pressure on painful spots on my back and I used that alot. But you were asking about YOGA...well...good news...I I tried Bikram yoga and found it to be very beneficial. The stretching and breathing exercises are amazing relief of the numbness and pain. Working through the overhead postures were more difficult but the heated room helped relax my muscles. The "cobra" pose put pressure on my elbows but after several sessions the pain lessened as well. I was happy and pain free for several months while I was practicing two or three times a week. Recently I took a 2 month break from yoga and my symptoms came back with a vengence. I know how important stretching, posture and the right exercise conditioninig are for TOS relief and for me Bikram yoga really did help. The 26 postures were perfect for me and no head stands! Good luck to you. nsthinkr1@aol.com

Katrina

Hello, I have been diagnosed with Thoracic Outlet Sydrome. I've had TOS for four years but wasn't diagnosed until fall of last year. Doctors have given me therapy exercises and prescribed pain killers but they seem ineffective. I am a young athlete in my early twenties and am used to doing exercises that are more fulfilling and effective to my overall performance. I tried yoga last summer but some of the poses placed stress on my shoulders so I stopped. But I have a feeling that despite the pressure and pain, TOS can be reversed through yoga or certain martial arts, or alternative medicine like vitamins, proper nutrition, and herbs. What other yoga positions and activities did you use to help treat TOS? Do you still have TOS? If not, how did u improve your condition? I'm tired of living with this. If you have any clues or answers, I would love to hear from you. Thank you!
kms3@u.washington.edu

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