Saturday, May 11, 2013

Investigating the Benefits & Risks of Headstand: Part 3

Part 3 of a three part series on headstand

by Kathleen Summers, MD, PhD, RYT500

In part one of this series, we investigated the historical importance of headstand in yoga. In part two we examined the benefits of practicing headstand. In this final article of the series, we’re going to look at the potential downside to turning upside-down on your head.

1)  Degenerative damage to the cervical spine

Too much pressure on the small disks and facet joints of the cervical vertebrae may lead to wear and tear over time. Degenerative disk disease and facet joint arthritis may ensue, leading to chronic neck pain. There is no quality evidence that speaks to this. We do know that hips and knees are damaged by too much weight and that taking pounds of pressure off of them lessens pain and helps to prevent progression. It seems like common sense then, that turning upside-down and putting the body’s weight on other joints (smaller ones not designed for such a load) will also cause cartilage degeneration and arthritis.

The only case in the medical literature that speaks to this, at least of which I am aware, reports on a man who practiced sirsasana daily for 25 years. He subsequently developed spondylolisthesis – a slippage of one vertebral body out of place in respect to the one beneath it, a condition that usually occurs in the lower spine where most of the weight of the body is carried. Some types of spondylisthesis are thought to be precipitated by gravity, posture, and high stress loads that lead to chronic disk degeneration, facet joint problems, and then eventual instability and gradual slippage. For this guy, it was devastating. His spinal cord was severely compressed resulting in quadraparesis with increasing weakness in all four limbs and numbness and tingling in his hands and feet. Eventually the damage began to affect his bladder function resulting in trouble with urination.

2) Glaucoma progression 

While there’s no indication that standing on your head causes glaucoma, it has been shown to worsen this chronic condition in which the pressure of the eyeball is elevated. Gravity increases the pressure leading to disease progression with an end result of blindness. It’s easy to tell those with glaucoma to avoid sirsasana, but the problem lies with those who are unaware they have the condition. See here for risks and diagnosis. Also, there’s one reported case of central retinal vein occlusion immediately after sirsasana leading to blindness in one eye. It’s hard to say though, that the headstand was the cause.

3) Falls 

I’ve seen a few bruises from a bad landing, but more concerning is the potential for breaks. Fractures are possible but unlikely unless pre-existing osteoporosis or osteopenia exists – in which case a person shouldn’t be doing the headstand anyway. Again, the trouble is that sometimes people don’t realize they have thin bones until after they have their first break. 

4) Stimulation

While there are claims that this asana causes relaxation, it actually does the opposite. It triggers the sympathetic nervous system, revving up our “flight or fight” stressor response. 

5) Potential bleeding if uncontrolled high blood pressure

I’ve posted about this before. This has never been documented to occur. It’s theory only. Patients with chronic, uncontrolled high blood pressure have diseased blood vessels that may not autoregulate in the same efficient fashion as normal healthy ones. The potential result is that an uncontrolled increased pressure within a small artery may cause it to rupture. Again, it’s all theory.

6) Retrograde menses 

Avoid sirsasana while menstruating, especially on heavy flow days, to decrease the risk of developing endometriosis. I know some people think this is passé, but it isn’t. I’ve posted about it here and here. 

7) Restricted breathing

In sirsasana, the rib cage muscles are contracted to help balance the body. Since they need to be contracted for posture maintenance, they are unable to relax to allow the rib cage to expand for a deep breath. Expansion of the chest wall is limited and thus the ability of the lungs to inflate in limited. Because of that, you have to either transfer gases more efficiently, or, the more likely scenario, you will automatically, by brain stem regulation at the subconscious level, slow down the rate and depth of breathing to keep blood gasses within a normal range. The unconscious, or involuntary, slowing of the respiratory rate by the brainstem centers explains the calming effect often reported with sirsasana. Since anxiety and emotion often follow breath, there’s a feeling of calmness – while at the same time the sympathetic nervous system is activated causing arousal.

So, what’s my conclusion after reviewing sirsasana again?

I’ve laid out the historical significance here and the potential benefits here. In this post, I’ve looked at the potential downside of practicing sirsasana.

Although some benefit may be gained by doing the headstand, the same effects can all be derived from other Yoga practices as well – and there are risks with sirsasana.

As I said before, I’m still not comfortable with it, and I don’t think it’s important.

I’d love to hear your thoughts. Do you have an issue with the regular performance of sirsasana? Have you been made to feel like a “lesser” yogi because you don’t stand on your head?

  1. P.K. Sethi, A. Batra, N.K. Sethi, J. Torgovnick, E. Tortolani: Compressive Cervical Myelopathy Due To Sirsasana, A Yoga Posture: A Case Report. The Internet Journal of Neurology. 2007 Volume 6 Number 1
  2. de Barros DS, Bazzaz S, Gheith ME, Siam GA, Moster MR. Progressive optic neuropathy in congenital glaucoma associated with the Sirsasana yoga posture. Ophthalmic Surg Lasers Imaging. 2008 Jul-Aug;39(4):339-40
  3. Gallardo MJ, Aggarwal N, Cavanagh HD, Whitson JT. Progression of glaucoma associated with the Sirsasana (headstand) yoga posture. Adv Ther. 2006 Nov-Dec;23(6):921-5.
  4. Baskaran M, Raman K, Ramani KK, Roy J, Vijaya L, Badrinath SS. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology. 2006 Aug;113(8):1327-32.
  5. Manjunath NK, Telles S. Effects of sirsasana (headstand) practice on autonomic and respiratory variables. Indian J Physiol Pharmacol. 2003 Jan;47(1):34-42.
  6. Rao S. Respiratory responses to headstand posture. J Appl Physiol. 1968 May;24(5):697-9.
  7. Nikunj J Shah and Urmi N Shah. Central retinal vein occlusion following Sirsasana (headstand posture). Indian J Ophthalmol. 2009 Jan-Feb; 57(1): 69–70.

Kathleen Summers, MD, PhD, is a contributor to Prevent Yoga Injury. She is a board-certified internist specializing in natural, Yoga-based care. Dr. Summers is a graduate of Northwestern University Medical School in Chicago and holds a second doctorate in neuro-pharmacology from Southern Illinois University. Currently, she is an Adjunct Clinical Instructor at Southern Illinois University School of Medicine, and she is a member of the American College of Physicians, the American Society of Nutrition, and the International Association of Yoga Therapists. 

During her frequent travels to India, Dr. Summers researches Yoga and its therapies. She enjoys uniting her two passions, Yoga and medicine, and is continually exploring Yoga's healing concepts and integrating them with modern, evidence-based care. Her primary Yoga influences have been the tantric styles of Sivananda and Agama. She holds a 500-hr Yoga teacher training certification. You can follow Dr. Summers on Facebook and Twitter. This article originally appeared on Dr. Summers' blog and is re-posted here with her permission.


  1. Stewart J. LawrenceMay 12, 2013 at 1:28 PM

    Great post, Dr. Summers, and kudos to Victoria McColm for re-posting it from your blog.

    The problem I see is that yogis are addicted to the presumed spiritual greatness of this pose, so it is a sacrilege what you are saying, and many refuse to accept it.

    Iyengar people I know, in particular, extol the virtues of this pose as an anti-aging miracle cure; so does Tara Stiles in her latest book, 50 Yoga Cures, in she literally claims you can get rid of your wrinkles with the headstand.

    Yoga Dork just ran an interview with Iyengar maven Judith Lasater in which she falls back on all the old arguments about sirsasana; she doesn't even mention elementary issues related to risk, which even mainstream pro-yoga health professionals like Tim McCall have noted.

    So, I wonder if you are even trying to have a dialogue with other yoga health professionals who are basically now sticking their heads in the sand -- also a dangerous pose, unless you're an ostrich -- and continuing to use William Broad as a whipping boy, rather than just dealing with the reality of the pros and cons.

    Also, I did look up that latest medical report from February 2013 --

    talking about the risk of compressive myelopathy. Does that study -- based on a single chronic case, it seems -- add anything of significance. You seem to have covered it generally under threats to the cervical spine.

    Thanks again.
    Stewart Lawrence

  2. I "second" everything Stewart has said, above. [Tks Stewart.]

    Wonderful article (and series), Kathleen. The tide is beginning to turn on this issue, IMO. Truth will prevail -- esp when the "sciences" (and people like you) get involved. You and Dr. Fishman, especially, are great truth-tellers -- and "genuine human beings," in my estimation.

    Yoga is a fantastic medium that benefits us in so many ways. Yet there are things within it that may not be in our best interest, overall. HS may be one of those.

    BTW, would you consider -- for your next "project" -- analyzing Shoulder Stand, in a way similar to what you've done here on Headstand?

    The Very Best to You,

    Robert Hoyle
    Santa Fe, NM

  3. I am a physiotherapist and yoga therapist in Sydney would agree with you that headstand is risky. Sometimes the neck and shoulder issues that are stirred up by headstand ( for example, underlying problems from previous motor accidents- whiplash, falls, neck tension headaches) really get worsened by headstand.Then the symptoms get in the way of students' whole practice and have them losing faith and ability to practice all the postures that are less risky and far more beneficial. I don't believe headstand should be contraindicated, but definitely steered away from in general yoga classes, and cautioned for students who have asymmetries in their upper back, shoulders and neck. How functional is headstand for daily life anyway? Students shouldn't ever feel that they're missing out by avoiding headstand, rather they should be told about the risks and encouraged to use their powers of discrimination and feel empowered to make a choice of ahimsa.

  4. Interesting....I did a few headstands and becoming a somewhat pro at it but it cause my head to feel like there is a brick on it afterwards. Then I get the occasional headache here and there. I've noticed ever since i've been doing headstands that my head feels weird on the inside.