by Kathleen Summers, MD, PhD, RYT500
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.
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.
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?
- 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
- 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
- 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.
- 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.
- Manjunath NK, Telles S. Effects of sirsasana (headstand) practice on autonomic and respiratory variables. Indian J Physiol Pharmacol. 2003 Jan;47(1):34-42.
- Rao S. Respiratory responses to headstand posture. J Appl Physiol. 1968 May;24(5):697-9.
- 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.