Prescript: This article was initially written as part of accreditation for my 200 hour hatha yoga teaching training with two wonderful teachers, Prakash Singh Bisht and Arun Rana. References are quoted at the end of the article for those of us who prefer evidence based annoyance:)
Yoga teacher: Do you have any injuries or issues?
Yoga student: No injuries, but I am not comfortable with Sirsasana. And I don’t think it is important.
Yoga teacher: Well, it IS important. You are just not there yet.
(true words spoken by a yoga teacher to another yogi, namely me).
The 10 amazing benefits from the Headstand (Sirsasana)
- Provides Great relaxation from Stress
- Helps to Increase Focus
- Helps to increase Flow of Blood to the Head and Scalp
- Helps in Strengthening Shoulders And Arms
- Helps to Improve Digestion
- Helps to clear the Adrenal Glands
- Helps in developing the Blood Flow to the Eyes
- Helps to decrease the Fluid Build-Up in Legs, Ankles and Feet
- Helps to Developthe Strength in the Core Muscles
- Stimulates the Lymphatic System. (see reference 3)
Could it do any more? The benefits of Sirsasana (Sirsasana, Shirshasana, Sirshasana) are legendary, with people claiming it can cure everything from heart palpitations to baldness.
This (Sirsasana) has become a panacea, a cure-all, “a sovereign specific for all diseases” (Sivandaonline.org)
I believe it is one of the most dangerous asanas, if not the most dangerous asana, for the yoga practitioner, new to experienced. I won’t teach it nor will I practice it.
“Believe nothing, no matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your own common sense.” Guatama Buddha.
How to go into a headstand (Sirsasana)
In case you don’t know what it is. In the Supported Headstand, the body is completely inverted, and held upright supported by the forearms, while the crown of the head rests lightly on the floor (at least that is the theory).
Kneeling down and resting the elbows firmly on the floor, interlocking the fingers together in front so as to form a triangular base with the forearms. Placing the very top of the head in between the interlocked hands and walking the feet slowly closer towards the chest, then lifting the toes off the floor while tucking the knees into the chest. Once balanced at this stage, the folded knees are raised up gradually. Once again balance is achieved and the feet are worked up straight. The key is to press the forearms down to reduce weight on the head. This posture is initially held for a minute, working up to 5 minutes (in some schools, for as long as 20 minutes). Coming down is accomplished in the same manner as going up . Every step should be carefully performed to avoid injuries.
The asana is contraindicated in the following situations: high blood pressure, heart palpitations, glaucoma, detached retina, conjunctivitis, brain disease, brain injury, menstruation, severe hypotension or hypertension, hiatal hernia, obesity, neck injury, and back injury.
What’s my beef with the sirsasana?
My instincts have been telling me I should not be doing this asana.
I am not comfortable, my neck always feels crunchy afterwards. Yet I obediently try it – there is this unspoken rule that you really can’t be a ‘good’ Yoga teacher unless you can do and teach Sirsasana.
I started listening to my intuition.
My commitment to Satya (truth) is one of my strengths (and consequently, my vulnerable spot). I seek truth in the same way that people might seek out the ultimate dining experience. This commitment means I regularly get into trouble for speaking the unspeakable. And for challenging convention. And for being a little rude.
The Sirsasana and the yogi world view
Loads of people practice the head stand. I have had some robust discussions with people who are utterly devoted to it. Isn’t it really a matter of individual choice whether or not to practice this asana?
It is perfectly reasonable for people, to continue to do something even if they have been advised of its potential dangers. I may not agree with what they are doing, but I will protect their right to be a complete nutter (sorry that just slipped out).
However, communities have to be guided by the overall good, not just the good for a few. So when the yogi community exercises this freedom (so core to yogis), but then holds up one pose over another, as the ‘king’ of asanas, AND makes people feel bad when they can’t or won’t do it, strikes me as morally irresponsible. Not to mention a little hypocritical. And a wee bit of bullying. And I get a little more uptight, when it seems as if the facts of the pose are being ignored because the theory fits the yogi world view just a little too conveniently.
When East meets West....
The introduction of yoga to the west has meant medical practitioners from all fields are now part of the yoga community. And they are researching, investigating and sharing information. They are also teaching yoga.
Medical research, from all over the world, is now publicly available on the health benefits and the downside of many yoga asanas.
Like I said, I am a stickler for truth. Surprising what you can find on the web for free or if you ask a chiropractor or back doctor for articles, thoughts or references on the up and down side of the headstand (pardon the pun).
What I found was larger than usual (meaning more than what I could find for other particular asanas) amounts of medical research outlining real case studies, real people and the significant health issues a Sirsasana can create.
And some yogis, some well known, who are prepared to speak out on the Sirsasana.
To be fair, there are cautions for all asanas, and for yoga generally, we have certainly seen the rise and rise of injuries, not just in Sirsasana.
But I want any yogi next time they go to a class where headstand is practiced and listen to how this asana is explained compared to others. The yogi teacher inevitably begins to list out some or all of the benefits listed previously, with a wild dreamy look in their eyes.
I personally have asked yoga teachers to explain the downside of the sirsasana, and most will recite the list that seems to apply all asanas. And most will NOT be able to name some of its most serious (and more common) injuries.
Sirsasana – its succession to the yoga throne
Viparita karani is one of the oldest mudras on record. If you read the classic work, Hatha Yoga Pradipika, from circa 1450 CE, you’ll see that the original description was simply:
“Navel above, palate below, sun above, moon below – this is called Viparita karani.” (3:23)
Viparita karani looks like a gentler version of Sarvagasana (shoulder stand) – one without the neck squishing. Some yoga styles call the “Legs-Up-the-Wall” pose Viparita karani, but the written description in the traditional version says the bottom half of the body needs to be well above the head.
Neither Sirsasana nor Sarvangasana are mentioned in the Hatha Yoga Prakipika – the foundation of modern yoga (and probably where one would expect to see an asana with such a royal heritage).
Lots of poses aren’t mentioned. But Sirsasana landed the title of ‘king’.
“Normally to be a king, you have to wait in line, for a long time, for someone to die, or be crowned.”
The crowning of this pose as the king (at least in the Western world) was probably undertaken by BKS Iyengar. In his book Light on Yoga, Iyengar explains that just as a country cannot thrive without a strong and effective king (or head of state), a person cannot thrive without a strong and healthy brain, which some yogis attribute to Sirsasana. He also advocates holding this pose for extended periods of time, to achieve its fullest benefit – creating the ‘yogic’ mind.
Krishnamacharya, the guru of K. Pattabhi Jois, B.K.S. Iyengar, and T.K.V. Desikachar, have all called Sirsasana the king of the asanas.
So if it is not the king, by a long and distinguished line of other asanas, and has been crowned simply because people have felt the need to explain the ‘rush’, could it have this esteemed ranking because of the health benefits?
The Sirsasana biology
Let’s look at the anatomy involved in a Sirsasana. Not all of it, but the major pieces. From a musculo-skeletal perspective, we have 7 cervical verterbrae, one postural longtitudinal alignment, and a cranium. Inside that skull, is some of our most important mental real estate – our brain. We have all of but one of major senses emanating from this region, taste, sight, hearing, smell. The major muscles groups meant to support us in the Sirsasana are forearms and stomach muscles.
The biological reality is that Sirsasana, despite all the words saying little weight on the head, does require most of us to balance most of our weight on our head.
This means extensive neck loading. On the smallest verterbrae in the body.
Does the average person have sufficient strength in their neck to bear this weight? Or even the right amount of flexion?
Most people hold their head out in front of their necks with their chins lifted, shortening their posterior neck muscles, which doesn’t allow for proper alignment of the cervical spine. This means most of us don’t have a good range of flexibility or strength in our cervical spine – unless we have been carrying loads of food and wood and water on our heads for a few years.
While performing Sirsasana (head stand), it is possible that the load instead of passing through the bodies of the vertebrae, is transmitted through the weaker portions of vertebral column disturbing the normal spinal biomechanics. Normally the flexion/extension movement in cervical spine takes place at C5-C6. That is doctor speak for screwed up neck and lower back issues.
But wait there is more….
Upper body strength is critical to getting into Sirsasana
Nature has given us muscles which help decompress the spine, when we are standing upright. It has not given us muscles to balance the spine when we are upside down. Tipping the spinal plumline of our body upside down means we need to rely on extra strength in both forearms and stomach, to reduce the wear and tear on cervical verterbrate.
“Those of us with ‘excessive flesh’ (read big breasts proportional to our bodies) will automatically be out of alignment in the ascent to a headstand.” Lee, WanderingYogi Teacher
Those of us with different skeletal structures (read Western, read Asian), will have differing degrees of strength in our forearms proportionate to the weight of our body. Paul Grilley argues that there are some body types that should never do Sirsasana.
The eyes have it…
It is generally accepted that anyone with a history of eye troubles (glaucoma for instance) should never practice sirsasana.
There has been much scrutiny (continuing the eye theme) on ocular pressure changes in sirsasana and other ‘inverted positions’ (such as down dog or the forward fold).
A 2006 study showed that the ocular pressure of an ordinary person doing a headstand increased pressure in the head to twice the normal range. That is the equivalent of a diver going to 100 ft (30 metres) (see reference 4). And divers usually remain upright, with maximum RBT (Recommended Bottom Time) at this depth is between 5 – 10 minutes.
Not the recommended up to 1/2 hour in the pose suggested by many famous yogis.
People often describe the sensation of dizziness, as the ocular muscles and surrounding area experience the sudden rush of blood to the head. There are multiple cases of unusual ocular problems arising from headstands in otherwise healthy patients (see reference 2).
The pressure in the eyes for sirsasana is the highest, with the next highest being the Ardho Mukha Schwvasana (Down dog), followed by the Forward Fold.
What does experience tell us?
As Paul Grilley (reference 2) and others point out, many of us do not have the ‘natural’ flexion in our verbertrate, due to life and work characteristics. So most of the time, for most of us, we place extensive pressure on the smallest verterbrate in our spine, in the wrong place.
“If you can’t hold your head on top of your spine effectively and sustain it for eight hours or more a day, then I’m not going to teach you to put the entire weight of your body on your head and neck,” Paula Lynch Iberis from Yogawork, NYC
Erica Mather, who teaches at Pure in New York, believes few people have the strength in their cervical spine and upper body to come properly into the pose. She will not teach headstand unless she is specifically requested.
Ana Forrest believes that we carry most of our tension in our necks. Because of this, it is far better to teach our necks to stretch and relax then to strengthen. She rarely does headstands.
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).
The sad scientific conclusion
In my very short foray into the world of science and research, vertebral artery and basilar artery occlusions and dissections have been reported in otherwise healthy people, as have thoracic outlet syndromes and cervical reticulates due to Sirsasana. We are talking extreme injuries.
Sirsasana has been associated with retinal hemorrhages and detachment in glaucoma patients. Cervical listhesis and compressive myelopathy are also associated with Sirsasana, again in fairly ‘normal’ people (see reference 1). This is also doctor talk for very very bad back injuries, from which recovery is long, if at all.
“There has been more attention paid to deaths from hot yoga than there has to this creeping statistic of damage by the sirsasana” Lee, Wandering Yogi Teacher
The Dalai Lama once said – “if science proves Buddhism wrong, then Buddhism will have to change.”
Can we not do the same with yoga?
Is it possible for the yoga community to consider that the sirsasana is like a monarchy, past its use by date, perhaps taught as part of history, rather than a present healthy part of yoga?
“I am a hard core New York yogi – I learn to stand on other people’s heads” Leslie Kaminoff
What will I be doing?
Any inversion, when the legs are held over the heart, which helps to move stored fluids into the core for oxygenation, filtration and elimination of metabolic/cellular wastes. Any inversion where the head is below the legs that will push blood to the brain. But not Sirsasana.
Give me wall ropes or an aerial hammock and I may do a suspended Sirsasana.
Otherwise, it is Arda Mukha Svasanasana, Uttanasana, Prasarita Padattosana, Setu Bandhu. And on my own I am sticking to Viparita Karani. Oldstyle Hatha way.
Nitin Sethi, MD Comprehensive Epilepsy Center Weill Cornell Medical Center New York, NY 10021
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. Adjunct Clinical Instructor at Southern Illinois University School of Medicine, a member of the American College of Physicians, the American Society of Nutrition, and the International Association of Yoga Therapists.
YogaCurious, Website, September 19, 2014
Baskaran M, Raman K, Ramani KK, Roy J, Vijaya L, Badrinath SS. (2006). Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology. 2006 Aug;113(8):1327-32. Epub Jun 27