Hi everyone!I’m a yoga teacher and I’m having trouble in deciding if people with an issue of high blood pressure (I mean, that should be checked from time to time) are allowed to practice inverted poses such as sarvangasana and sirsasana. Obviously I wouldn’t keep them for more than one minute, anyway, is it dangerous?
Thank you so much
Students with high blood pressure may be best served with modified or gentle inversions rather than the full poses you mention. When it is appropriate for them to do those poses then keep them only for three breaths.
Hi,
I have a number of students in my class with HBP of which one is a medical doctor. Most important is to ensure that their BP is under control, in other words if they are on medication it should work and they should have a near to normal BP. You have to ask and question them about this. If their BP is under control there is no reason why they cannot do the inversions, just don’t hold them too long, a minute at most. I have a Tensoval automatic blood pressure monitor which I take to class and we have taken BP’s before inversions and again after inversion and what astounds me is the drop in especially the diastolic reading for most of the BP students.
Please note, it is important to also gradually introduce these students to inversions. Take your time with them and slowly working it up to a full inversion one day. Also I do not allow a student to do inversions if they cannot bring me their medication as many will say yes they are on medication and it is under control and meantime it might not be so. So ask them to bring their medication and invest in a BP monitoring device and take their BP’s before class. I try to make it a fun and relaxing experience for them.
Here is also an interesting article on HBP.
Good luck with this. 
I am a HB pressure person , i will do inverted asanas according to how my body tell me , breath slowly & when begin to feel uncomfortable , I will slowly release myself from the poses without waiting the stop signal from teachers.
Happy for doing in this way as i shouldn’t avoid those poses and gaining the benefit from them as well.
Great! I found your answers really helpful, I read that article too, it really deepened my understanding, thanks a lot to all of you.
I have a different theory about this. I hope some of you might find it useful. Some of you might not agree with this. I would sure like comments.
I also have High Blood Pressure. Many people say they have high blood pressure but to me without actually defining it properly does not tell much. I will put in my best effor to define mine. I am not on any medication at all. I do check my blood pressure at least 3-4 times per week. My regular doctor visits makes me feel comfortable. My doctor is working with me and my strong desire NOT to get on any medication. I try to eat very very low sodium diet. I do cardio 4-5 times a week. After all that my systolic most of the time stays in the range of 127-135. There would be few time it would shoot all the way upto 148-150. My diastolic would usually range from 75-86. There would some times when it would shoot to 90-96. As per my doctor as long as my range stays what it is right now I am fine and he is OK that I do not start on any medication.
About inversion poses, I am a HUGE fan of headstands (shirshasana) I have read at many many places that inversion poses could cause high blood pressure. I am cautious about it. But I at the same time I am a very strong believer that anything that makes you happy cannot be wrong. If your body feels like doing it, it cannot be wrong. I find myself few times that when I am restricted on doing certaing things that I want to and have passion for…I feel low and depressed and sad and angry. This anger than converts into frustrations and wrong beahvior towards others and ultimately affects me negatively and cause my blood pressure to rise.
So my point as if doing an inversion pose makes you happy. If you feel like doing it. Go for it. Just don’t go extremes (look who is talking) :)
I enjoy doing headstands and I will keep doing it. It keeps me happy and helps me laugh and that eventually helps me keep my blood pressure low.
[QUOTE=yalgaar;25256]I have a different theory about this. I hope some of you might find it useful. Some of you might not agree with this. I would sure like comments.
I also have High Blood Pressure. Many people say they have high blood pressure but to me without actually defining it properly does not tell much. I will put in my best effor to define mine. I am not on any medication at all. I do check my blood pressure at least 3-4 times per week. My regular doctor visits makes me feel comfortable. My doctor is working with me and my strong desire NOT to get on any medication. I try to eat very very low sodium diet. I do cardio 4-5 times a week. After all that my systolic most of the time stays in the range of 127-135. There would be few time it would shoot all the way upto 148-150. My diastolic would usually range from 75-86. There would some times when it would shoot to 90-96. As per my doctor as long as my range stays what it is right now I am fine and he is OK that I do not start on any medication.
[/QUOTE]
High Blood Pressure is an objective stat. It is considered HBP anybody who has a systolic/diastolic pressure over 140/90, on ideal conditions (e.i. rested, sitting down, no coffee, coke or tea or any xantine containing beverage) , etc. I agree with the blood pressure you indicate there is no need at all for medication.
A trick you can use is to add Green Tea to your diet. Even though it is a xantine containing beverage, it has some components which act as tiazide diuretics which can be helpful to decrease BP (I’m too lazy right now to find the bibliography but I’ll have it for tomorrow :D).
thank you Yalgaar, I totally agree with you. The problem is that in the yoga center where I practice and teach there are “strong oppositors” to our point of view and even if the student (who suffered from BP, but now is considered to be borderline) would like to practice inversions they claim she needs a special permission from a cardiologist in order to do shirshasana for a few breaths…thank to you Xamilo, I’ll pass the information about green tea to this student (and friend) of mine
[QUOTE=pondicherry;25277]thank you Yalgaar, I totally agree with you. The problem is that in the yoga center where I practice and teach there are “strong oppositors” to our point of view and even if the student (who suffered from BP, but now is considered to be borderline) would like to practice inversions they claim she needs a special permission from a cardiologist in order to do shirshasana for a few breaths…thank to you Xamilo, I’ll pass the information about green tea to this student (and friend) of mine[/QUOTE]
The problem is the U.S. is the “suing capital of the world”. If a patient with a mild HBP is doing yoga and he suffers a heart attack (it doesn’t mater if it has anything to do with the position/exercise, he might be eating a triple Quarter Pounder with Fries every morning and a bottle of whiskey every night and never taking his medication), the easiest legal way to get out of it would be “he was practicing a `physically challenging activity without medical prescription, so its the institution he practices fault for not being “aware” of the patients condition”. So any intelligent institution will armor itself by asking for a doctos prescription.
Thank you Xamilo for your advice. I live in Italy, we ask to [U]anyone [/U]who enroll to our yoga lessons to give us a doctor’s declaration in which has been stated that the person is healthy. You know, , the document is called litterally “certificate of good health” (certificato di buona salute) and whoever practices any phisical activity in a public place is bound to have it. It’s generic and most of the time free of charge, on the contrary, for a visit and a prescription from a cardiologist the amount to pay is at least 200$! This student has the first document, I mean she was declared healthy by a doctor, but she fefuses to have the other one…
[QUOTE=pondicherry;25279]Thank you Xamilo for your advice. I live in Italy, we ask to [U]anyone [/U]who enroll to our yoga lessons to give us a doctor’s declaration in which has been stated that the person is healthy. You know, , the document is called litterally “certificate of good health” (certificato di buona salute) and whoever practices any phisical activity in a public place is bound to have it. It’s generic and most of the time free of charge, on the contrary, for a visit and a prescription from a cardiologist the amount to pay is at least 200$! This student has the first document, I mean she was declared healthy by a doctor, but she fefuses to have the other one…[/QUOTE]
If her only disease is Hypertension, its controlled, and there is a Certificato di Buona Salute signed already, I would see no issue in letting her train, but I would advice to have a signed agreement that she knows she will be put at risk of a physical activity bla bla bla bla… That way, you’re legally armored against any complication…
OK I am sure we all have heard that inversion poses especially headstand can raise your blood pressure.
I am looking for some more information about this theory that will answer my following questions:
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Will the blood presssure rise immediately once you do the headstand? Has anybody done such testing. i.e measured blood pressure before and after headstand. What did you find? I have done this myself but did not find any noticable change in my blood pressure. I used 1 of the best “Omron” device to do this.
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If the above is not true, can somebody throw some light on who exactly the blood pressure would rise for somebody who practices headstand on a regular basis?
You have measured the blood pressure in your arm or wrist, ideally holding this limb at heart level. You have measured your BP before and after headstand. It would have been more relevant to measure your blood pressure (a) inside your head and (b) during headstand itself. In headstand, the head is below the heart and therefore there is a greater hydrostatic blood pressure inside the head due to the effect of gravity. The pressure at the bottom of a swimming pool is higher than the pressure at the surface.
The effect of headstand on blood pressure has been studied since Kuvalayananda (1926). In a study by Gilmore in 2002, testing men and women with normal blood pressure, cranial blood pressure recorded when performing a headstand averaged 150/110 mm Hg. Therefore, there is a potentially heightened risk of stroke. Baskaran (2009) found that intraocular pressure rises by 15 mm Hg immediately after assuming headstand. This may cause retinal detachment in people with eye disease.
However, many yoga teachers feel that that people with [B]controlled high blood pressure [/B]can practice headstand provided that they (a) move into the pose slowly, (b) limit the duration to a few minutes in the beginning, and © do not exceed 15 minutes in the pose. Controlled blood pressure means a pressure below 140/90 using medication. A better criterion is: if you feel strain, get out of the pose. It is wise to practice gentler inversions for several months before moving to headstand (e.g. downward facing dog, bridge, half-shoulderstand, shoulderstand, in this order).
The good news is that practicing yoga and meditation for a few months can lower both systolic and diastolic blood pressures (by values of 10 -15 mm Hg).
[QUOTE=Willem;25624]You have measured the blood pressure in your arm or wrist, ideally holding this limb at heart level. You have measured your BP before and after headstand. It would have been more relevant to measure your blood pressure (a) inside your head and (b) during headstand itself. In headstand, the head is below the heart and therefore there is a greater hydrostatic blood pressure inside the head due to the effect of gravity. The pressure at the bottom of a swimming pool is higher than the pressure at the surface.
The effect of headstand on blood pressure has been studied since Kuvalayananda (1926). In a study by Gilmore in 2002, testing men and women with normal blood pressure, cranial blood pressure recorded when performing a headstand averaged 150/110 mm Hg. Therefore, there is a potentially heightened risk of stroke. Baskaran (2009) found that intraocular pressure rises by 15 mm Hg immediately after assuming headstand. This may cause retinal detachment in people with eye disease.
However, many yoga teachers feel that that people with [B]controlled high blood pressure [/B]can practice headstand provided that they (a) move into the pose slowly, (b) limit the duration to a few minutes in the beginning, and © do not exceed 15 minutes in the pose. Controlled blood pressure means a pressure below 140/90 using medication. A better criterion is: if you feel strain, get out of the pose. It is wise to practice gentler inversions for several months before moving to headstand (e.g. downward facing dog, bridge, half-shoulderstand, shoulderstand, in this order).
The good news is that practicing yoga and meditation for a few months can lower both systolic and diastolic blood pressures (by values of 10 -15 mm Hg).[/QUOTE]
Thanks Willem for your reply. So if I understand this correct, are you saying my tests showed me what it was supposed to show and there was nothing strange about it? I mean we always say headstand would increase blood pressure. So when we say this are we referring to the BP in ones head and not in ones arm or wrist? Honestly, I really find this strange.
By the way how does on measure the BP in the head?
By definition, blood pressure is the pressure at the exit of the heart (aorta). It is close to the pressure that you measure in your arm or wrist, provided that you keep it at heart level when measuring BP. The blood pressure is different at different locations in the body, e.g. higher in the feet and lower in the head when standing up.
In inversions, there can be a surge of blood to the head and a corresponding increase in local blood pressure. This short increase in blood pressure in the head (not at the heart) is the one causing potential risks of stroke. Once you are in headstand, the body will attempt to lower blood pressure. For uncontrolled hypertensives this adjustment can be impaired, putting them at greater risk than the rest of the population.
I don’t know how the blood pressure measurements were done in the medical studies. Some of the earlier studies may have just calculated the hydrostatic pressure from the distance the head was below the heart. It would be interesting to get hold of the more recent studies, like Gilmore (2002) so see what they have done. Perhaps the doctors on this forum will comment.
[QUOTE=yalgaar;25630]
By the way how does on measure the BP in the head?[/QUOTE]
Your “head blood pressure” is exactly the same blood pressure you’ll find in your arm, in our leg, in your genitals, etc. The differences you find are due to the method used (i.e. sphyngomanometer), rather than having a diffeent blood pressure in your body. If you have for example, a considerable difference between an arm an a leg (in controlled conditions), we could have a diagnosis of an aorta’s dissection, if you find a considerable difference between left and right arm you it could be due to Portal Hyper Tension, etc.
Now, if you are talking about high intracraneal pressure, well, that is SOMETHING ELSE. Your cranium is a closed cavity composed of three main elements: brain, blood and cerebrospinal fluid. By measuring the changes in the third you can calculate intracraneal blood pressure. By doing a lumbar punction or inserting a catheter for continuous monitoring in your fifth ventricle (inside your brain, which sounds incredibly extreme but is a 10 minute procedure) you can calculate such.
Your brain has a regulatory system for the blood pressure which works this way: If your blood pressure rises over the normal rates your body takes cerebrospine fluid out of your head to compensate for pressure. If the BP rises over 150/100 approximately (changes between individuals, but this is the percentile 50 rate), the regulation is lost and your intracraneal pressure rises.
[QUOTE=Willem;25635]By definition, blood pressure is the pressure at the exit of the heart (aorta). It is close to the pressure that you measure in your arm or wrist, provided that you keep it at heart level when measuring BP. The blood pressure is different at different locations in the body, e.g. higher in the feet and lower in the head when standing up.
In inversions, there can be a surge of blood to the head and a corresponding increase in local blood pressure. This short increase in blood pressure in the head (not at the heart) is the one causing potential risks of stroke. Once you are in headstand, the body will attempt to lower blood pressure. For uncontrolled hypertensives this adjustment can be impaired, putting them at greater risk than the rest of the population.
I don’t know how the blood pressure measurements were done in the medical studies. Some of the earlier studies may have just calculated the hydrostatic pressure from the distance the head was below the heart. It would be interesting to get hold of the more recent studies, like Gilmore (2002) so see what they have done. Perhaps the doctors on this forum will comment.[/QUOTE]
By definition, blood pressure is the force exerted by the blood to the arterial walls. It is measured in the aorta because its related to the peripheral vascular resistance which peak is found in the aorta.
The problem with a head stand is related to the fact it is much more difficult for return blood from your head to the heart due to simple gravity, and yes, it can cause blood stasis which increases the blood pressure inside your head.
[I]I agree [/I]when your pressure is not regulated a little increase might break the brain’s regulatory pressure system and cause intracraneal hypertension. [I] I don’t agree[/I] on the idea this is the cause of a stroke though. For a stroke you pressure would have to rise at least to numbers close to 200/100. Chronic hypertension though, causes arterial degeneration, including obviously, intracraneal arteries (Willy’s Polygon is how the main blood system is called), which can lead on pathologies including “head strokes” (sorry, it’s the only word I could think of not being a medical term to help everybody understand).
High Blood Pressure is called the “silent assassin”, because you never have a symptom until it is already too late.
The potential risks of headstand continue to intrigue me. Headstand can increase arterial blood pressure in the head as a result of (a) the effort of holding the pose and (b) the position of the head below the heart.
Based on recent measurements, I estimate that arterial blood pressure at the top of the head will rise to 165/121 in headstand. This estimate is higher than the earlier calculation of 150/110 made by Coulter (2001). Note that this estimate is valid for experienced yoga practitioners with normal blood pressures.
The response of hypertensive, inexperienced yoga students is expected to be much higher. Not being a doctor, I don?t know how these blood pressures will affect intracranial pressure and the risk of stroke. However, in my opinion, headstand is contraindicated for people with uncontrolled hypertension.
Background:
Recent measurements show that average brachial blood pressure will rise from 122/83 to 151/107 during 5 min. of headstand (Blank, 2006). The 15 females in this study were intermediate/advanced Iyengar yoga practitioners who practiced 6 hours per week and had an average practice history of 9 years. Earlier studies (McArdle, 1996) measured the effects of a 3 min (unspecified) inversion on 50 normotensive men and women and found an increase from 114/76 to 140/91. Many yoga writers refer to Coulter (2001), but he merely presents calculations showing that arterial pressure at the top of the head changes from 100/60 (standing) to 150/110 (headstand). Gilmore (2002) has not performed any measurements but refers to McArdle and Coulter.
Arterial blood pressure in the head is different from the pressure at heart level. There are hydrostatic pressure differences and slight viscous pressure losses to consider. According to Martin-Du Pan (2004), the pressure correction (in mm Hg) can be approximated by 0,76 h ? 5 with h being the distance in cm. I will use a distance of 45 cm from the heart (or upper arm) to the head and 25 cm from the upper arm to the top of the head in headstand. Resultant pressure corrections amount to 29 mm Hg and 14 mm Hg, respectively.
For the skilled yoga practitioner in Blank?s study (normal BP 122/83), I estimate that the blood pressure at the top of the head will change from standing (93/54) to headstand (165/121).
References:
Blank, S.E. ?Physiological responses to Iyengar yoga performed by trained practitioners?, JEPonline 9,1,February 2006.
Martin-Dup Pan, et.al., ?The role of body position and gravity in the symptoms and treatment of various medical diseases?, Swiss Med Wkly 2004.
McArdle, et.al. Exercise Physiology, William and Wilkins 1996
Coulter, Anatomy of Hatha Yoga, 2001.
Gilmore, R., ?The Effect of Yoga Asanas on Blood Pressure?, IJYT, 12 (2002).
Arterial blood pressure obviously rises in inversions, but so must intracrainial pressure simply because of the weight of blood backing up in the venous system, this will cause increaed leakage into the interstitual spaces upping intracrainial pressure. If this is so then inversions would actually reduce risk of stroke as the difference between intracrainial and arterial pressure would be equalised, and it is the difference that is the problem. Also if you go through the medical literature there doesn’t seem to be any correlation between head down positions and risk of stroke, you do find a correlation for glaucoma for instance. I emailed the professor of neurology at Zurich (Ralf Baumgartner) university on this subject last year, he felt is was highly unlikely that that headbalance would increase risk of stroke; he also said auto regulation failure was 220 sys or 120 dia. Personally I’m happy to teach inverteds to students with hbp if they are confident and secure in their practice.
[QUOTE=Peteblackaby;25836]Arterial blood pressure obviously rises in inversions, but so must intracrainial pressure simply because of the weight of blood backing up in the venous system, this will cause increaed leakage into the interstitual spaces upping intracrainial pressure. If this is so then inversions would actually reduce risk of stroke as the difference between intracrainial and arterial pressure would be equalised, and it is the difference that is the problem.
Also if you go through the medical literature there doesn’t seem to be any correlation between head down positions and risk of stroke, you do find a correlation for glaucoma for instance. I emailed the professor of neurology at Zurich (Ralf Baumgartner) university on this subject last year, he felt is was highly unlikely that that headbalance would increase risk of stroke; he also said auto regulation failure was 220 sys or 120 dia. Personally I’m happy to teach inverteds to students with hbp if they are confident and secure in their practice.[/QUOTE]
First and second assumptions contradict each other. If the arterial blood pressure increases, the blood wouldn’t “back up” in the venous system. On the contrary, it backs up in the arterial system. The head stands make the returning blood from the lower limbs to return to the heart with the help of gravity which increases the amount of blood in the arterial system, increasing blood pressure. As said before, the way to equalize intracranial pressure is by decreasing cebrebrospinal fluid in the cranial cavity, not due to “blood leakage”. The “leakage” you talk about is always returned to the system via the lymphatic system.
I agree I don’t see much of a relationship between a head stand and a stroke as stated before in this same thread, but here is no valid statistical study I can bring to prove such though 