High Blood Pressure and Inversions
The practice of Yoga poses (Hatha Yoga) offers tremendous health and wellness benefits, but certain health conditions require important modifications and omissions of specific asanas. High blood pressure is a serious health condition that generates many possible contraindications especially in Yoga postures that invert the head below the level of the heart.
High blood pressure (or hypertension) is the occurrence of abnormally high arterial blood pressure at resting state. High blood pressure can result from a variety of factors but is commonly associated with atherosclerosis (a common arterial disease in which raised areas degeneration and cholesterol deposits form on the inner surfaces of the arteries), poor dietary habits, lack of physical activity, and high proportions of body fat.
High blood pressure is a result of arteries having poor blood flow. This resistance to flow requires the heart to pump more vigorously in order to circulate the blood (oxygen and nutrients) to all the cells of the body. This extra effort placed on the heart has a wearing effect on heart tissues and places a greater amount of fluid pressure against the walls of blood vessels.
How Does High Blood Pressure Affect Yoga Poses?
When we invert the body such that the head is below the level of the heart, there is a tendency for blood to pool into the head. This pooling of blood into the head greatly increases when one also elevates the lower body and legs above the level of the head. When we do Yoga poses and other forms of exercise, there is an increased demand for oxygen by muscle cells.
The way that the body meets this increased demand for oxygen is by increasing heart rate and blood flow. So if we invert or place the head below heart-level during Yoga poses and other exercises, not only is there a pooling of blood in the head, there is elevated blood flow and pressure coming into the cranial region.
Normally, the body is adapted to handle blood pooling and mild pressure in cranial blood vessels. But if one already has elevated blood pressure at resting states, the sudden inversions in Yoga can add to the elevated blood pressure, thus generating pressure that is enough to damage delicate blood vessels in the brain. In severe cases, high blood pressure combined with inversions may cause blood vessels to hemorrhage.
Another area of awareness required, when high blood pressure is present, is the process of breathing. When one holds the breath while doing heavy exertion, blood pressure dramatically increases. This contraindicating effect is called the Valsava Maneuver. Many people are familiar with hearing fitness trainers saying “breath out” during the exertion stage of an exercise repetition.
Again, this breathing pattern not only keeps a steady flow of oxygen moving to the tissues but also has physiological benefits in preventing negative pressure occurring in heart and brain tissues. Therefore, when one has high blood pressure, holding the breath in Yoga poses or holding the breath in specific pranayama (breathing exercises) should be avoided.
If you have concerns about having high blood pressure, consult your physician. If you are diagnosed with high blood pressure, make certain you tell every Yoga teacher with whom you practice. Your Yoga teacher can then offer the appropriate modifications and variations in Yoga postures and pranayama.
Poses to Avoid When One Has High Blood Pressure
In simple terms, avoid Yoga poses that position the head below heart level especially when the practice or pose is vigorous. Here are examples of complete and partial inversions:
- Salamba Sarvangasana (Shoulder stand)
- Shirshasana (Head Stand)
- Adho Mukha Svanasana (Downward-facing Dog)
- Setu Bandhasana (Bridge or Spinal Lift pose)
- Uttanasana (Standing Forward Bend)
- Prasarita Padottanasana (Wide Leg Standing Forward Bend)
Having high blood pressure should not prevent one from doing Yoga. By understanding the degree of the health condition and by following the recommendations of physicians, one can still have a fulfilling Yoga practice with a wide range of Yoga poses.
Hatha Yoga Poses
Swami Svatmarama’s Hatha Yoga Pradipika (Light on Yoga) is one of the most influential early texts on hatha yoga practice. Written sometime between the 14th and 15th century CE, the text includes descriptions of 16 hatha yoga poses, eight pranayama (breathing) techniques and a number of different seals (mudras) to be used to redirect prana (energy) during meditation.
Swami Svatmarama believed that the regular practice of Hatha Yoga asanas could give “steadiness, health, and lightness of body.” As such, he recommended that the practice of yoga asana should be performed as the first step in the practice of Hatha Yoga.
Many of the postures in the Hatha Yoga Pradipika are variants on the full lotus pose, and as such are relatively advanced in nature. This article includes a brief survey of 10 of these hatha yoga asanas, an overview of their benefits and instructions for their practice.
Virasana stretches the ankles, gluteal muscles and other smaller muscles in the hips.
In modern day practice Virasana is performed with the shins facing downward with both legs parallel to the sides of a yoga mat. In contrast, Swami Svatmarama’s description of Virasana much more closely resembles the modern day for of Gomukhasana, (Cow-Face Pose). Instead of folding the legs back near the sides, this pose is done with one leg crossed over the other.
While the modern day equivalent of this posture includes specific positioning exercises for the arms, Swami Svatmarama only includes instructions on leg positioning.
Come to Dandasana, (Staff Pose – a seated posture with both legs straight). Cross your right knee over your left knee, and draw your right foot back near the side of your left hip. To do the same with the other leg, lean to your left and draw your left foot back near the side of your right hip.
One you’ve wrapped your legs into the initial position, lean forward and use your hands to press your knees closer together. With practice, one knee will stack on top of the other. Draw your feet tightly back near your sides, ground both sitting bones downward into the floor, lengthen your spine upward, and forward fold over your legs to deepen the stretch.
Kukkutasana, (the Rooster’s Pose) strengthens the chest, shoulders, arms, and wrists, and improves balance. Full performance of the posture requires the ability to comfortably sit in Padmasana (the Full Lotus pose)
From a seated position, draw your right foot into the half lotus pose by placing the blade edge of your right foot in your left hip crease. Lean back, grab your left foot, and draw it up and over your right knee in similar fashion. Continue sliding your left foot up the front of your thigh until the edge of the left foot rests near the right hip crease.
Once you’ve positioned your legs in the full lotus pose, thread your right wrist and forearm into the space between the muscles of your right calf, inner thigh muscles and hamstrings. Slide your left wrist and forearm into the same position on the other side.
To enter the final posture, rock backward slightly to get momentum. Next, rock forward quickly onto your hands and lift your buttocks off of the ground.
Uttanakurmasana (the Upside Down Tortoise Pose) stretches the muscles of the hips and the back. The pose also tones the abdominal muscles.
After holding Kukkutasana for some time, allow your hips to settle back down to the ground. Keep your arms threaded through your legs and roll onto your back. Belly crunch up, slide your arms even further through your legs, bend your elbows and hold your chin with both hands.
The Hatha Yoga Pradipika lists a number of specific benefits for Matsyendrasana (the Lord of the Fishes Pose). These benefits include increased appetite, the destruction of multiple diseases and the awakening of kundulini energy.
From Dandasana place your right foot in the half lotus pose. Roll your weight toward your right hip and cross your left ankle over the top of the right knee as if you were going to do the full lotus pose. Allow your left foot to rest on your thigh, just near your right knee.
To initiate the twist, draw your left knee toward your chest so that your left knee faces upward and place your left foot on the floor. Twist your torso to the left, cross your right elbow over the leg and grab your left foot with your right hand. Place your left hand on the floor behind you to stabilize the balance, or alternatively, wrap your left arm behind your back to grab your right inner thigh.
Paschimottanasana (the Intense Back Stretch) is a deep stretch for the entire posterior chain of the body. The posture creates openness in the calves and hamstrings and can relieve tension in the back muscles as well.
According to Swami Svatmarama, Paschimottanasana is one of the most important hatha yoga asanas. He claims that the posture increases health, reverses the breath’s flow, improves digestive power and flattens the belly.
While the modern form of this posture is typically taught with a relatively straight spine, Swami Svatmara’s variation integrates strong spinal flexion for a deeper stretch to the back muscles. Because of this, the text directs the practitioner to rest their head on their knees as opposed to the shins.
From Dandasana, straighten both legs. Grab the flesh of your buttocks and slide your sitting bones backward to tilt your pelvis forward. Internally rotate your thighs by rolling your upper thighs inward and reach forward to grab your big toes. Ground downward through your hip-creases, pull your belly in and elongate your spine. Forward fold, and allow your head to rest on your knees.
Mayurasana (the Peacock’s Pose) is a challenging posture that strengthens the wrists, chest, shoulders, back muscles, and the gluteal muscles. Regular performance of the posture also improves balance.
The Hatha Yoga Pradipika attributes a number of benefits to this hatha yoga pose. According to the text, this posture is said to be good for digestion and is purported to have the ability to overcome poisonous snakebites. It’s also credited with the ability to overcome numerous diseases, including enlargement of the spleen and enlargement of the abdomen.
Come to a kneeling position on your shins. Sit on your heels and slide your knees apart until they’re slightly wider than hip’s width apart.
Place your hands on the floor between your legs, with your wrists facing forward and your fingers facing your waist. Lean forward, place your elbows on your abdomen and transfer your weight forward until your knees lift off of the floor. Maintaining the balance, straighten both legs as you continue to hover.
Dhanurasana (the Bow Pose) stretches the hip flexors, abdominals, chest and shoulders. The posture also strengthens the back muscles.
In the modern day form of this hatha yoga asana, the arms are extended backward and the ankles are clasped in order to open the chest. The version in the Pradipika integrates a more challenging overhead bind into the posture for a much deeper shoulder opening.
Lie down on your belly and prop yourself up on your elbows like a sphinx. Bend your legs and externally rotate your ankles so that your toes point outward toward the sides of your mat.
Rotate your torso to your right, turn your right hand upward, and clasp the inner arch side of your right foot with your right hand (or alternatively, your big toe). Press your right foot upward into your right hand and rotate your elbow outward and upward until your elbow points toward the ceiling. Continue to hold on, rotate your chest left, and do the same on the other side.
Bhadrasana (the Auspicious Pose) stretches the the inner thighs and opens the muscles of the pelvic floor.
In modern practice, this hatha yoga asana is more commonly known as Baddha Konasana (the Bound Angle). While the modern form of Baddha Konasana often integrates spinal flexion with a variety of different forward folds, Swami Svatmarama’s variation is done while remaining upright.
Draw your heels toward your inner groin and allow your knees to drop outward like the pages of an open book. Place your hands behind you on the floor, lean forward slightly and slide your hips closer to your heels.
Once you’ve positioned your hips and legs, reach around to grab your feet or big toes with both hands. Sit up tall and press your knees outward and downward toward the ground.
Padmasana (the Lotus Pose) is an excellent pose for seated meditation because it makes it very easy to avoid slouching. The posture also creates openness in the hips and inner thigh muscles. In addition, the Hatha Yoga Pradipika mentions that this hatha yoga pose also clears blockages in the body’s energy channels (nadis) when done regularly.
Come to a comfortable, cross-legged seated position with your right leg crossed in front of the left. Pick up your right foot with both hands, swing your right knee out to the right hand side of the room, and draw your heel closer to the front of your body. Continue pulling your right foot inward toward your belly and slowly swing your right leg to the left until the edge of your right foot rests in your left hip crease.
Once the right leg is in the half lotus pose, place one hand behind you on the ground and lean backward. Use your other hand to pull your left leg upward and over your right knee. Slide your left foot to the right hip crease.
Once your legs are in the full lotus pose, Swami Svatmarama recommends that you sit up tall, place your upturned hands on your thighs, and redirect your eyes to the tip of your nose.
The Hatha Yoga Pradipika mentions that Savasana (The Corpse Pose) is restful for the mind and good for removing fatigue.
Lie on your back with both eyes closed. Slide your legs apart until your legs are positioned hip’s width apart or wider, and let your big toes fall outward toward the sides of the room. Slide your arms out from your sides as well. Your palms can either face upward or downward.
Close your eyes, and redirect your focus to your breath.
Please note, all asymmetrical postures should be done on both sides. A full overview of all 16 hatha yoga poses can be found in Brian Dana Aker’s translation of the Hatha Yoga Pradipika.