Neck Position in Camel Pose (Ustrasana) and Other Backbends

by Baxter and Janet Rae Humphrey

Margann Green, Age 77

We received this excellent set of safety recommendations for Camel pose for older adults from Janet Rae Humphrey, E-RYT, of YogaForStability.com in Scottsdale, Arizona, and wanted to share it with you all: 

Dear Nina and Baxter, 

As a yoga teacher who specializes in older adults ages 70 to 95, I would like to comment on your post Are Backbends Stimulating or Relaxing?

The photograph of Margann Green doing Camel inspires me to write about precautions that are necessary when teaching people over 70. At age 77 Margann’s ability to do a full Camel pose is remarkable and certainly shows the advantages practicing yoga as one ages. I see a distinct difference between the residents of senior living centers who have exercised all their lives and those who have not. The first group is far stronger, more flexible, and is less likely to use assistive devices. Those that begin a yoga practice in their later years also benefit greatly by the increased mobility that yoga offers. 

Camel is frequently performed and photographed with the chin up to the ceiling or the head tilting back even further. In yoga we follow the principle of doing no harm. Camel, therefore, as well as other poses, needs to be modified as we age. 

Baxter identified how aging affects the cardiovascular system in his post The Aging Heart: How Aging Affects the Cardiovascular System:

• Baroreceptors (see Why You Should Love Your Baroreceptors) become less sensitive with aging, which can contribute to sudden drops in blood pressure when you move from reclining to sitting or standing, and general dizziness. 
• The walls of the smallest blood vessels, the capillaries, can get thicker with aging, which could contribute to slower exchange of fuel and waste into and out of our body’s tissues. 
• Both the main artery leaving the left heart, the aorta, and other arteries in the body start to have changes in their connective tissue layers. This can lead to the vessels becoming stiff and less flexible, which in turn can make the heart work harder. 
• Arteriosclerosis, or hardening of the arteries (mentioned in #8 above), in which fatty plaque deposits inside the blood vessels cause them to narrow and which can totally block blood vessels. 
• Transient ischemic attacks or strokes can occur if blood flow to the brain is disrupted, as a result of arteriosclerosis, arrhythmias, and other factors in the CVS. 

These types of changes may affect the ability to do and/or the safety of a person assuming certain physical positions or yoga poses. 

I worked in the neurology department at several teaching hospitals and have seen the damage done by someone over 70 tilting their head back. Think stretching a piece of rubber tubing with fluid running through it. The shape changes from round to flat and the opening is greatly restricted. When the stretching stops, the fluid gushes through with increased pressure. 

When the head is tilted back, the carotid arteries in the neck become flat and the flow of blood to the brain is restricted. This can lead to a stroke or transient ischemic attack. Furthermore, when the head is lifted, blood rushes to the head, increasing the blood pressure. This becomes more problematic with aging because the baroreceptors are less sensitive to changes in blood pressure, the walls of the blood vessels are thicker, fatty deposits in the vessels further restrict the blood flow, and the capillaries in the brain are more likely to burst when they are under high pressure. 

One of the more common places for older women to have a stroke is in the beauty parlor when their hair is being washed. I mentioned this in a class I taught and one of my older students said that was where she had a stroke. 

I encourage your readers who teach people 65 and above to remind students to keep their chins tucked and not allow their head to fall back during back bends. One way to do this is to put one hand behind the head to support the head during a backbend. 

A second reason for older adults not to tilt their head back is the changes in the discs between the vertebrae as we age. Baxter discuss these changes in his post Degenerative Disc Disease and Yoga: 

"Degenerative disc disease is a process of change to the cushion-like discs found between the vertebrae or spinal bones. It most commonly affects the discs in the neck/cervical region and the lumber/lower back region. There is some ongoing debate on whether the deterioration of the discs is a natural part of the aging process (since it is seen in people without symptoms of back or neck pain in gradually increasing percentages as we age) or whether it is directly related to an abnormal condition of change in the discs. It is really part of the general wear and tear arthritic changes we see in other joints, as the discs represent a unique kind of cushion structure that is similar to the cartilage caps found on the ends of other bones in major joints of movement. But it is different from the regular cartilage in other joints in that it is a larger structure, not adherent to the vertebrae above and below it, as well as having a unique structure that distributes the intense force of gravity that travels down the spine in a specialized way. 

Not only do the discs degenerate, but they also lose moisture and become thinner and denser. Their cushioning ability decreases. A sponge fresh from the package is tall, soft and pliable. An old sponge that has been sitting on the counter is thin, dense and hard. The same is true for the discs as we age. The thinning of the vertebral discs is the major reason why we become shorter as we age. The natural padding in the spine degenerates with age and the cervical vertebrae can be crushed together when the head is tilted back. Older adults, both men and women, have a much higher risk of osteoporosis and can easily get compression fractures of the spine. Forward bends and twists can be hazardous for someone with osteoporosis because these postures can cause painful compression fractures of the spine. "

Poses performed in a supine position can also cause neck problems in older adults. If the student has hyperkyphosis or a tight front chest, their shoulders will not reach the floor in the same way that the shoulders of a younger students do. Because of the excessive curving of the thoracic area, the student will be lying on their spine and just the tips of their shoulder blades. In this position the neck is elevated off the floor and the chin is higher than the forehead because the entire back of the head does not reach the floor. One end of a folded blanked can be rolled to go under the neck and the other side folded to support the head so the forehead and chin are at the same level thus maintaining the correct cervical curve. 

These precautions are most important for people over 70, but they are good to consider in regards to younger students who have neck injuries, arthritis of the spine, tight shoulders, over developed musculature of the shoulders, arterial sclerosis, high blood pressure or other medical conditions that could cause changes in the arteries and the shape of the upper back. 

I remind my students, “Keep your neck in a normal cervical curve and in line with your spine. Being safe is more important than looking like the picture in the yoga book.” 

—Janet Rae Humphrey, E-RYT

Thoughts on Janet’s advice: 

First off, I am grateful to Janet for sharing her wisdom and experience with us regarding safety precautions specifically for Camel pose (Ustrasana), in which the head and neck are often taken into extension along with the rest of the spine. And I generally agree with her recommendations for modifications for those over 70 and even for younger adults who may have skeletal issues like cervical problems, pronounced thoracic kyphosis (rounding of the upper back), or osteoporosis. 

Keep in mind, however, that these are not hard and fast rules, and that those who older and are healthy and without risk factors for such problems (no diabetes, hypertension, hardening of the arteries, history of past heart attacks or strokes, arthritis, osteoporosis, etc.) and have good flexibility and strength may still be able to approach the full pose, under expert guidance. 

One key factor to consider is how long you are in such poses. It seems the risks of serious adverse events rise the longer you are in such an extended position, for example, longer than 5-10 minutes. I’d recommend, if you choose to try Camel with some head and neck extension, that you do it for very brief timings, say 10-20 seconds, and use support to start with. Or, as I do now, do it with the chin tucked to the chest and enjoy the backbend in the rest of your spine! 

Also, please note that Janet is referring mostly to neck awareness and cautions for Camel pose, which involves dropping the head back in space into the pull of gravity. I don’t have the same concerns for backbends like Cobra (Bhujanghasana) and Locust (Salabasana), where you are lifting your neck up and so have different forces acting on the neck. Taking the head and neck into extension in these backbends is generally not going to put you at risk for strokes and compression fractures of the cervical area. 

—Baxter

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