Friday Q&A: The Safety of Headstand (Sirsasana)

Q: There is a lot of controversy these days about the safety of Headstand. What is your opinion about its safety?

A: Just recently, I read an article by Grace Bullock, Ph.D., E-RYT 500, Headstand and Neck Safety in Yoga: What You Need to Know about a recent study Sirsasana (headstand) technique alters head/neck loading:Considerations for Safety in the Journal of Bodywork & Movement Therapies.

In the study, researchers in Austin, Texas, observed a group of experienced yoga practitioners entering Headstand (Sirsasana), maintaining the pose for 5 breaths, and then exiting the pose, using specialized techniques and technology to measure the forces at work on the neck and head area. The practitioners had one of three ways of moving into Headstand, as shown in the illustration above: 

1. straight legs going up together
2. bent knees going up together
3. bent knees, going up one at time

In all three groups, the amount of weight born by an individual’s neck and head was 40-48% of his or her total body weight. This is in contrast to the assertion is often made by yoga teachers that in this pose the neck and head bear very little of the body weight and the arms bear most of it. Now, can you imagine a 163 lb. person, like me, regularly carrying a 65-78lb. weight around on the top of his head and it not leading to problems in his neck?

They also observed that the longer the practitioners were in the pose, the more weight their heads and necks were bearing, and they were only in the pose for 5 breaths, around 30 seconds or so. Now, most classes I attend that include Headstand have you in the pose for a minimum of two minutes. So, using myself as an example again, this would mean that as time goes on the weight on my head might start to be more like 80-90 pounds.

The investigators also were able to observe side-to-side shifting of the weight on the head and neck during all three the phases of the Headstand, and although it was less noticeable in those that could go up and down with both legs straight, this side-to-side shifting did happen in all three methods of moving into and out of the pose. And the more side-to-side shifting that occurs, the higher the risk of injury is to the neck structures and tissues.

Keeping in mind that these were all experienced practitioners in the study, I can surmise that new and inexperienced practitioners are likely to be putting much higher pressures on their necks and have a lot more shifting of the weight on their necks in the learning process, thereby increasing their chance of injury.

Following an incident where my car met a deer on a country road a few years back, my neck did not come out of the encounter unscathed. So I have let go of Headstand, as it typically worsens my neck symptoms. I have also dropped it from my teaching because of my concern that the risks of doing full Headstand outweigh its benefits, especially in light of the safer poses I can substitute in its stead, such as Forearm Balance (either Pinca Mayurasana or “Headless Headstand”) or using a Headstander prop. Forearm Balance and using a Headstander provide some of the same benefits of an inversion that Headstand provides, reversing the blood flow and encouraging return of venous and lymphatic fluids, all without the risk of cervical injury. In addition, using the Headstander prop for longer holds adds the calming and grounding effects some people experience with Headstand.

So this new study confirms my personal and professional preference in this regard. And, in her article, Grace points out several other contraindications to doing Headstand that are important to remember: osteoporosis/osteopenia, hypertension, glaucoma, detached-retina, pregnancy, menstruation, cervical injury or dysfunction, heart conditions, or other serious medical diagnoses.

Regular readers of our blog know that I believe yoga is generally safe and well tolerated by most people. But there may be a few exceptions, such as Headstand, where we need to be more discriminating about who learns and practices it. If you are going to practice Headstand, you may want to work towards the straight legs entry and exit, as that method had slightly lower pressures on the neck than the other two ways. Grace provides some good guidelines in her article, which I agree with, that you can check out on your own at Headstand and Neck Safety in Yoga: What You need to Know.

—Baxter

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