King and Queen No More?

Headstand, Shoulderstand, and the Yoga of Experience and Evidence

February 16, 2015    BY Matthew Remski

Framing the Problem

Leena Miller Cressman, my colleague at Queen Street Yoga in Kitchener, Ontario, recently posted an explanation for why the studio doesn't teach headstand or shoulderstand, and why she has taken the further—some would say radical—step of strongly requesting that students not practice these postures in the studio space, even outside of class time.

Her reasoning goes like this:

  1. The oft-touted health benefits of the "king and queen" of asanas are not sufficiently supported by medical literature.
  2. Most North Americans present with device-induced forward head carriage, which heightens the risk of bearing weight on the cervical spine.
  3. Cressman’s personal experience of pain associated with these postures has convinced her that even high levels of yoga training (compared to industry standards) have not equipped her or her staff to adequately assess the spinal health of her students, or how to gauge the effects of these poses as practice proceeds.
  4. If the postures aren't instructed in classes, her faculty can't be assured that students who improvise them before, during, or after class time have any training at all.
  5. Inversion show-offism can either intimidate or encourage others to crave or try the poses, also without supervision. (This fifth point is not fully fleshed out in the post itself, but Cressman has confirmed her thoughts on it with me via email.)

Cressman’s post was well-received by her community. But in the online beyond, it struck a spinal nerve, so to speak, exposing sharp divisions of views, approaches, and—most importantly—epistemologies.

Informed concern about the practice of postures like headstand is nothing new. No less a figure than Dr. Timothy McCall, medical editor for Yoga Journal, has suggested that headstand is “too dangerous for general classes."1 Like Cressman, McCall’s view is informed by personal experience. He cites headstand as a possible factor in his diagnosis of thoracic outlet syndrome, a condition in which the arms and hands periodically throb with pain resulting from neurovascular compression in the shoulder girdle.

In my own research for the WAWADIA project, I’ve spoken to several medical professionals who support McCall’s position by expressing doubts in two areas. They question whether there is any health advantage to bearing more than cranial weight on the cervical spine, and they wonder, along with Cressman, exactly how many people have the requisite skill, training, and mindfulness to perform these inversions safely.

On the other side of a growing cultural divide, some long-term practitioners say that the postures are not only essential to personal development, but absolutely safe, given the correct instruction and intelligence. Taken together, the spectrum of views traces the contours of an intractable debate: Is the posture inherently healthful (or dangerous), or is it healthful (or dangerous) only according to how it’s performed?

When facilitating discussion in yoga philosophy, I always try to show students that it’s useful to identify and avoid potentially false dichotomies. In the case of the inversion debate, a third possibility might be to investigate the posture as a cultural artifact, defined not by the edicts of gurus or the MRIs of orthopedic surgeons, but by the reality of how most people practice it. Looked at this way, we might avoid making idealism (these poses should be safe) the enemy of pragmatism (it’s really hard to make them safe).

Let’s suppose there are safe ways of performing these inversions, but that very few practitioners have access to these ways or the skill to execute them. If the inversion is a cultural artifact rather than an ideal form practitioners should aspire to, how does it help to say that everyone who attempts it and hurts their necks is “doing it wrong?" And what about practitioners who felt assured that they did have safe instructions—from Light on Yoga, for example, in which Iyengar advises that in headstand “The whole weight of the body should be borne on the head alone”23 —only to suffer from chronic neck pain years later?

A Few Nuanced Voices

Can these postures be performed safely?

Here’s a brief survey of nuanced opinions that walk a middle ground between aspiration and practicality. They mostly come from my WAWADIA informants, who were so generous with their email responses they’ll have to forgive me for excerpting and paraphrasing them.

In direct contradiction to his lengthy Iyengar training, Richard Rosen has suggested that headstand should be performed with little to no weight upon the cervical spine.3

Yoga anatomist Leslie Kaminoff is more liberal: “The cervical vertebrae are small and delicate compared to the lumbars, but that doesn’t mean they are so fragile they can’t take any weight. After all, when upright, the cervical spine is supporting the weight of the head. It’s a question of intention, distribution and joint balance.”

Amy Matthews, Kaminoff’s colleague at The Breathing Project in Manhattan, extends his thought. “I wouldn't endorse any statements about the benefits of these inversions, but my take is that they can be done safely. I think safety requires a fair amount of time spent in deep inquiry about how the body is organized, and how to turn that support upside down.

Matthews continues: “Many people I see in my classes are not yet ready to do headstand—often because they have some pre-existing postural patterns that when turned upside down would make it much harder for them to find support (like the head-forward position Cressman mentions).

“But the existence of the patterns isn't a reason to not do headstand. It's a reason to approach it with a lot of attention and care. There is a lot to be learned from the inquiry, and I consider every step of the process 'doing the pose.'”

Yoga TuneUp creator Jill Miller comes at the question from another angle, implying that even “safe” instructions coupled with movement intelligence may not be worth the risks: “Just because you can do the pose, doesn’t mean you should do the pose,” writes Miller. “I am one of those “lucky/unlucky” practitioners who has the range of motion in the shoulders and neck, along with the upper body strength, to get into these poses ‘safely.' But I don’t.

“You only get 7 cervical vertebrae and their associated discs in this lifetime. You only get one posterior longitudinal ligament in this lifetime, and the more you consistently overstretch it with the pressure and position that shoulderstand/plow require, the more slack you create in the soft tissues of your back body.

“If those tissues become weakened, they may not hold the harder structures like bone and cartilage properly, and the muscles can overwork as a result. This can cause trigger points, muscle imbalances, and can lead to pain and poor proprioception. It sucks when you can’t get a clear sense of your head and neck carriage, given the precious real estate that they contain.

“Furthermore,” Miller adds, “we have to be honest: Even if the practitioner has the range of motion for these poses, we have no evidence of what the ‘minimum or maximum dose’ is for musculoskeletal health in these shapes.”

Yoga Therapist Jules Mitchell, M.S., was able to squeeze out some thoughts between travel connections in her teaching schedule, which has filled up completely since her graduate thesis in the science of stretching and tissue loading (with a special concentration on applications to asana) was accepted by CSU at Longbeach. She offers this:

“If we take a step back and use some biomechanical logic, it becomes very evident that the general population is not prepared to practice these poses. Human tissues adapt over time to applied—but also unapplied—loads. The average 30-year-old student has probably not spent a lot of time bearing weight on the head. So the cervical vertebrae, along with all the surrounding ligaments, tendons, muscles, and nerves are not adequately prepared to take on the compressive and tensional loads associated with these poses.

“Can these tissues be adapted over time?” Mitchell asks. “In many cases, yes. Is that something that should explored in a group class setting? Probably not. Firstly: yoga teachers are not required to be trained in biomechanics. Second: it is unreasonable to expect yoga teachers to be responsible for knowing the loading history of all the students in a drop-in class.”

Edmonton Yoga therapist Michele Theoret also steers the question back to the situational: "We hear about the circulatory and nervous system benefits of these poses, but in terms of classroom practicalities, we have to remember that many studio practitioners have one or more of the following: scoliosis, forward head posture, excess weight in the abdomen or breast tissue, little awareness of the "shoulder joint"—which is actually four joints and not one—all while fighting a general sense of shame around their body and performance. We also have to remember that most studio teachers are educated in an outdated and often generalized script, and have little idea how to approach delicate situations with much besides aspirational statements like 'practice and all is coming.'"

What most of my sources agreed on was the necessity of navigating the narrow passage between bubble-wrapping each studio with the impossible wish that no one get injured, and finding a space in which the transformative values of faith, uncertainty, and judicious risk are supported.

The Scope of Practice Question

So if headstand and shoulderstand are only teachable if seemingly strangled by so many caveats, should the biomechanics training of studio teachers be upgraded for those who want to teach them? As a yoga anatomy educator, Kaminoff has built his practice on providing graduated levels of training for practitioners and instructors. But he’s adamant about defining his scope of practice, and maintains a strong distinction between “yoga educators” and “medical and therapeutic practitioners."

"Is it really a yoga teacher's job to diagnose the spinal health of their students?" he asks. “We're not doctors or radiologists. What about equipping teachers to help students to tune into their bodies, so they can assess their own joint, breath, and spinal sensations? I want to help students feel confident about living in their bodies—not fearful.”

However, as increasing numbers of yoga teachers and trainers bring pre-existing biomedical expertise into the yoga studio—foreshadowed by certain scientizing forefathers of MPY like Swami Kuvalyananda and Sri Yogendra4—Kaminoff’s distinction between the yoga teacher as “informed guide to confident self-awareness” and the yoga teacher as “diagnostician” is being smudged by many. In my own personal circle of colleagues alone, I know more than a dozen teachers and trainers in asana who are also certified osteopaths, physiotherapists, kinesiologists, neurologists. I even know a neonatal surgeon who’s working towards entering a YTT program. These crossover practitioners are definitely changing the expertise landscape of asana.

Even this isn’t new, nor a predominantly North American thing. David McAmmond is one of Canada’s most senior and respected teachers. He’s also one of the only long-term students of Dr. S. V. Karandikar of Pune, India. Over curries in Calgary, McAmmond told me that Karandikar was Iyengar’s yoga student and on-call doctor for over a decade, until the guru’s verbal abuse drove him across the Mutha river to establish the Kabir Baug Institute for Yoga Therapy.

Dr. Karandikar and his staff see thousands of yoga therapy clients each year. McAmmond tells me that all clients are referred to laboratory testing before yoga treatment begins. Every client that reports back or neck pain is sent for x-rays or MRIs before they are given a single asana.

Why is Karandikar virtually unknown beyond India, while the opus of his late mentor (who had no formal medical training at all) remains the universal go-to for yoga therapeutics? To me, this suggests that the global yoga demographic is more interested in intuition, charisma, and an exclusively pranic model of healing than in the biomedical methods it distrusts, but then relies on when things really go south.

What Knowledge, Which Authorities?

Cressman may have been making some rather simple studio policy statements about a few postures, but the response to her post has revealed the epistemological turmoil at the heart of modern postural yoga, not to mention the strain between serving the hyper-individualism of modern practice and the necessity for sound group exercise policy.

Numerous Facebook commenters on the various shares of Cressman’s post rejected her reasoning outright. They spoke of their enjoyment of the poses, and how they’ve reaped great benefit from them. “I love these poses.” “They’re the most important poses in yoga.” “I wouldn’t go to a studio that told me what I could and couldn’t do.” “Aren’t we all adults? I know how to take care of myself. I listen to my body.”

I think: Well, maybe you do, and it’s great that that’s worked out for you so far. But how about everyone else? How about those who listen to their bodies and are still injured?

It’s worth noting that most pushback to Cressman’s plan offers little but personal testimony and anecdote. This is to be expected, since yoga’s most immediate gift seems to be the enhanced subjective awareness provoked by the revelation of intensive self-care and inquiry. This is the same gift, however, that seems to elevate motivated reasoning and confirmation bias into the lingua franca of modern yoga. And we’ve seen subjective claims taken to absurd conclusions as entrepreneurial teachers copyright and evangelize personal epiphanies into commodified methods (cf. John Friend’s “Universal Principles of Alignment”).

Especially defensive are the teachers who make evidence-free claims like: “I’ve taught these poses safely for years.” This is a meaningless humblebrag, unless the teacher has sophisticated tracking data for students extending far beyond their period of membership at the studio. I teach at a lot of studios and don’t know any that track long-term outcomes. It would take a lot of effort, and a commitment on the part of studio directors to a far different level of evidence-based service.

In cash terms, I can understand why these teachers may automatically reject the suggestion that headstand and shoulderstand should be taken out of public circulation. These are central postures to the workshop and graduated-practice economy through which students are encouraged to “deepen their yoga." My yoga-teaching partner calls them “carrot postures,” because while most practitioners know that they’ll never put their legs behind their heads, they can be easily convinced that with a little encouragement they can push themselves up into headstand. Safe or not, the Wow Factor here is high. When a student comes home from class and blurts out to her partner: “I stood on my head today! I haven’t done that since I was six!”—this is yoga studio gold.

If this discussion is ever to be resolved, the yoga world will have to get straight on its issues with evidence and authority. This seems acutely important in a poorly-regulated industry that seems hell-bent on remaining poorly-regulated until public health authorities step in. Will exercise scientists rule the day? Or are they not committed enough to extra-physical yogic ideals to merit our attention? If we finally admit that the main students of Krishnamacharya knew virtually nothing about modern biomechanics, will we lose faith in their other gifts? If the guru doesn’t know everything, can he still be the guru? How many people, with how many areas of expertise, can sit on the teacher’s seat? And what is the appropriate amount of responsibility to be assigned to the student?

Beneath the controversy, the implications of Cressman’s policy may provoke a meditation on those primal questions of childhood that likely set us all off upon the yogic journey: What is this? How do I do it? Why? Who will show me? How will I know anything for certain? That we can never see ourselves clearly binds us to each other in the mystery of learning. Guru, doctor, broader community, or Google Scholar—we will undoubtedly reach out to others. The question to ask is whether we will reach out to be changed, or to confirm what we already think we know.

One thing is for sure. Whatever the fate of headstand and shoulderstand, one pose should clearly be junked: the posture of self-certainty.

_____

Note: Special thanks to those sources who because of space limitations I haven’t been able to include: Jason Brown, who teaches yoga anatomy in Manhattan, and Rolfer Maria Christina Jimenez, who teaches yoga anatomy in Los Angeles. I’d also like to acknowledge William Broad’s compilation of headstand references in his Science of Yoga, which I have cherry-picked here, but used in a substantially different way.

References

  1. McCall, T. (2007). Yoga as medicine: The yogic prescription for health & healing: A yoga journal book. New York: Bantam Books. pp. 499-500.
  2. Iyengar, B.K.S. (1979). Light on yoga: Yoga dipika (Rev. [pbk.] ed.). New Schocken Books. p. 187.
  3. Richard Rosen, “Taking the Danger out of the Headstand,” Yoga World, vol. 1 no. 9 (April-June 1999), pp. 3-4. 
  4. For more on this fascinating subject, check out Alter, J. (2004). Yoga in Modern IndiaThe body between science and philosophy. Princeton, N.J.: Princeton University Press.

Matthew Remski
Matthew Remski has practiced meditation since 1996 and asana since 2000. He’s taught yoga, yoga philosophy, and ayurveda in Toronto and beyond since 2005. He maintains an active ayurveda consultation practice from his home, which he shares with his partner Alix, son Jacob, and someone else who's on the way. He’s authored several books on yoga and related subjects, and is working toward completing What Are We Actually Doing in Asana?—an examination of pain, injury, and healing in modern... Read more>>

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