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Inversions: Should You Go Upside Down if You Have Glaucoma?
Inverted poses are considered very beneficial, particularly in Iyengar yoga. Senior yoga practitioners often cite an inversion as their most essential yoga pose.
Sarvangasana (Shoulderstand Pose) seems to be a favorite. However, can anyone do yoga inversions? General contraindications include spinal disorders, hypertension and glaucoma. Recently, however, I’ve met yoga students with glaucoma who do brief inversions with the approval of their ophthalmologists. Hmm…
Around the same time, I read a PLOS ONE study published in December 2015 that measured intraocular pressure (IOP) in 10 subjects with primary open-angle glaucoma and 10 normal subjects during the following poses, each done for two minutes: Adho Mukha Svanasana (Downward Facing Dog Pose), Uttanasana (Standing Forward Bend Pose), Halasana (Plow Pose), Viparita Karani (Legs Up the Wall Pose). The researchers opted not to study Sirsasana (headstand) to see if less-inverted poses also affect intraocular pressure.
In both normal and glaucoma subjects, the following occurred:
Intraocular pressure increased in all non-upright body positions. Pressures increased within one or two minutes after entering a pose. Likewise they returned to baseline values a few minutes after exiting the pose.
(The prompt “return to baseline” is apparently one reason why ophthalmologists allow glaucoma patients to do inversions.)
Intraocular pressure change is directly related to body angle from upright to inverted.
Among the four study poses, Adho Mukha Svanasana caused the greatest increase, followed by Uttanasana, Halasana and Viparita Karani.
Intraocular pressure remains elevated while non-upright position is maintained.
Glaucoma subjects did not show more severe intraocular pressure increases than normal subjects. Both groups showed a rise in intraocular pressure between 6-11 mmHg.
Note: Limitations of this study include small sample size, short pose duration, no measurement of blood pressure and age variation between glaucoma and normal groups.
What the study could not (and did not) answer: Are temporary intraocular pressure increases safe for glaucoma patients?
I solicited my own eye doc’s opinion, and he was wary of inversions for glaucoma patients. He prefers not to take chances with possible optic nerve damage. A few minutes of elevated pressure day after day, he hypothesized, adds up over the years. Loren Fishman, MD, a longtime Iyengar yoga practitioner, also advises glaucoma patients to weigh the risks of increasing IOP during inversions. In a 2013 New York Times interview, he said, “I believe Headstand and Handstand are contraindicated by wide-angle and narrow-angle glaucoma.”
In a self-administered study he, then a 67-year-old male without glaucoma, held Sirsasana (Headstand Pose) and variations for 21 minutes. During this time, his intraocular pressure doubled from a 14-15 mmHg baseline to an average of 31-34 mmHg during the next 20 minutes of variations. (Personally I was reassured that intraocular pressure stabilizes during a long Headstand rather than creeping higher and higher.)
He found a similar 100% increase in Adho Mukha Vrksasana (Handstand) to 31-34 mmHg, but much smaller increases in Sarvangasana to 16-22 mmHg and in Halasana to 17-18 mmHg. Viparita Karani was measured at 12-14 mmHg, so intraocular pressure was stable and even dropped slightly.
He concluded that Sirsasana causes significant intraocular pressure elevation, but that intraocular pressure returns to normal once upright. For him–and for those without glaucoma–this temporary rise in pressure seems reasonably safe. There’s no proof otherwise, anyway.
But neither he nor the recent researchers make a recommendation either way for those with glaucoma. Perhaps, if glaucoma is managed with drugs or surgery, it doesn’t preclude inversions (or other poses that increase intraocular pressure). For those who don’t know they have glaucoma, however, increasing intraocular pressure above their already-high intraocular pressure might indeed damage the optic nerve.
What Poses Could You Give Up?
Ultimately the decision whether or not to invert depends on the individual. How risk-tolerant or risk-averse are you? What are you willing to continue or to give up, in the face of health risk?
In terms of yoga asana, how much would you miss Sirsasana and other inversions if you had to give them up? While Headstand is fundamental to my practice, there are myriad poses and even I, a creature of habit, could adapt to a no-headstand practice. It would be harder for me to give up Adho Mukha Svanasana. In any case, we must remember that yoga is more than poses, and avoid becoming dependent on any pose or habit or way of living.
Images by: Rope Sirsasana, Iyengar Yoga Association of Canada; study poses, PLOS ONE; glaucoma, London Eye Specialists
Study with Dr. Loren Fishman and Ellen Saltonstall - How to Make the Most Progress in Your Yoga Practice: Keys to a Safe Practice.
This article originally appeared on YogaSpy.com. Reprinted with permission.
Luci Yamamoto discovered Iyengar yoga in Berkeley in the late 1990s. A decade later in Vancouver, she decided to teach and now holds an Intermediate Junior I certificate. Luci's teaching is perceptive, articulate, rigorous, and always geared to the individual. She encourages students to challenge themselves and to appreciate the precision and depth of Iyengar yoga. In August 2014, she traveled to Pune, India, to study with the Iyengar family. Originally from Hawaii, Luci is a professional writer, editor, and Lonely Planet author. She blogs as Yoga Spy, yogaspy.com.