13 July, 2016

Yoga is therapeutic, both for the mind and the body. Yet there’s no denying that without proper instruction, its physical demands can lead to injury. Shoulderstand and headstand in particular are areas of concern. So what precautions can yoga instructors take to ensure student safety?

It was February of 2015 when Leena Miller Cressman, owner of Queen Street Yoga (@queenstreetyoga), made a decision that sent reverberations through the yoga world. She stopped teaching headstand and shoulderstand at her studio, and asked that students to “not practice these poses before, after, or during public classes for the safety of all QSY members.”

The decision was highlighted in this excellent post on Yoga International by Matthew Remski. It raised the question that all instructors (and instructional schools) must consider: Are there some poses that are simply too risky to teach?

Moving beyond yoga: Leena Miller Cressman

At the core of the debate is the potential for neck and spinal injury — both short-term and long-term — when performing the pose.  The possibility prompted Cressman’s decision — one she reached after years of training and research.

Leena Miller Cressman

She had always received instruction from her yoga teachers about how to practice poses safely, and she had imparted those lessons onto her students as well. But she began to conduct research beyond the yoga world, consulting with various medical practitioners. What she discovered prompted her decision.

“People have strong attachments and beliefs that are not evidence-based,” she said. “There’s a lot of hyperbole about the benefits of the poses.”  She explained her decision in this blog post, and she provides additional background in this short audio interview.

Yoga back and neck Injury: Why the risk factor is increasing

Cressman’s main concern centered around the following areas:

Medical benefits in dispute: A number of medical benefits have always been championed in regards to inversions, including improved blood pressure and heart function.  Cressman believes there’s not sufficient medical literature to support this.

Assessing current back situation: A student’s spine might be susceptible to injury, and because yoga teachers are not “trained medical professionals, osteopaths, or chiropractors,” they’re not in a position to evaluate risk.

Lack of supervision and consistency: Cressman believes if the position is taught at all, it should be “done in a small group setting, with an experienced teacher who can take the group through a regular practice that builds up the postures consistently over time.” But in today’s yoga climate, drop-in classes are more common.

Extreme Yoga: The head and shoulder stand are like the slam-dunk in basketball. People love to view the difficult poses on social media — and it may even be used by some studios as a marketing draw. That’s a reckless practice and invite newbies to reach beyond their training.

Should you teach shoulderstand and headstand or not?

Cressman said that her studio’s students were appreciative of her decision, thankful that she was concerned about preventing injury. In comments on social media and attached to the post, reactions were mixed.  

For the purists, the poses are integral part of yoga and they believed strongly that they should keep teaching them.

Cressman counters that “the poses (shoulderstand and headstand) in their traditional form, cannot be taught without significant risks in most cases, and those risks, in my opinion, don’t outweigh any benefits. I feel that alternatives can be taught safely and are preferable.”

Yoga teachers may feel the pressure from advanced students to teach the poses. So where does this leave you?  

Weigh the risks, consider all the factors

The decision to teach the poses is a personal one, and you should base it on research and the advice of your most qualified instructors.  

Allison Eaton of Yandara notes that it’s hard to make “a blanket approach” to just using alternatives, because many people do the poses safely – they have the physicality for it and have learned how to practice the pose safely.

However, because public classes are often mixed-levels, she personally isn’t likely to teach headstand or shoulder stand in a public yoga class.  

“In this (public) setting, I am more likely to teach Setu Bandhasana (Bridge Pose) or a supported restorative inversion like Viparita Karani (Inverted Lake Posture/Legs Up The Wall),” she said.

In a teacher training format, she (and Yandara) will break down both Shoulder stand and Headstand in lengthy workshops. “The teachers in training need to know how to safely guide people in and out of these poses if they choose to teach or practice them later on,” she said.

13 tips for teaching shoulder stand safely

The decision to teach Shoulder stand is a personal one, as was the case for Cressman. If you proceed, we recommend the following approach.

1. Be aware.

You’ve read this article. That’s a great first step. Now continue to educate yourself on the various medical views and the ongoing debate. Check out the varying opinions in Matthew Remski’s post, and note the resources Cressman lists at the end of hers.

2. Screen for pre-existing medical conditions.

Ask your students if they have have any of the following pre-existing conditions: Scoliosis, forward head posture, excess weight in the abdomen or breast tissues. You can set up a criteria that their medical practitioner should clear them on before they learn the poses.

3. Only teach in an advanced setting in which students attend on a regular basis.

As Cressman mentioned, you want to “build up the postures consistently over a period of time.” Teach the pose in a small group setting only to students who are advanced in their yoga training. We completely advocate one-on-one settings for the pose.

4. Assist in the pose.

If the student is in a Shoulder stand, the weight should be distributed between the shoulders and upper arms, not on the neck. Take care not to flatten the back of the neck to the mat. Instead, allow enough space so that you could easily slide 1-2 fingers between the neck and mat.

(Some practitioners prefer to use 1-3 folded blankets under the shoulders to maintain space at the cervical spine. To use blankets or not to use blankets is a personal decision and both options can have their pros and cons.)

As a teacher assisting Shoulder stand, there is the common assist where the teacher lifts the students legs up higher in an effort to create space so that the student can shimmy their elbows closer to the spine – which allows for more foundational support of the upper back and neck.

We do not recommend using the lift assist. However, if you choose to give this hands-on assist, take care not to lift student’s legs up so high that the back of the neck becomes over flexed (flat) to the floor which compromises the safety of the cervical spine.

Often when students come into Shoulder stand, they have already brought themselves to maximum flexion of the cervical spine, in an effort to lift their own legs vertical to the sky. Take note to see if the student’s neck is flat or approaching flat to the floor. If it is, do not lift their legs up higher.

Again, we do not advocate using the lift assist. Just use your vocal cues to guide and assist your students into Shoulder stand.

5. Go slow, and use vocals for the assist.

Guide the students to slowly lift their legs toward a full Shoulder stand. Have them start in Half Shoulder stand and assess the sensations they feel at the back of the neck as they shimmy upward half inch by half inch.

Your vocal cues can be more efficient and safer than your hands-on assists in this pose. Teach the student to do the pose by themselves, instead of you making them go deeper with your own physical assists.

6. Don’t do the pose while they’re doing the pose.

It is harder for students to hear you when they are lying on their backs and twice as hard if you are on your back and in the pose yourself. If they can’t hear you, they will start looking around for a visual.

You don’t want them to turn their heads in effort to see or hear you better because the neck is in a vulnerable position. Instead, stand above them and guide.

As an option, give the students a visual of Shoulder stand ahead of time by demonstrating the pose while they are in an easy seated position and can see you. Stand above the students and use your vocals to guide them in.

7. Your voice should be heard, not your music’s vocals.

Not only should you be speaking loud and clear, but avoid loud music or music with distracting vocals when teaching Shoulder stand. You don’t want your voice to compete with the music, as your students will already be straining to hear you.

8. Three is the magic number for cues.

Less is more when people are upside down, so keep your cues to minimum. Avoid giving more than 3 cues while the student is in Shoulder stand.

9. Provide modifications and variations.

As Allison mentioned earlier, she usually teaches a modified version of the Shoulder stand. Two good poses include Viparita Karani (Inverted Lake Posture) with either the hands or a block under the sacrum….

Viparita Karani (Inverted Lake Posture)

Viparita Karani (Inverted Lake Posture)

….or the restorative version of Viparita Karani with the legs up the wall and sitting bones tipping over a bolster.

Viparita Karani (legs up the wall and sitting bones tipping over a bolster)

Or substitute with Bridge Pose (Setu Bandhasana).

Bridge Pose (Setu Bandhasana)

Bridge Pose (Setu Bandhasana) w/ block

10. Prep certain areas of the body for shoulder stand.

If you know you’re going to be focusing on Shoulder stand toward the end of the class, then prep other areas of the body at the beginning of the class.

• Use strap work to open chest and shoulders.

• Engage in easy neck rolls.

• Downward facing dog is a great position that gets the back muscles fired up and the spine lengthened.

• Lengthen the psoas muscle through the back leg of a Lunge or Crescent Pose.

11. Translate the key points of Tadadasna (Mountain Pose) into Shoulder stand.

Everything you do in your feet, legs, thighs, tailbone, ribs, shoulder blades, etc. in Tadasana will translate into the inversion later on. Go through these points with the students when they’re standing up, then help them find the actions when they’re upside down.

12. Engage, engage, engage.

The more students engage their muscles the better, as it puts less stress on the vulnerable parts of your neck and upper back.

You want good, strong abdominals and legs. Spread the toes, hug the inner thighs, bring the navel to the spine. There should be a light engagement to the buttocks. The whole lifting action through the feet and tail bone should take the weight up and out of the upper back and neck. (But be mindful to not lift beyond your limits causing you to flatten or put extra pressure in the neck).

13. Re-acclimate and relax.

When you come out of Shoulder stand, take time to transition within a supine position before taking your next pose. Either transition in Savasana, or lying with knees bent, soles of the feet on the floor. Take a minute before the next pose to allow the spine and nervous system to rest and re-acclimate.

Are Western medicine and yoga starting to blend?

We’ve provided you with a number of preventative measures to avoid injury with your students. But you likely sense a great deal of uncertainty in both the yoga and medical fields as to how to proceed.

Perhaps voices like Leena and Matthew’s are speaking up because more yoga teachers are having medical training, and more are collaborating with medical practitioners.

Take the example of Dr. S. V. Karandikar of the Kabir Baug Institute for Yoga Therapy. As Matthew Remsik notes in the post, Dr. Karandikar and his staff sees students that have reported back or neck pain, and they are given x-rays or MRIs “before they are given a single asana.”

This isn’t a bad thing. As Yoga becomes more popular, medical practitioners will speak up about moves like shoulder and head stand and offer informed objections. That’s good for the health of your patients and the health of yoga.

As teachers, we have a lot to learn in this area. Just as we do in Yoga, let’s continue to explore, grow and extend in ourselves in new and beneficial ways.