Admittedly, there is some gratification in knowing that medical advice now supports what should have been part of asana teaching for decades. A 45-year old woman, a glaucoma suspect, is advised by an ophthalmolgist to avoid inverted positions such as a headstand and “semi-inversions” such as downward dog. This was discovered in the post by the ophthalmologist Dr. Carolina Valdivia on her blog http://www.glaucoma-eye-info.com/yoga-positions.html.
With increased attention regarding yoga injuries in the main stream media, there is some openness now that did not exist some years ago. This is a welcome change for everyone. Yoga injuries are not a badge of honor or any indication of a high level of personal commitment to an asana practice. This attitude to yoga is completely misguided. The risks and limitations of asanas are still not part of most yoga teacher training programs.
Dr. Valdivia answers the following question by a 45-year old woman from New South Wales, Australia:
“Hi Dr. Valdivia. I have been very recently diagnosed as a glaucoma suspect, but at the moment my eyes are healthy. I am not taking any medication for it.
I practice yoga and my eye specialist has told me that because I am a glaucoma suspect I should not attempt any fully inverted yoga poses (legs above the head, for example: headstand) and to limit time spent in semi-inverted yoga poses and postures (head below the heart, for example: downward dog).
My question is, how many seconds can I safely hold the semi-inverted yoga poses and postures before I create an eye pressure problem?”
In response to that question. Dr. Valdivia gives an extended and thorough explanation that readers can read via the above link. However, for people who do not like to click, here are the commonly identified triggers which cause a temporary increase in intra-ocular pressure (IOP) that must be avoided not just for glaucoma but for macular degeneration, high myopia, retinal tears, and retinal detachments.
- Abrupt or sustained physical exertion, such as lifting a heavy object.
- Bending over, while standing or sitting, so that the head is below the heart.
- Straining during defecation.
- Playing a brass or woodwind musical instrument.
- Wearing constrictive clothing around the neck.
- Various acrobatic or gymnastic maneuvers.
- Certain yoga positions.
Several scientific studies have specifically investigated the effects of yoga positions on generating high intra-ocular pressure in adults. The concern has been that not only do certain yoga positions carry a risk of creating a transient eye pressure problem, these positions often are held for extended periods, which carries the risk of sustained high intra-ocular pressure.
Here is an outstanding table from Dr. Valdivia’s post that illustrates how some commonly practiced inversions increase intro-ocular pressure:
The table below presents combined (meta-analysis) data obtained from 12 published studies looking at the effects of various yoga positions on intraocular pressure (IOP). Particular emphasis is given to inverted yoga poses and those that are semi-inverted. Participants in the studies were free of ocular disease, were between the ages of 22-63 years, and ranged from intermediate to advanced levels of proficiency. Average intraocular pressure at a seated position for this combination of studies was 15.2 mmHg.
AVERAGE IOP AFTER
INCREASE IN IOP
|33.6 mmHg||+18.4 mmHg|
|33.2 mmHg||+18.0 mmHg|
|33.5 mmHg||+18.0 mmHg|
|33.9 mmHg||+18.7 mmHg|
|Pincha Mayurasana (peacock
|31.5 mmHg||+16.3 mmHg|
|Eka Pada Viparita Dandasana (one-legged inverted-staff
|28.2 mmHg||+13.0 mmHg|
|Utthita Pada Sirsasana
|33.7 mmHg||+18.5 mmHg|
(attempting to forcibly exhale
while keeping the mouth and
|38.1 mmHg||+22.9 mmHg|
|Adho Mukha Vrksasana
|34.8 mmHg||+19.6 mmHg|
|25.4 mmHg||+10.2 mmHg|
|22.4 mmHg||+7.2 mmHg|
|Halasana (plow pose)||19.0 mmHg||+3.8 mmHg|
|Adho Mukha Svanasana
|19.9 mmHg||+4.7 mmHg|
|Setu Bandha Sarvangasana
|24.3 mmHg||+9.1 mmHg|
|Urdhva Mukha Svanasana
|14.5 mmHg||-0.7 mmHg|
|14.0 mmHg||-1.2 mmHg|
|Virasana (hero pose)||13.8 mmHg||-1.4 mmHg|
|Padmasana (lotus pose)||13.7 mmHg||-1.5 mmHg|
Meta-analysis by Carolina Valdivia Cáceres, MD and Ángela Pattatucci Aragón, Ph.D., 2011.
Dr. Valdivia advises the woman:
Spikes in high intraocular pressure appear to be immediate upon entering yoga poses and postures. Thus, there appears to be no safe period of time for you to practice either inverted yoga poses or semi-inverted yoga positions.
Here we have one doctor saying no inverted or semi-inverted positions and one saying semi-inverted positions are not to be held for extended periods of time. What is “extended period of time”? To me, it is anything beyond 10-15 seconds but depending on the individual experience even that may be too much–we generally did not hold more than 5 seconds.
Why the gratification? Because ever since I have been teaching yoga, new students were asked about any medical conditions and family history of eye problems. Returning students were asked about changes in medical conditions. This way, they could be cautioned about what to avoid and modifications, where possible, could made for them. When people who said they had a family history of glaucoma (or high blood pressure, cardiac problems, GERD, high myopia, hernia, etc.) were told they could not do the only inversions we did sometimes do–the shoulderstand and the plough (a modified plough), the explanation was almost always received with disbelief. They said that no other teacher said this to them and it was taken as an unnecessary restriction that limited the physically challenging practice they wanted.