Keeping Yoga Safe for People with High Blood Pressure

by Timothy

Monterey Cyprus by Melina Meza

I recently taught a course on Yoga for High Blood Pressure on Yoga U Online. During the program I suggested that doing certain inverted poses such as Headstand (Sirsasana) may not be a good idea, even for some people whose blood pressure (BP) is “well controlled” by medications. But one listener had heard during her teacher training that inversions were okay in this situation. Her instructors had consulted a local cardiologist and shown the doctor the poses in question, and he had said he didn't have a problem with them in people whose BP was under control.

The concern is that when you go upside down, the pressure in the head increases, which could at least theoretically increase the risk of a stroke. I say theoretically, because actually no one really knows how large the risk is, though it's likely very, very small. As I've written elsewhere, more than likely yoga greatly decreases the overall risk of a stroke. But that doesn't mean it's a good idea to push your luck.

Interestingly, blood pressure is one area where yoga teachers are sometimes more conservative than doctors. Aadil Pahkivala, the teacher I worked with on the high blood pressure chapter of my book Yoga as Medicine, has found that some people with well-controlled BP nonetheless demonstrate jitteriness when they do some inversions and strong backbends. This nervous system agitation, which can be visible to the teacher and palpable to the student  (at least the ones who have developed their internal awareness though their yoga practices), suggests a potential problem.

In medical school, we were taught to always weigh risks vs. benefits of any test, drug or medical procedure under consideration. In medicine, this comes under the category of “first do no harm.” In yoga, we've got the same idea with the notion of ahimsa, non-harming, which is considered the foundation of any yoga practice. Again, the risk of a stroke when inverting with “well-controlled” high blood pressure is likely very small, but even a tiny risk of something very bad should be factored in when deciding whether or not to do a particular yoga pose. In yoga, a crucial way to assess safety is to study your student—or yourself, if you're the student in question—as they do the practice in question.

So rather than simply saying, “The doctor says it's okay to do Headstand so let's do it,” a more prudent approach is to let that be the beginning of your evaluation. If you're a teacher, consider the following questions: Does the student appear to have the strength and flexibility to do the pose safely? How is their breathing in the pose? Do they look uncomfortable? Are they able to maintain a healthy curve in the neck? Are their neck veins bulging? How do they say they feel in the pose? It is even possible, if you've got a blood pressure device, to measure the pressure to make sure it isn't spiking in the pose or poses you're concerned about. And if you're a student concerned about high blood pressure, ask your teacher to help you do this evaluation.

Especially when the risks are uncertain, the more information you can get the better. And after you have all the information, it’s time to practice ahimsa.

Enrolling Others in Change

There are nearly 4,000 of us who work in the GBMC HealthCare System as employees, volunteers or physicians in private practice. When I think of all the improvements that we have made on our way to our vision, I am amazed at how many of them started with only one or two of our people in action and then spread to many more people. A fantastic example of this is the work that has been done by our nurses at reducing pressure ulcers.

It has now been more than seven months since the last pressure ulcer at GBMC! Those of us who don’t have to turn debilitated patients every two hours to prevent these can only imagine how hard our nurses and nursing technicians have been working to prevent them. Our people have always understood that they needed to help patients avoid pressure ulcers but only after a few folks started the movement to guarantee standard work in assessing who was at risk for skin breakdown and then delivering the measures shown to prevent it reliably, have we improved our performance.

Why is it that some change initiatives achieve great results and others don’t? There are a number of reasons but I think the single biggest reason is failed enrollment. We often hear: “People don’t like change.” Doug Krug, the author of the book Enlightened Leadership, makes the point that this is not true. Krug says that people change all the time; just think of all of the people that got rid of their flip phones and Blackberries to get iPhones, for example. The true statement according to Krug is: “People don’t like to be changed.”  We humans need to see and accept the need for the change and we need to feel that we have played a part in the design of the change or at least have chosen to make the change and have not had it forced upon us.

We have achieved zero pressure ulcers at GBMC because the overwhelming majority of our nurses and nursing technicians have been enrolled in the change. They understand the reason for the standard work, they now know what the work is and they have accepted that it must be done to prevent harm to their patients.

It is hard to get everyone enrolled in any change initiative in a large complex organization. The GBMC System is not presently making the same degree of progress on some of our other goals. From me on down the line we need to do a better job of enrolling others to achieve these goals. The enrollment starts with a conversation about the need for the change – what we are trying to accomplish. It continues with a discussion of what is expected of the person being enrolled. Then the enrollee must have some time to ask questions, voice any concerns, and be heard. Finally, the person doing the enrolling needs to hear from the enrollee that they have understood and that they are in!

I am very grateful for everyone’s hard work and particularly for everyone that enrolls others in change.

Finally, I'd like to congratulate two of GBMC's nurse leaders on recent accomplishments: Jody Porter, RN, DNP, Senior Vice President, Patient Care Services and GBMC’s Chief Nursing Officer, has been re-elected to the board of directors position of Treasurer of the Maryland Organization of Nurse Executives and CJ Marbley, RN, has been named to the same organization’s board of directors as a Member-at-Large. These individuals are certainly enrolled in creating positive change right here at GBMC and throughout the nursing community. Thank you for your commitment to excellence!