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Dwi Pada Pitham (Bridge Pose) - Issues and solutions

List of some of the issues that can be relevant for practising this pose:


Dwi Pada Pitham Potential Problem Areas Image
            Head below heart
            Neck (two issues)
            Chest (two issues)
            Lumbar spine
            Sacro-iliac joint
            Knees
            Pregnancy


Head below heart

Although taking the head below the heart is beneficial for most people, this is potentially unhelpful or dangerous for a few people - these are people for whom there is already a risk of stroke or too much pressure in the head. For this reason, taking the head below the heart is usually considered unwise for those with conditions such as: high blood pressure; previous history of stroke; tendency to headaches or migraines; and, possibly, for certain eye conditions like glaucoma. In addition, if one currently has a cold or a headache, taking the head below the heart may well feel uncomfortable. As with so many precautions, issues of whether they apply to you can determined by observing how you feel - if taking the head below the heart in this pose causes the following sensations then avoid doing so (if not then it is unlikely you will come to harm doing so) : feeling flushed or hot in the head or face; increased feeling of pressure in the head or feelings of pressure pulses; face looking red; feelings of discomfort in the head or face. One approach, if this is relevant for you, is to lift into, and lower out of, the pose with the breath - i.e. with no holding of the pose. Alternatively, one can practise an alternative pose such cobra or sitting fish pose.

Neck
                   - Two potential issues here.

In the full version of this pose the neck is very strongly flexed and so one might expect this pose to be a problem for those with neck problems. In practice, one only lifts as far into the pose as the neck is ready for (or possibly less - restrictions lower down the body or lack of strength can mean that the neck does not become significantly flexed). However, even for healthy necks, it is important to have the neck aligned with the rest of the spine (i.e. the head should not be tilted or twisted to one side and the back of the neck should be long) before lifting into the pose if the neck is going to be significantly flexed.

Also note that the thyroid gland is squeezed by strong neck flexion. This is generally desirable but for some thyroid disorders (over-active thyroids) this squeezing can make matters worse (by stimulating it further).

Chest
                   - Two potential issues here

Breathing. When holding this pose, the breath is heavily restricted. It is restricted in the upper and middle part of the lungs since the spine and ribs are held in an extreme position. It is restricted a little in the lower part of the lungs since the abdominal muscles are stretched, limiting movement of the diaphragm. This is generally beneficial due to the muscles of respiration either being stretched (which helps to improve their elasticity) or having to work hard against resistance (which strengthens them). However some people may find this uncomfortable at first and feel that they can't breath (cf. asthma) - such people need not hold the pose but can move in and out of it until they feel comfortable holding it.

Heart. This pose encourages the heart to beat harder and faster. This is generally beneficial for the heart as it gives it a bit of a "work-out" - helping it to stay fit and strong. However for those with an already compromised heart, there is some danger that the heart will be asked to do more than it can cope with - such people should listen/feel to how their hearts are responding and should only hold the pose for short periods (if at all) until the heart has built up its strength and stamina again. Moving in and out of the pose is not intrinsically more strenuous for the heart than moving in and out of a forward bend.

Lumbar spine

This pose can be a strong back bend for the lower back and for those with lumbar lordosis (excessive inward curving in the lower back), or for those with a highly mobile lower back, this is an issue to watch as it can lead to over-arching of the lower back. This need not be a problem as long as one practises the pose so as to keep the lower back long. A good way of doing this is to start by flattening the lower back into the floor and then pressing the feet into the ground until the hips and lower back start to peel off the floor.

Sacro-iliac joint

The two joints (one on each side) between the sacrum bones of the spine and the iliac bones of the pelvic girdle are often considered to be immovable joints - they do however allow a small degree of movement. When strong forces are applied across these joints they can thus become misaligned which can cause discomfort at the joint and also have bad knock-on effects on one's posture in general. In the bridge pose it is possible to put potentially damaging compression across this joint if one does not take suitable care about what one is doing with one's legs (i.e. if one allows the legs to lean sideways). For this reason care should be taken to make sure the knees point upwards (as well as forwards - see below).

Knees

In this pose the knees take a lot of strain moving in/out of the pose and holding the pose. Thus even for very healthy knees it is very important that the position of the legs and feet does not lead to unhealthy forces being applied across the knees. Thus, care should be taken to ensure that the feet are parallel and pointing away from the buttocks (to avoid twisting forces). Classically the feet should be placed close enough to the buttocks for the shins to be vertical. However, for damaged or weak knees, this leads to excessive forces being applied across the knees, and the feet should thus be placed far enough away from the buttocks for this pose to feel comfortable.

Pregnancy

Practising yoga in the first trimester is considered by most yoga teachers to be contra-indicated. The only explanation I have heard for this is that there is then  a fairly high tendency for spontaneous miscarriage and this could in principle be exacerbated by yoga (although, as far as I know, there is no evidence for this). Possibly a mid-wife or an expert pregnancy yoga teacher might be able to give a better explanation.

In the later stages of pregnancy one of the issues that needs to be borne in mind is that the womb starts to press against the inferior vena cava (main vein in the trunk) and the aorta (main artery). This has implications for blood circulation to and from the legs. It is thus unwise to lie on one's back (with the womb resting on top of the main vein and artery in the trunk) for more than a very short period - with risks of discomfort, and an increased likelihood, over the long term, of getting varicose veins or tissue fluid issues (oedema) in the legs. With regard to this pose, this means it is best replaced with an alternative back bend - e.g. sitting fish pose or simply sitting with the back arched and resting on a pile of cushions or blankets.

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