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Uttanasana ( Standing forward bend ) - Issues and solutions

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


Uttanasana Potential Problem Areas Image
            Head below heart (two issues)

            Lumbar Spine (two issues)

            Tight Hamstrings

            Knees

            Tight calf muscles

            Pregnancy





Head below heart
                                - Two potential issues here.

One is that, 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 like: 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 found by observation of how one feels - 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 head or feelings of pressure pulses; face looking red; feelings of discomfort in the head or face. For some people, the gentler, more relaxed versions of this pose such as "rag doll" may feel fine, while the more strenuous, active ones (in which there is less encouragement of the relaxation and thus blood pressure lowering) may cause problems. Where you feel that taking the head below the heart is inappropriate, the pose can be modified by taking the forward bend only as far as taking the trunk to horizontal (and thus avoiding taking the head below the heart). Alternatively, one can practise an alternative pose such as staff pose or sitting forward bend where the issue of taking the head below the heart does not arise.

Another issue for some is that a too rapid lifting of the head from below the heart may cause the blood pressure in the head to drop a bit too low, so causing a feeling of dizziness or even fainting. This is particularly likely to be an issue for those who have a tendency for low blood pressure and when the pose is practised in a very relaxing way. The solution is to take care to lift out of the pose sufficiently slowly and / or to consciously activate muscles when lifting out of the pose so as to encourage blood pressure to rise a little. Another solution is to exit the pose by folding downwards or via the down-facing dog pose instead of directly rising up to standing.


Lumbar spine
                                - Two potential issues here.

One is due to the fact that large forces are potentially acting across the lumbar spinal joint particularly in the entry and exit of the pose. As a result the muscles and ligaments of the lumbar back are at potential risk of strain (and hence injury). With the "soft" rag-doll type of approach to this pose, this risk is minimized because the center of gravity of the trunk is as close as possible to the vertical line going through the hips and as a result of the very slow and gentle movements. Other approaches rely on taking a lot of care over the alignment of all the spine joints so that one minimises bending at spinal joints. Everyone should take this care of their spine when practising this pose, but this is particularly true for those who currently have, or have a history of, lumbar back strain, those with a tendency to lumbar kyphosis and anyone who begins to feel even the slightest hint of lumbar back discomfort when practising the pose. The slightest hint of discomfort in the lumbar area should be taken as a sign to exit the pose (with extreme care) and seek advice (e.g. from an experienced yoga teacher). Many would consider this pose to be counter-indicated for those with any degree of lumbar strain. A safer approach (for the lumbar spine) for getting some of the enefits of this pose is to lie on one's back and bring knees to chest and then straighten the legs into the air, keeping the weight of the legs over the trunk. Note that, in this approach, the legs should be kept above the trunk to avoid putting the lumbar back at risk.

Another issue is for those with a strong tendency toward lumbar spine lordosis (in a normal standing position such people have very inward curving lumbar spine and may appear to be sticking their bottom out). In general, this pose would be very beneficial for the lumbar back for those with a tendency towards lumbar lordosis as it tends to encourage stretching and relaxation of muscles which in them tend to be over-tight in the lumbar spine. However, some approaches to this posture - and some teachers - encourage one actively to try to put the lumbar spine into extension (back bend) particularly in the entry and exit of the pose - and for most people this is highly beneficial and safe. The potential problem is that those who have a tendency to lumbar lordosis can easily take the lumbar spine too far into an extension (backbend), so they should be careful to avoid excessive backbends in the lumbar spine.


Tight Hamstrings

Of itself having tight hamstrings tends to limit how far one can go into the pose rather than being a pre-cautionary issue. However, because tight hamstrings do limit how far one can go into this pose, ignoring this limitation and trying to push beyond what the hamstrings will comfortably allow will tend to cause problems in the lumbar back area. Since those who are at high risk of lumbar back strain often also have tight hamstrings, it is particularly important to accept the limitations of tight hamstrings and adapt one's approach accordingly.

Because of the relationship between the hamstrings and what is happening in the lumbar spine, most teachers recommend that one keeps the knees bent when first learning this pose - this maximizes the freedom of the spine to stay long and straight as the hips becomes flexed. Even with the knees bent, many find that they are not able to bring their trunk to rest along their thighs while still keeping the spine essentially straight and long - in this case one should only enter into the pose as far as possible whilst keeping the spine essentially straight and long. Otherwise one can bring the trunk to rest along the thighs - and this position can be a wonderful place to just relax and allow the trunk to feel as though it is sinking downwards. From here one can gently and slowly explore straightening one or both legs at a time - taking care that the trunk remains at all times in contact with the thighs (hence keeping the lower back straight) and avoiding straightening so far that one feels discomfort in the hamstrings.

Those who are experienced with this pose have good body awareness, have long stretchy hamstrings and have strong, robust lumbar backs can safely practise this pose, entering and exiting to and from standing quite safely. This can look quite impressive and beautiful but is not necessary for obtaining the key benefits of practising this pose.



Knees

It is not an essential part of this pose for the knees to be bent - but, at least when first learning how to practise this pose, it is highly recommended. In this, and most other standing poses, where the knees are bent, the integrity of the knees is protected by making sure that the knees move and point in the same direction as the feet. Most people find this relatively easy with this pose - but it is a good idea actively to check before entering into the pose that the feet are actually parallel and a comfortable distance apart. Should you notice that your knees tend to point inwards then you will find it helpful to consciously press the outer edge of one's feet (or the pad of one's little toe joint) downwards. Should you notice that your knees tend to point outwards (very unusual) then you will find it helpful to consciously press the pad of your big toe joint downwards.


Tight Calf muscles

Tight calf muscles are unlikely to be a limiting factor of the pose if practised with the legs straight. But if you need to practise this pose with flexed legs then you may find that tight calf muscles can be a contributory limiting factor. A relatively easy solution is to put a fold or two of a blanket or towel under the heels - if, during practice, one consciously thinks in terms of encouraging the heels to sink then one will find that the calf muscles gradually allow the heels to stay down without using padding even when the knees are significantly forwards.


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 in the first trimester there is 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 stand in static poses for more than a very short period - with risks of discomfort, tiredness (in legs) 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 that one wants to use variants that are gentle enough to safely practise in a smooth flowing way with little or no static holding of the pose and including as much leg movement as is feasible and pleasant.

Another issue to bear in mind is that the increasing size of the womb will at some stage make resting the trunk along the thighs impossible. One approach is to only take the trunk to the horizontal position (or higher) while perhaps resting the arms on a ledge or a table - and this can feel very peaceful and comfortable. Another approach that those with lots of body awareness and asana experience might like to try is to practise the pose with the feet significantly wider than hip-width apart so there is space for the abdomen between the legs in the fully folded position.

Another issue is that the increasing size and weight of the womb has an impact on one's natural standing posture in a way that can significantly but temporally change the shape of one's spine. Also the increased weight of the womb increases the forces acting across the lumbar spinal joints. For these reasons the lumbar spine may well be more vulnerable to harm in this pose than before pregnancy - this means that the earlier comments regarding the lumbar spine are particularly pertinent when pregnant.         

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