Yoga & High Blood Pressure

So the student that got sick after yoga a couple of weeks ago came to me after class yesterday and informed me she has high blood pressure. When I started classes I had them complete a questionnaire about some basic health concerns and she did not indicate any problems at that time. I searched yoga journal for "high blood pressure" and got a long list of poses to avoid. What do I do with her? Or, what do I not do with her?

Also, I had a new student come out to try yoga. She was in a very serious car accident several years ago and after many surgeries and therapy she walks again. I don't know the extent of all her limitations but I know her right foot turns out about 30 degrees. When we are doing asanas like Setu Bandha Sarvangasana where I think her ankle must be under a lot of pressure is there something we can do with that foot to make it more comfortable for her? I think yoga would be very good for her once we figure out all her kinks. Hopefully I did not turn her off.

Correct me if I'm wrong but no inversions for high BP, have her do the easiest variations so she doesn't over do it, lots of props like chairs. Yes? no? I didn't research anything just thinking off the top of my head(which you probably has to do at the class).

The lady with the car accident....I'd go with props again and encourage her to experiment with them in poses to where she is comfortable. For eg. Setu bandha sarvangasana over the bolster so she has no pressure on her ankle. I'd also encourage her to take it slow so you both can find ways of making the yoga work for her.

If only I had known that my student has high blood pressure. It's amazing we didn't bring on a stroke because we did a lot of stuff she should not be doing, or at least we should have modified. No wonder she felt sick and I feel pretty stupid. As I said I searched Yoga Journal for "high blood pressure" and came up with a long list of asanas to avoid or modify. There are the obvious - no inversions and I think you could say no, or only passive, backbends. But, who would have thought Virabhadrasana I, II and III would all be on the list; Vrksasana and many twists - on the list. I get that the arms should not reach above the head but what part of Bharadvajasana I is risky? Whatever the answer is, does that apply to the other twists? The good news is, for many of the asanas, Yoga Journal offers modifications.

the relationship of the postures to blood pressure is not simple. blood pressure naturally increases and decreases depending on your body's needs, your posture, time of day, etc... Having high blood pressure is, in itself, not a bad thing. it is only a bad thing if your blood pressure goes up and stays up. So high blood pressure is really a defect in which the body has a hard time adjusting blood pressure from one moment to the next. My teacher Nivedita calls this a "barostat" that measures blood pressure internally and makes the appropriate adjustments.

So in terms of what to avoid - inversions could potentially be a problem, but really anything that increases blood pressure (sun salutations, standing postures, deep backbends) could all be considered dangerous. However, and this is a BIG however, not enough research has taken place explaining exactly how and why blood pressure gets elevated or depressed. As a result, different teachers have different views on how to treat and adjust for elevated BP in yoga classes.

For example - go look in the back of Light on Yoga to see what Iyengar recommends. I think you might be surprised.

Nivedita recommends introducing mild inversions to give the body an opportunity to practice adjusting blood pressure by itself. Learning to breath will help because proper breathing lowers BP. Learning to relax will be helpful as well - but not just in Savasana. Also learning how to relax in potentially stressful situations (ie. Vira 2). By intentionally taking the blood pressure up and down (ie. uttanasana followed by a forward bend) the internal barostat might gain in intelligence - resulting in "lowering" BP (but actually just controlling and adjusting BP more efficiently.)

I agree with Colin and have worked with a number of high blood pressure clients in therapeutic classes. I usually introduce things like legs up the wall, asana that are good for the heart(supta virasana at the top of that list), breath work, stress awareness, and forward bends and mild inversions where the forehead is grounded(usually on a wood block).
By stress awareness I mean to get them in touch with their breath and pulse and identify and monitor them while practicing, knowing their limitations and learning how to bring the breath back down.