Adapting the Sivananda Sequence for Students with High Blood Pressure


As a Yoga Teacher, it is vitally important to get really familiar with the postures you teach, their therapeutic benefits and contraindications. If you are unsure then ask your own teachers or refer to the movement library for more help.

As a Sivananda Teacher there is somewhat an advantage that you will be teaching a set series of postures and so can get to know them thoroughly! Some poses such as Headstand (Sirsasana) and Bow Pose (Dhanurasana), are not recommended for somebody with hypertension (high blood pressure) and should not be taught to them unless their blood pressure becomes safely stabalised. If someone has declared a medical condition to you, then it’s your duty to the student, yourself and the good name of yoga to do the research and find out what’s is safe.  You are teaching the class, and people are here for your guidance.  In the Centre where I teach, I know which teachers to ask for guidance on pregnancy or kids yoga, and they know they can come and ask me cardiac conditions and women’s health.  Who are your local supports?

When Can a Student with Hypertension Advance with Asana?

if the student’s blood pressure has been proven to be controlled, by lifestyle or by medication (trust the student to give you correct information, or perhaps you have already liaised with their Doctor) then gradually build up to the fullest versions of the postures. How can you be sure a student is ready for the posture? Monitor exertion. Just like anyone in class, a posture needn’t involved huffing and puffing and brute force! Its simple – is the student finding it easy, moderate or hard?  Someone with unmanaged hypertension should stay in the moderate zone – they can self assess and you will also learn to spot exertion levels.  If a student has been taught clearly the correct base for any posture then the base, plus the breath, will support them into the pose. Use adaptations and variations until ready. If you believe someone to be putting themselves as harm then stop them! Always offer a private session to provide tuition on the correct poses and how they are done. Unsure? Then ask! Yoga is a knowledge that has been handed down for thousands of years, and even the most experienced of teachers are only scratching the surface of a vast knowledge. Reach out to your peers, teachers, and Gurus for help.

Making the Sivananda Sequence Therapeutic for Hypertension

Please note that whilst I am proud to be a teacher of Sivananda Yoga, I also teach and am closely aligned with Intuitive Yoga as taught by the world respected Ashram Yoga.  Over the last three years I have greatly enhanced my teaching knowledge by using (what I believe is a vital resource for all teachers wishing to teach asana safely for all, including themselves!).

Breath retentions during Pranayama – I do not recommend breath retentions for the reason of raising intra-abdominal pressure, which increases blood pressure. It would be best to take deep yogic breaths with a slight pause at the top and bottom of the breath.

Kapalahbhati, Skull Shining Breath – forced exhalation breathing to be done VERY lightly without the fullest force of the diaphragm. If the spine is collapsed then sit up against a wall with buttock and back supports, to keep the front body open, otherwise you are creating more intra-abdominal pressure which raises BP.  For all students, the most important aspect is that they are fairly comfortable with the diaphragm exposed.  Initially this could mean using a chair, buttock supports or kneeling.

Alternate Nostril Breathing, which is called Anuloma Viloma in the Sivananda tradition – Without the retentions, simply inhaling left, exhaling right, inhaling right, exhaling left etc. For a beginner, start with counts of 4 for all breath movements.  When that is comfortable, increase the exhalation to 6 and eventually 8. Only to be performed without tension.

Sun Salutations, Surya Namaskara -  use slow rounds keeping breath steady.  Pause if breath becomes dysregulated or exertion more than moderate. Offer beginner variations such as walking the feet forward from Down Dog, instead of lunging.  If you have a mixed class then no doubt there can be benefit to others to move through the sequence slower with more attention to correct body positioning and breath.  Yogasync members can access my favourite version here.

Leg Raises, Pawanmuktasana Series 2– To be done without unnecessary strain and with steady breathing. Adapt if breathing becomes dysregulated by pausing, using single legs only, and/or using bent legs and/or only using the top 30-60 degrees of the movement.

Headstand, Sirsasana is not recommended for hypertension and should not be taught to someone until their blood pressure is under control. Use either dolphin pose, rabbit pose, or if the student already has the flexibility in the legs and back then try this.

Shoulderstand, Sarvangasana – If the student requires force to get into shoulderstand then use a wall for support or Legs up The Wall.  To use wall as a support, lie next to wall with buttocks close, knees bent, soles of feet on wall, arms as shoulderstand.  Press firmly through feet to walk up wall, raising buttocks.  Knees can stay bent or walk further up to straighten legs.

Plough Pose, Halasana – My experience is that many beginners force themselves into this and are under quite a bit of duress in the pose. This is not okay for someone who already has high blood pressure. I would instead recommend Poorwa Halasana. there are many variations. The most important thing is the quality of breath is chosen variation.

Matsyasana, Fish Pose – Uness a student is comfortable releasing their neck back with correct alignment, then I suggest blankets or a bolster for support.

Paschimottonasana – Seated Forward Bend – YES!! Use a strap if the student is tight in the back body, as once again, it should be comfortable enough for regulated breathing.  For all students, it better to set them up to loosen up behind the pelvis (eg, folding from hips) instead of folding from the upper back.

Incline Plane, Purvottanasana– For people without the flexibility through the front body or strength in arms, I recommend Bridge Pose, as it will start to loosen up the front chest and provide extra strength. Then move onto table top.  The fullest version of Incline Plane is fine if the student can execute with alignment and regulated breathing.

Cobra Pose, Bhujangasana – Just about everyone in class needs to do Sphynx or Half Cobra instead. It is rare to see a beginner create the required length in their sacrum for a safe back or have the shoulder blades drawn down the back. Remove the struggle by encouraging Sphynx and Half Cobra Pose  

Locust Pose, Salabhasana – Hands up if you have ease if breathing in full locust posture? A few people will yes, but its rare, and until symptoms are managed, stick with half locust or other variations. Let students know to keep breathing smoothly!

Bow Pose, DhanurasanaThis pose is contraindicated for high and low blood pressure. I recommend bridge pose which can gradually be increased in height for a backbend. NB: Camel Pose is not a suitable alternative as it is contraindicated for hypertension.

Spinal Twist, Ardha Matsyendrasana – Great with a smooth breath. I also use a version with the legs extended out in front, one draped over the other, for someone very tight in the hips: and/or using a block behind for the hand to rest on.

Arm Balances – no reason not to do these if hypertensive. HOWEVER..what is the level of exertion required and breath quality? You could choose to teach a standing balance will be suitable for most people. Something like Tree Pose, Vrksasana, has many variations available for all levels.

Padahastasana – Standing Forward Bends – Great, adapt for the body you are teaching.

Trikonasana, Triangle Pose – For hypertension, this pose must be taught looking down at the floor

Relaxation, Savasana – Fantastic for all!

We hope you found something useful here to take into class.  What medical conditions have you met in class and how have you adapted your teaching to keep it safe, therapeutic and healing?

Extra Resources: - evidence for slow sun salutes being beneficial for systolic blood pressure (though was done on a teenage population!!)

Yogasync Me!  What every teacher needs to know about little toes and back bends!

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About Claire Bhavani-Winzar

Claire Bhavani-Winzar is a Certified Women's Health & Nutrition Coach, and Yoga Alliance 500 Registered Yoga Teacher. Her favourite work is with women who find themselves frazzled and rushed - using hormonal balancing strategies that are proven to work. Previous incarnations have been a physical trainer, supporting people with chronic medical conditions to their best health; a pharma rep and a genetic sequencer on the Human Genome Project. Claire has made a lifelong study of positive physical, emotional, mental and spiritual growth - she studied it so you don't have to. Claire brings you the best nuggets of information to propel you back to health, plus the 200% enthusiasm in YOU so that you can spend you time doing what you do best: living a happier, vibrant, satisfying life with your family. Healthy Lifestyle Workshops, Yoga Prescription and Women's Circles. Visit to access yoga videos, health education, your free coaching session, and your Sistahood Community.

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