A bout of vertigo can put the brakes on a lot of daily activity. Can you still practice yoga? Will it help? Will it make it worse?
As with most questions in life, the answer is, When in doubt, go to yoga.
I have suffered from motion sickness and periodic bouts of vertigo throughout my life. It wasn’t until my early thirties that an ear exam revealed I have Meniere’s disease, a genetic condition shared by my father and sister, and an explanation for vertigo at such a young age.
Practicing yoga has been a life-saver.
I cannot say classes with vertigo are easy or fun, but they are a path to feeling better for the rest of the day. To understand how to use your practice to help your vertigo, it’s critical to understand the main causes of Benign Positional Vertigo (BPV).
The otolith organs (utrical and sacculus) in your ear monitor your position in relation to gravity with a combination of fine hairs and tiny crystals. For different reasons, the crystals can occasionally get dislodged from these organs and find their way into semicircular canals that make up the vestibular labrynth. It is the out-of-bounds crystals in the vestibular canals that cause the nystagmus, nausea and dizziness that make up vertigo.
To get on track to feeling better, we must first get those crystals back where they belong. There are several techniques out there to counter BPV. The most popular for years was the Epley Maneuver, which I found effective about 50% of the time and works better if it is done to you by a professional.
In recent years, I discovered the Foster’s Maneuver designed by Dr. Carol Foster. This technique is simple to use and can be repeated until you feel better. It is easily assimilated right in the middle of class if you notice the vertigo returning. Please watch the technique in the video below.
What to do in class?
First, perform the Foster’s maneuver prior to class. Because it is ideally done in 15-minute intervals, it is best to do it about 5-10 minutes prior to the start of class. Before you do the technique, lie on your back and roll over to one side and sit up. Repeat on the other side. Note which side made you feel worse. This is the side you will turn your head to during the exercise.
When the class begins Prayanama, it may feel a little bit gross the first few times you drop your head back. If there are still free crystals, they are moving around. That’s why you may feel nauseated or a little dizzy. The exhale breath actually helps to bring the crystals to the back of the vestibular canals where you want them for the maneuver. Go slowly, but don’t skip over it. It will make you feel better in the long run.
Half Moon Pose is helpful in loosening all of the muscles you’ve been tensing since you woke up with vertigo. It’s good for your overall health, so participate. I often find I don’t have a lot of strength when I have vertigo, so don’t be surprised if it looks very different from your usual posture. Complete the lateral flexion (side bends) and the back bend, but skip the forward bend, Hands to Feet, for this class.
The backward bend of Half Moon is the same as the prep phase of the Foster’s Technique. Since the first forward bend in class is about 15 minutes after you did the first set of Foster’s, now is a great time to repeat it. From the back bend, keep looking up and come down to your knees and execute the rest of the maneuver from there while the class completes hands to feet.
In the second set, do not repeat the Foster’s Technique, but skip the forward bend.
Awkward, Eagle, Standing Head-to-knee and Standing Bow can be executed as usual, with one exception. If you have the ability to put your forehead on your knee in SH2K, don’t do that today. Keep your face parallel to the mirror.
Balancing Stick should be done to tolerance. Most people find they cannot come all of the way down to parallel. If you woke up with a full-fledged vertigo this morning, I’d recommend keeping your face parallel to the mirror for this class. This means you will only come down about halfway into the stick pose.
By the time we get to Standing Separate-leg Stretching, if has been about 15 minutes since your last Foster’s Technique. If you are still experiencing a little of that shaky-eye nystagmus, this is a good time to repeat it.
If you are feeling okay at this point, feel free to perform the posture, but keep your face up, above the horizontal plane. For flexible students, you may be able to achieve this by placing your hands on the floor and doing the posture with a flat back. If you are a little less loose in the hamstrings, do this with your hands on your thighs for support.
Triangle can be performed normally, but pay attention to how you feel. You may not be able to turn your head to the ceiling if it is making you sick, especially to your bad side.
So that you don’t reverse the good you’ve been doing with the Foster’s maneuver, please do not go down in Standing Separate-leg Head-to-knee. Setting up the arms and turning to the side is enough for today. Stretching your arms up and lengthening your spine is plenty of hard work anyway.
Tree Pose is not likely to present any problems. Go slowly in Toe Stand to see how far down you can go before the headache and nausea creeps back in. Again, try to keep your face parallel to the front mirror.
Once we get to the floor, it can be very difficult to lie on your back in Savasana with your head completely horizontal. Trying using a block or a rolled up towel to prop up your head to a position where can lie comfortably without the world spinning.
It is okay to perform Wind-Removing Pose with your head slightly elevated, but don’t tuck your chin strongly to your chest.
For the Cobra series the postures are generally helpful for vertigo, but you may need to start and finish the postures with your face parallel to the mirror. This would look like setting up Cobra propped up on your elbows or Full Locust and Bow with your chest already off the floor. On really bad days, I find I need to do the pregnancy version of Locust pose to stave off the nausea.
For the belly-down Savasanas, I generally find that propping my turned head up on two fists is enough lift to stave off the dizziness, but still feel able to rest comfortably. Your rolled-up towel from Wind-Removing would probably work fine here, too.
During the rest of the class, the up and down of each Savasana may be too much for your spinning head. Feel free to sit up between postures or lean against the back wall.
Fixed Firm should feel nice. Go slowly with dropping your head back until the vertigo is gone. Half Tortoise is not recommended until you’re feeling better. It’s really not worth it to try it and start the world spinning again.
Camel is another wonderful back bend that gets the crystals to drop back in the vestibular canals. At this point, it has been more than 15 minutes since your last Fosters maneuver. After the second set of Camel, you’re in the perfect position to whip down into another set. Rabbit should be avoided anyway, so you have a few minutes to do a good, long hold. Remember to hold each phase of the maneuver until the nystagmus stops.
Head-to-knee and Stretching can be performed to tolerance, as long as you don’t drop the head below the horizontal line.
Spine Twist can also be performed as usual, although you may find you need to move your head very slowly through the twist if it brings back the nystagmus.
For the final Savasana you may continue to use the rolled up towel to prop your head or you might find you are feeling well enough to test out a normal execution.
The most important part of this process is to move slowly and with awareness so you can discover what makes your body feel better or worse and stay within your physical limitations for today.
It is recommended with the Epley maneuver that you sleep propped up for the next 24 hours. It does not come recommended with the Foster’s maneuver, but I generally sleep with my head elevated for the next couple of days just to be sure it doesn’t return.
BPV can be initiated or exacerbated by low barometric pressure due to pressure sensitivity in the ear. In times of low barometric pressure, it will help to continue these recommendations both for class and for sleep until the pressure changes.
If you have any questions, ask your teachers for help navigating this difficult time.
Sara Curry is the co-owner and Director of Bikram Yoga in Portsmouth, New Hampshire. When her vertigo is under control, she enjoys spending time upside down with her husband and two kids in Southern Maine.