Yoga therapy for an inguinal hernia

Every case of a naturally healed hernia that I have studied has involved physical exercise to strengthen and tone the body, especially the abdomen area. These exercises are universal and can be found in many different practise disciplines and styles. However, they are best documented in the yogic tradition, and for that reason I am using yoga as the basis for my restorative exercise program.

The list below is the standard Ashtanga Yoga posture sequence. I have included the full list here for the sake of completeness only. One does not need to practise every posture in the list to heal a hernia; in fact, in some cases success has been reported after following a program consisting of just three postures. I have marked the most beneficial postures on the right hand column.

Ashtanga Yoga Primary Series

Opening Sequence
1Surya Namaskara A (Sun Salutation A)   ×  5
2Surya Namaskara B (Sun Salutation B)   ×  5
Standing Postures
3Padangusthasana (Big Toe Posture)
4Padahastasana (Hand Under Foot Posture)
5Utthita Trikonasana (Extended Triangle Posture)
6Parivrtta Trikonasana (Revolved Triangle Posture)
7Utthita Parsvakonasana (Extended Side Angle Posture)
8Parivrtta Parsvakonasana (Revolved Side Angle Posture)
9Prasarita Padottanasana A (Spread Leg Intense Stretch Posture A)
10Prasarita Padottanasana B (Spread Leg Intense Stretch Posture B)
11Prasarita Padottanasana C (Spread Leg Intense Stretch Posture C)
12Prasarita Padottanasana D (Spread Leg Intense Stretch Posture D)
13Parsvottanasana (Intense Side Stretch Posture)
14Utthita Hasta Padangusthasana (Extended Hand to Big Toe Posture)
15Ardha Baddha Padmottanasana (Standing Bound Half Lotus Posture)
16Utkatasana (Fierce Posture)
17Virabhadrasana A (Warrior Posture A)
18Virabhadrasana B (Warrior Posture B)
Seated Postures
19Dandasana (Staff Posture)
20Paschimottanasana A (Intense West Stretch Posture A)
21Paschimottanasana B (Intense West Stretch Posture B)
22Paschimottanasana C (Intense West Stretch Posture C)
23Paschimottanasana D (Intense West Stretch Posture D)
24Purvottanasana (Intense East Stretch Posture)
25Ardha Baddha Padma Paschimottanasana (Bound Half Lotus Intense West Stretch Posture)
26Triang Mukhaikapada Paschimottanasana (Horizontal Facing One Leg Intense West Stretch Posture)
27Janu Sirsasana A (Head to Knee Posture A)
28Janu Sirsasana B (Head to Knee Posture B)
29Janu Sirsasana C (Head to Knee Posture C)
30Marichyasana A (Marichi's Posture A)
31Marichyasana B (Marichi's Posture B)
32Marichyasana C (Marichi's Posture C)
33Marichyasana D (Marichi's Posture D)
34Navasana (Boat Posture)Beneficial!
35Bhujapidasana (Pressure on the Shoulders Posture)
36Kurmasana (Tortoise Posture)
37Supta Kurmasana (Sleeping Tortoise Posture)
38Garbha Pindasana (Embryo-in-the-Womb Posture)
39Kukkutasana (Rooster Posture)
40Baddha Konasana (Bound Angle Posture)
41Upavistha Konasana (Seated Angle Posture)
42Supta Konasana (Lying-down Angle Posture)
43Supta Padangusthasana (Lying-Down Big Toe Posture)
44Ubhaya Padangusthasana (Both Feet Big Toe Posture)
45Urdhva Mukha Paschimottanasana (Upward-Facing Intense West Stretch Posture)
46Setu Bandhasana (Bridge Posture)Beneficial!
47Urdhva Dhanurasana (Upward Bow Posture) – optional
Finishing Sequence
48Salamba Sarvangasana (Shoulder Stand Posture)Beneficial!
49Halasana (Plow Posture)Beneficial!
50Karnapidasana (Press the Ear Posture)
51Urdhva Padmasana (Upward Lotus Posture)
52Pindasana (Embryo Posture)
53Matsyasana (Fish Posture)Beneficial!
54Uttana Padasana (Extended Leg Posture)Beneficial!
55Sirsasana (Headstand Posture)Beneficial!
56Baddha Padmasana (Bound Lotus Posture)
57Yoga Mudra (Closed Posture)
58Padmasana (Lotus Posture)
59Tolasana (Scale Posture)
60Savasana (Relaxation Posture)Beneficial!

Some background on the Ashtanga Yoga Primary Series

There are over 1,000 known yoga postures—or asanas as they are called in yoga literature. The Ashtanga Yoga Primary Series, as listed above, is a carefully selected subset of those that is considered to be most beneficial and therapeutic for a beginning yogi.

The order of the postures is significant. The initial two Sun Salutation sequences (A & B), which are performed five times each, are designed to warm up the body to the point where it is safe to perform the rest of the postures. The series then progresses in a systematic manner where each posture is followed by its counter-posture, working the body in a progressive yet balanced way. There is also overall symmetry in that the series opens with standing postures followed by seated postures, and then finishes up with the inversions of the same.

An experienced yogi will perform the full series every day, six days a week. Performing the full series takes about one and a half hours. Beginner classes typically skip the seated postures, going straight to the finishing sequence for a total practice time of one hour. A nice 15-min home practice can be had by performing just the two Sun Salutation sequences and selected finishing postures.

Please note that this web page is not about Ashtanga Yoga per se. The Ashtanga Yoga system is introduced here merely as a reference point. Readers who are interested in practicing Yoga in earnest are advised to sign up for classes at their local yoga studio, or at the very least start by watching an instructional DVD.

How yoga works to reverse a hernia

Yoga practice is known to be a working remedy for countless different ailments. As a therapy, it is holistic in nature—i.e. rather than concentrating on specific “issues” in the body, it works on the whole musculoskeletal system. Regular practice lowers blood pressure, improves metabolism, balances hormones, and stimulates lymph flow to eliminate toxins from the body, just to list a few of the many beneficial effects.

Given the holistic nature of yoga, we probably shouldn't put too much effort into trying to second guess how exactly yoga works when reversing an inguinal hernia. However, some of the effects are well known:

  • it burns excess visceral fat, relieving abdominal pressure and allowing more room for the intestines
  • it massages internal organs, including the intestines
  • it strengthens and tones abdominal muscles
  • it promotes tissue regeneration and healing
  • it helps foster peace of mind

Which postures to practice?

There are two classes of yoga asanas (postures) that are known to be especially effective for inguinal hernia: (1) inversions, and (2) asanas that work out the external and internal oblique abdominal muscles (two sheets of muscles around the anterior and lateral walls of the abdomen).

Now, it does go against the yoga philosophy to “cherry pick” asanas. But one has to start somewhere. And if an ailment prevents one from performing a more well-rounded practice, it is better to do what's possible now, and then perhaps expand one's practice once the body has began healing.

Also, some specific asanas are cautioned against until your hernia has healed. In particular, extreme abdominal stretches may be problematic for a hernia patient. For example, in the Sun Salutation sequences (A & B), step 5, called Urdhva Mukha Svanasana (Upward facing dog), is generally cautioned against for this reason. [There is more information on problematic asanas below.]

My advise is to first and foremost listen to your body and only do what feels right to you.

My program

Taking all the above into account, my initial asana practice program consists of the following:

  1. Surya Namaskara A & B (taking it easy with the Urdhva Mukha Svanasana)
  2. Salamba Sarvangasana
  3. Uttana Padasana
  4. Savasana

This is all I can manage to begin with. Listening to my body, I will make additions to the program as I go.
[Changes will be documented in my progress diary.] My goal is to perform this practice a minimum of five times a week.

Which postures other people are recommending for hernia

Dr. P. S. Venkateswaran, in his book Yoga For Healing, recommends Matsyasana, Sarvangasana, Sirsasana, Vrischikasana (very advanced only) and Viparita Karani Mudra (similar to Sarvangasana) for hernia. He cautions against doing Paschimottanasana.

BeyYin reportedly healed his inguinal hernia in six months using an exercise program consisting of Setu Bandhasana, Utthan Pada Asana (Raised Feet Posture), Navasana, crunches (sit-ups) and Nakra-Kriyas (Crocodile Exercise Sequence). His program also includes stroking the abdomen, and work on self-awareness. He writes: “In any case one should carefully listen to one's body and only do what feels right...” He has posted a demonstration video on YouTube.

Julian Clegg reportedly healed his inguinal hernia in three weeks (!) by doing yoga asanas in combination with fasting and herbal medicine. He practised Setu Bandhasana, Sarvangasana and Sirsasana. He cautions against doing the latter two if you have high blood pressure. He also cautions against Bhujangasana (Cobra Posture) if you have hernia. [Note: Bhujangasana does not feature in the Ashtanga Yoga Primary Series, but the fifth step in the Sun Salutation A & B sequences called Urdhva Mukha Svanasana (Upward Facing Dog) is very similar.] Julian writes: “Presumably the benefits that accrue from doing head- and shoulderstands could also be derived from other kinds of inversion – with the same caveat about high blood pressure.”

A writer at ChennaiOnline.com recommends Pavan Mukta Asana (Wind Relieving Posture), Navasana, Titali Asana (Butterfly Posture), Halasana, Sarvangasana, Matsyasana, Vajrasana (Diamond Posture), Shashankasana (Hare Posture), Marjariasana (Cat Posture), Ushtrasana (Camel Posture), Viparita Karani (Legs-up-the-Wall Posture) and Supta Vajrasana (Lying-Down Diamond Posture).

A writer at The Holistic Care recommends Pavan Mukta Asana, Utthan Pada Asana, Sarvangasana, Paschimottan­asana, Matsyasana, Vajrasana, Shashankasana and Ushtrasana.

A writer at Bell Infotech Systems recommends Viparita Karani Mayurasana (Peacock Posture) and Sarvangasana. The writer cautions against Bhujangasana, Dhanurasana, Makarasana (Crocodile Posture), Matsyendrasana (Spinal Twist Posture) and Yoga Mudra.

Tips and cautions

Getting in the habit

The biggest challenge in yoga (or in any exercise discipline for that matter) is to actually do it. To not just read this web page, and maybe watch a few videos, but actually perform a yoga practice today (or tomorrow if you are reading this in the evening) and daily thereafter.

Because it is so easy to slip out of the routine, especially when first starting out, it behooves one to make all arrangements about the practice as easy and enticing as possible. A good way I have found to “cement” a yoga routine into my daily life is to put some initial planning into the time and place of practice.

Time. Scheduling a regular time of day for yoga eliminates the need to think about scheduling from then on. This can be a fixed clock value, or it can be a slot within, say, your morning routine. Either way, this will greatly contribute towards making the practice happen every day.

Place. Dedicating a space in your dwelling for yoga not only simplifies things but also has a strong psychological effect. It enforces the habit and helps with concentration during practice. Clearing out a corner of a room and placing your mat there is all that is needed to make things more “official”. I was lucky enough that I was able to dedicate a full spare room for this purpose. Seeing that I sometimes have difficulties concentrating, I find that this has helped me a great deal.

A dedicated space for yoga can help keep a daily practice going

Learning the asanas

Yoga can seem a little intimidating at first. The asanas look difficult—some impossibly so—, and their names are in Sanskrit[1]. The practice discipline, however, is neither easy nor difficult, or anything in between. It just is. The feeling of dauntingness is a reaction coming from our western culture which emphasises striving for achievement.

The asanas are documented in their ideal form, but you get the full benefits just from attempting to perform them. I.e. performing them within the limits of your current abilities, no matter how far from the ideal you are. Every practice will get you a tiny bit closer, but there is no finish line that you could ever reach. Nor are there any competitions to participate in. Yoga is practiced for the resulting benefits, which you will start noticing almost immediately.

Working towards the ideal form still matters, though. Not because of some external reason—no one will give you points in “artistic or technical merits”—, but because it will push you to grow more, and consequently reap greater rewards.

Traditionally, a yoga student learns the asana practice from a guru (teacher) in a yoga shala (studio). And ultimately, this is the way to go. But for someone with an inguinal hernia, the situation is a little different. Participating in a yoga session in a studio may be too overwhelming and uncontrollable with regards to the hernia.

My recommendation, therefore, is to devise your own “mini” yoga routine based on the information and pointers provided on this web page while taking into account your physical state and the severity and location of your hernia. For this purpose, the asanas can be learnt by watching videos online or from an instructional yoga DVD.

Practice tips

Always practice with an empty stomach. Allow for at least two hours between your last meal and your practice. Never drink during practice.

Do not listen to music while practicing. Listen to yourself.

The inverted postures (Sarvangasana, Sirsasana) should not be practiced during pregnancy or menstruation, or if you have high blood pressure.

Regularity of practice is more important than intensity. Nearly everyone who has managed to heal their inguinal hernia engaged in daily practice.

Keeping a yoga diary is considered beneficial. It will make you reflect on each practice and its effects. Also, it allows you to more clearly see long term progress, ultimately telling you what it took to heal your hernia.

  1. In case you are wondering how to pronounce those names, Richard Freeman has posted on his website an audio recording (names_of_postures.mp3) containing a recitation of the name of each of the asanas in the Primary Series.