There are many variations of this pose, some of which have a reputation for being riskier than others, For example, consider the variation of extending the arms overhead and clasping the toes. As in karnapidesana and niralamba sarvangasana, this upwardly rotates the scapulae and makes the adduction of the scapulae difficult to maintain—the rhomboids and trapezius then lengthen, and weight falls into the upper spine. This variation can overstretch the thoracic and cervical spine, as there is potentially damaging pressure from the pushing action of the feet and, if the hamstrings and gluteals are tight, from the limited hip flexion forcing greater spinal flexion.

Because this pose can produce very intense flexion for the spine, especially the cervical region, it’s more important to maintain the integrity of the scapulae and cervical thoracic spine than to get the legs to the floor— support the legs, if necessary, to protect the neck.