Breathwork Yoga

Why do my hands cramp up during breathwork?

May 27, 2022

By Devendra Narayan, PhD.

The blog post is part of the Better Breathing through Science series.

If you’ve ever taken a breathwork class, it’s very likely that you’ve experienced tetany. It’s the sensation of numbness and tingling in the fingers and toes often experienced during conscious connected breathing.

Photo by Min An: Pexels

Breathwork practitioners and facilitators have offered several explanations for the relationship between tetany and psycho-spiritual conditions. These include:

Tetany is “symbolic of holding onto something tightly” [1]

Tetany “facilitates emergence of old emotional and physical tensions associated with unresolved psychological and physical traumas” [2]

Tetany is cause by “holding onto unconscious, ‘stuck’ energy” [3]

In this article, we will explore the physiological origins of tetany and, in particular, hyperventilation-induced tetany.

What is tetany?

Tetany is a physical manifestation of spasms in the hands and feet that are the result of the constant firing of axons, which are long, thin nerve cells that carry electrical impulses in peripheral and central nerves. It can manifest in one of two ways: unilaterally, on one side of the body; or bilaterally, on both sides.

Photo by Arina Krasnikova: Pexels.

The first documented case of tetany was reported in 1908 by Haldane and Poulton who observed that forced breathing caused tingling of hands and feet [4]. In 1920, Grant and Goldman reported several clinical observations of tetany produced via forced respiration [5].

A few years later, in 1922, Goldman reported a list of symptoms for hyperventilation-induced tetany in a subject as follows:

“He continuously started to breathe deeply, and after about 10 mins of forced respiration became dizzy and developed tingling of the hands, face and then the entire body, and then spasms of the feet, hands and face.” [6]

Let's explore the underlying mechanisms that produce these symptoms.

Hyperventilation, which is faster than normal breathing, causes the arterial Carbon dioxide (CO2) to drop below normal. Simply put, during breathwork, you breathe out more CO2 than normal, resulting in a condition called hypocapnia.

You may wonder - What's wrong with releasing more CO2? After all, we've been taught that CO2 is the waste gas.

It is! But CO2 also regulates critical biological and chemical functions in the human body, for example, pH of the blood. Breathing plays an integral role in regulating blood pH between 7.35 and 7.45.

Less CO2 in the blood causes an increase in blood pH, which in turn causes an increase in the binding of oxygen to the red blood cells.

Note that Oxygen and CO2 both are carried throughout the body by binding to the hemoglobin protein in the red blood cells.

It’s the concentration of CO2 in the blood, which is what facilitates the release of Oxygen from red blood cells and into tissues. If breathwork causes a drop in CO2 levels in the body, it can temporarily result in a drop of oxygen supply to tissues below normal levels.

This is only half of the story. What happens next is what causes tetany.

Further effects of alkalosis include a reduction in free ionized calcium (Ca2+) in blood plasma. This occurs because there is an increased binding between calcium and albumin, the protein found in blood that carries everything from water to ions to hormones, vitamins, etc. throughout the body.

Several cellular processes are affected by the low levels of free ionized calcium in blood. Specifically, lower levels of ionized calcium cause neurons to be more excitable, which causes muscle cramps, tingling around the mouth, abdominal pain etc., which are often experienced during tetany.

While studying induced hyperventilation attacks in patients, Frazer and Sargant reported that “some lie limb, but others wave their arms and struggle restlessly”. But “the severity of these induced attacks is rarely as great as with those coming on spontaneously.” [7]

This brings us to a very important point that tetany associated with breathwork is temporary and subsides as one transitions back to normal breathing. The body also adapts to the low CO2 and calcium ions. Therefore, the symptoms of hyperventilation-induced tetany may subside as one returns to breathwork practice regularly.

Frazer and Sargant were also the first to report that hyperventilation can cause interference with consciousness of varying degree, beginning with mild giddiness to feelings of being “far away”. These consciousness phenomena are also experienced during breathwork and I will explore them in detail in another article.

What should you do if you experience tetany during breathwork?

As I mentioned, the symptoms of tetany disappear in a short period of time. And as you now know, tetany results from low CO2 and Ca2+ ion levels in the body, so you need to give some time to build CO2 and Ca2+ ion to normal levels. Here are some recommendations that can help:

Keep calm and relax your breathing.
Reduce the rate of respiration. For example, if breathing through the mouth, one may switch to nasal breathing to lower the breathing rate.
Practice controlled breath holding. The breath holds can be short, lasting 5-10 seconds between breathing cycles, which will help you restore a normal level of CO2 in the body. Remember never to force the breath holds.

About the Author

Devendra Narayan is a scientist, yoga teacher, breathworker, scholar and founder of Cultivate Prana Academy. Cultivate Prana's mission is to empower modern day healers through education that integrates ancient wisdom and modern science.

References:

Understanding Tetany and Discovering the Treasure Within It
Hyperventilation & Tetany - what is this all about?
Why Do My Hands Curl When I’m Hyperventilating During Breathwork?
Haldane J. S. and Poulton E. P. J Physiol 1908; 37:390.
Samuel B. Grant, and Alfred Goldman. Am J Physiol 1920; 52:209-232
Goldman A. JAMA. 1922;78(16):1193-1195.
Fraser R and Sargant W. The British Medical Journal 1938; 1(4024):378-380.

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