Blowing the shofar is a mitzvah, but it’s also a physical act that can affect your health. Whether you’re a Ba’al Tekiah concerned about the demands of producing 100 blasts on Rosh Hashanah, or a congregant with a heart condition wondering if intense listening might affect you, understanding the medical aspects of shofar sounding is important.
This article examines the physiological demands of shofar blowing, potential health risks, and practical guidance for those with medical conditions. While fulfilling mitzvot is central to Jewish life, halacha prioritizes health—those who are ill are exempt from shofar blowing and may even be forbidden from activities that endanger them.
Who Should Read This Article?
- Shofar blowers (Ba’alei Tekiah) preparing for the High Holidays
- People with respiratory conditions considering learning to blow shofar
- Anyone with cardiovascular concerns
- Those recovering from surgery or illness before the Yamim Noraim
- Rabbis and gabbai’im responsible for selecting a Ba’al Tekiah
The shofar has called the Jewish people to attention for thousands of years. To understand how this ancient practice developed, see our article on Shofar History.
The Physiology of Shofar Blowing
Shofar sounding is akin to Trumpet playing is the sense that the two principal attributes are the embouchure (musculature of the lips and facial muscles), the wind generation and the agility of the tongue.
Insofar as wind generation, we come upon the Valsalva maneuver – a physiological response to holding one’s breath and bearing down (as in childbirth).
The trumpeter’s Valsalva is modified because air is released through the resistance of a .144-inch-diameter hole at the mouthpiece throat and through 5 feet of brass tubing. The respiratory tract pressures generated by trumpet players have been measured and are impressive. Mouthpiece pressure on the lip during normal playing has been measured at 5 to 10 pounds. Higher-register playing produces greater pressure.
Brass Instrument Pathology
Problems inside them mouth such as canker sores, braces or “bump” can sideline a player for days. Playing with a cold or worse is also not good for the wind generation. And it may lead to dizziness, decreases the velocity of air generation (decreasing the tonality of the instrument)
Mucous is not the only possible pathological hindrance to a trumpeter’s airflow. Asthma decreases the volume and velocity of exhaled air. Smoking-related obstructive lung diseases such as emphysema and chronic bronchitis create similar difficulties.
In 1973, a volley of letters to the New England Journal of Medicine described wind parotitis. The typical story of these patients was inflammation of the parotid gland, similar to that occurring in mumps . . . Although one writer postulated that the pressures generated within the mouth forced bacteria from the mouth through the tube that drains saliva into the mouth from the parotid gland, most writers believed the symptoms were caused by trapped air within the gland.
Transient dizziness, as a result of thoracic cavity pressures decreasing blood flow to the head, can occur. In addition, a peculiar syndrome called facial dystonia is the wind instrumentalist’s version of writers’ cramp. This malady causes lips or cheek muscles to lock or stiffen after a period of playing. The cramp disappears with rest but naggingly returns when playing resumes.
The tongue is the precision part of a brass instrumentalist’s anatomy. The tongue needs agility. Anything that swells, cuts, or slows the tongue, such as canker sores, lacerations, and allergic swelling, blurs the attack and can even trigger an unwanted half-tone.
Accordingly, although there are medical consequences inherent in brass instrument playing, one should take care of their health and be very careful when a cold, sore or cramp develops.
Specific Medical Conditions and Shofar Blowing
Beyond the general concerns above, several specific conditions warrant special attention:
Cardiovascular Conditions
The Valsalva maneuver increases intrathoracic pressure, which can temporarily affect blood pressure and heart rhythm. Individuals with the following conditions should consult their physician before attempting to blow shofar:
- Uncontrolled hypertension (high blood pressure)
- Recent heart attack or cardiac surgery
- Aortic aneurysm
- Arrhythmias or pacemaker
- History of stroke
Eye Conditions
Increased pressure can affect intraocular pressure. Those with glaucoma or recent eye surgery should be cautious. The pressure generated during sustained Tekiah blasts may temporarily elevate eye pressure.
Hernia
Individuals with inguinal or abdominal hernias may experience discomfort or worsening of the hernia due to increased abdominal pressure during blowing.
Pregnancy
While listening to shofar poses no medical concern, pregnant women should generally avoid blowing shofar, particularly in the later trimesters, due to the abdominal pressure involved.
Recent Surgery
Anyone who has had recent abdominal, thoracic, or facial surgery should wait for full recovery before attempting to blow shofar. The increased pressures can affect surgical sites.
The Halachic Perspective: When Health Takes Priority
Jewish law is clear: pikuach nefesh (saving a life) overrides nearly all commandments. A person whose health is at risk is not only exempt from blowing shofar but may be forbidden from doing so.
Key halachic points:
- Choleh (ill person) – One who is ill is exempt from hearing shofar if attending synagogue would harm their health.
- Listener vs. Blower – Someone unable to blow shofar can still fulfill the mitzvah by hearing another person blow.
- Partial fulfillment – If health allows hearing only some blasts, partial fulfillment is still meaningful.
- No endangerment – A Ba’al Tekiah should never continue blowing if experiencing chest pain, dizziness, or other concerning symptoms.
For a complete guide to Rosh Hashanah observance including alternatives when health is a concern, see our Complete Guide to the Jewish New Year.
Practical Tips for Healthy Shofar Blowing
Before Rosh Hashanah
- Begin practicing during Elul to build endurance gradually
- Stay hydrated—dehydration makes blowing harder
- Avoid practicing when sick or fatigued
- If you have a medical condition, consult your doctor before taking on this role
On Rosh Hashanah Morning
- Get adequate sleep the night before
- Eat a light breakfast (the fast is not until Yom Kippur)
- Avoid dairy products that may increase mucus production
- Warm up with a few quiet blasts before the service
During the Service
- Take breaks between sets of blasts
- Breathe normally between sounds—don’t hyperventilate
- If you feel dizzy, stop immediately and sit down
- Have a backup Ba’al Tekiah ready if needed
Warning Signs to Stop Immediately
- Chest pain or tightness
- Severe dizziness or lightheadedness
- Vision changes
- Numbness or tingling
- Shortness of breath beyond normal exertion
For Those Who Cannot Blow Shofar
If medical conditions prevent you from blowing shofar, remember:
- The mitzvah is to hear the shofar, not necessarily to blow it
- You can arrange for a private shofar blowing at home if unable to attend synagogue
- Many communities organize “Shofar on Wheels” visits to hospitals and homebound individuals
- Recording do not fulfill the mitzvah—live sound is required
Ideas for this article came from Charles R. Meyer, M.D., “The Perils of Trumpeting,” Minnesota Medicine, Minnesota Medical Association, February 2003/Volume 86
http://www.mmaonline.net/publications/MNMed2003/February/Meyer.html. Accessed June 14, 2006
For more information about Shofar and other Holy Temple instruments.
This article draws on research by Arthur L. Finkle and medical insights from “The Perils of Trumpeting” by Charles R. Meyer, M.D., published in Minnesota Medicine (February 2003).
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical conditions or concerns before engaging in shofar blowing.
Frequently Asked Questions: Health and Shofar
Can blowing shofar cause a heart attack?
While rare, the increased pressure from shofar blowing can stress the cardiovascular system. People with heart conditions, uncontrolled high blood pressure, or recent cardiac events should consult their doctor before blowing shofar. Listening to shofar poses no cardiac risk.
Is it safe to blow shofar with high blood pressure?
If your blood pressure is well-controlled with medication, blowing shofar is generally safe for most people. However, those with uncontrolled hypertension should avoid the sustained pressure of shofar blowing and consult their physician.
Can I blow shofar if I have asthma?
Many people with well-controlled asthma successfully blow shofar. Use your inhaler before practice sessions, avoid blowing during flare-ups, and stop if you experience breathing difficulties. Severe asthma may make shofar blowing inadvisable.
What if I get dizzy while blowing shofar?
Stop immediately and sit down. Dizziness during shofar blowing usually results from hyperventilation or the Valsalva effect reducing blood flow to the brain. Rest, breathe normally, and if symptoms persist, have someone else complete the blowing.
Does Jewish law exempt sick people from shofar?
Yes. The principle of pikuach nefesh (preserving life) overrides the mitzvah of shofar. A person whose health would be endangered by attending synagogue or by the stress of hearing/blowing shofar is exempt. One who cannot blow can still fulfill the mitzvah by hearing another person blow.
