This article is separated in 4 chapters:
Part 1: How can yoga help to strengthen your bone capacity?
Part 2: Yoga for osteoporosis
Part 3: What kind of asana practise is suitable for people with osteoporosis?
Part 4: Example of asana practise
Today you can read part 3:
What kind of asana practice is suitable for people with osteoporosis?
First, the good news: osteoporosis is a condition that is both preventable and treatable if caught in time. However, the bad news is that there is not enough awareness of the opportunities for prevention and treatment of osteoporosis, and too many people, mostly women over the age of 50, suffer significant illness, deformity and sometimes death from this condition.
Osteoporosis itself does not cause back pain. However, osteoporosis can weaken the vertebral body (spine) so that it can no longer withstand normal stress or a minor trauma resulting in a fracture. In fact, a fracture is typically the first outward sign of the disease, and advanced osteoporosis is potentially very painful and disabling. Therefore National Osteoporosis Foundation recommends not to do risky movements like bending forward from the waist, twisting the spine to a point of strain, and doing toe touches and sit-ups.
Three years ago when the doctors did discover I have osteopenia in the spine, this information left me quite worried. Could the mainly ashtanga yoga based practice I love actually be damaging my skeleton? Should I stop doing forward bends and deep twists? Did I need to give up yoga entirely? It turns out that osteopenia requires me to have patience, honesty, and, perhaps most important, humility. Nowadays I adapt my yoga practice to avoid injury. Asana practise helps me to maintain the bone mass I still have.
So what postures are safe for people with compromised bone mass?
Not everyone is in agreement on which postures are safe and effective for people with compromised bone mass. In Yoga for Osteoporosis, the authors—yoga therapist Ellen Saltonstall and Dr. Loren Fishman, medical director of Manhattan Physical Medicine and Rehabilitation—caution against a convex rounding of the spine. An example of these is Cat-Cow Pose, which can cause tiny fractures in the spine. Twists have the potential to do the same, but Fishman contends that twisting poses are “the only way I know to strengthen the anterior part of the vertebral body.”
Although some teachers might say the opposite, Ellen Saltanstall feels that gentle, supported twists are safe to do as part of one’s yoga practice. There’s almost no other way of developing strength and stimulate bone growth than exposing that vertebra to some pressure. Therefore, twists are very important, because they give a complete stimulus to the vertebral body. Only if you have certain other spine conditions, like a herniated disk, twists can be a problem.
Actually twisting the vertebra is one of the few ways to get all of the vertebrae under some compression and stimulate bone growth in the vertebrae. This is extremely important, because so many osteoporosis fractures happen in the vertebrae. On the other side Saltanstall recommends to avoid forward bends for people with osteoporosis, and the side bends they can do are limited.
Over the last 10 years, Ellen Saltonstall has given yoga practices including twists to many people, generally over the age of 65, from whom almost all have had significant osteoporosis. This has been well over 30,000 hours of yoga. There hasn’t been a single incidence of fracture, In fact, nothing bad has happened. We haven’t had one thing go wrong. This is something that both yoga teachers and yoga practitioners should know.
7 poses who are “ good to the bone” 🙂
In her Yoga Journal article “Good to the Bone,” Catherine Guthrie lists bone strengthening yoga poses recommended by Loren Fishman, Carol Krucoff and Sara Meeks. Guthrie suggests incorporating these seven poses into your home practice or substituting these poses in class when everyone else is practicing poses that are contraindicated for you:
- Tree Pose
- Warrior II
- Warrior I
- Chair Pose
- Cobra Pose
- Alternating arm and leg lifts from table position
- Bridge Pose
Tree pose / Warrior 2 / Warrior 1
Chairpose / Cobra / Urdva Dhanurasana
Further, Fishman states that holding yoga poses for at least 72 seconds can stimulate new bone growth, as reported by Jill Miller in her Gaiam Life article “Can Yoga Prevent Osteoporosis? 72 Seconds is the Magic Number.”
There are yoga poses, however, that are contraindicated if you have osteoporosis. The National Osteoporosis Foundation lists the following yoga poses to avoid.
- Forward bends
- Deep twists
- Plow and shoulderstand
- Jumping between poses
- Abdominal crunches
- Downward facing dog with a rounded low back (Downward facing dog with straight back is ok)
The National Osteoporosis Foundation (North America) states that forward bends should be accomplished by bending the knees and hinging at the hips rather than bending from the waist with a rounded spine. While twists are most often safe, the Foundation says “twisting to the point of strain” should be avoided.
Caution: if you’ve been diagnosed with osteopenia or osteoporosis, always consult your doctor before you start practicing yoga. You might choose to begin your yoga practice with a chair yoga class, or by working individually with a yoga therapist.
Being a yoga teacher myself, I agree with Ellen Saltonstall and Dr. Loren Fishman, that the key to getting the benefits of yoga is to ensure that the yoga postures are done with proper alignment. Every joint in the body and every part of the body has an optimal alignment. If the joints are aligned properly you get the best stimulus of the bones and have a better balance. There are different yogatypes with different alignment theories, such as iyengar, ashtanga and anusara.
Example of alignment: make sure that the tops of the arms (upper arm bone) and the tops of the legs ( the thigh bone), both move back in the sockets of the joints. When they are rooted firmly in the sockets of the joints, the congruency of the joints is better, it’s stronger. Make sure the chest bones lifts up. This prevents the stoop forward posture that is commonly seen in osteoporosis.
And yes! I just want to make sure that nothing in this article should be construed as a medical advice. Osteoporosis is a serious condition, always consult a doctor about any medical concerns and before starting any (yoga) exercise regimen. 🙂
Yoga for Osteoporosis: The Complete Guide by Loren Fishman and Ellen Saltonstall.