Question from Sandy O. in Southbury, CT:
I have Osteoporosis and need to learn poses that will help me and my students manage this condition safely. I love yoga and teach elderly people. (I am one myself!)
Your interest in understanding how to work with Osteoporosis is well founded. First, a bit about the condition for the sake of others reading:
Literally translated as “porous bone,” Osteoporosis is a progressive disease in which bones lose density, become brittle, and are susceptible to breakage, especially in post-menopausal women. (If you are a woman over 50 and haven’t had a bone density scan yet, check with your doctor to see if it’s time.)
Men can get it, but the International Osteoporosis Foundation estimates approximately one-tenth of women over 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90 are affected. Osteoporosis has no symptoms. Many people find out they have it when a bone suddenly breaks–usually the hip, spine or wrist, often after a minor fall or bump. Or they experience a compression fracture where a vertebral body collapses after something as innocuous as a sneeze.
Causes vary and include family history, prolonged use of certain medications, and lifestyle choices around alcohol consumption and smoking. Many breast cancer survivors experience bone loss due to chemotherapy and/or reduced estrogen. While yoga offers tools to deal with virtually any condition, it’s hard to give a one-size-fits-all recommendation regarding poses due to the individual circumstances of each case. I can offer some broad guidelines, but you’ll need to determine what is safe for you.
Arm yourself with information. You’ll be managing this condition for the foreseeable future. The Internet offers a wealth of resources to help with the bigger picture, including non-yogic ways to support your bones.
Here are some general guidelines for approaching asana practice:
Gentle weight bearing exercise is essential for healthy bones. Movement is a critical element in maintaining bone health and slowing or stopping disease progression. More about yoga in a minute, but you should be walking—a minimum of 4 miles per week, including day-to-day movements. There is simply no better exercise for bone health than walking.
In terms of all other physical activities, including asana practice, ask your health care professional what movements or positions pose risks for you, particularly in your spine.
- Avoid extreme versions of any posture, but especially anything with an element of spinal twisting or forward bending.
- The Viniyoga method of moving into and out of a pose before holding facilitates easeful motion, increases circulation, and prepares your body for the full pose. I’m a broken record on this point, but look for a Viniyoga teacher in your area.
- Standing poses are great for posture, strength, and balance.
- Start by doing less and building up. Don’t worry about what others are doing around you–practice on your own mat!
- If in doubt, practice in a chair. Yes–you can get a thorough and comprehensive physical workout in a chair!
Strengthening posture muscles is very important for support and preventing further degradation. Prone and supine back bending poses, such as supported bridge, baby cobra and locust pose are generally safe ways to engage the muscles that support the spine.
- Draw your belly toward the back of your spine to support your low back.
- Don’t use your arms to press or push your torso up from the prone position, use the muscles in your back as much as possible.
- Avoid creating compression at the back of your neck. Gently tuck your chin and do not pull the spine with the head, force yourself up, or lift your head to look forward. The spine leads, the head follows.
- Lift your torso on inhale, lower on exhale.
Balance is essential for fall prevention. Asymmetrical standing poses, such as Warrior 1 or Tree Pose help build strength and stability.
- Use a chair, ballet barre or wall for light support. One finger is probably enough to steady you.
- Try this: stand at the wall close enough to touch, if needed. Take the weight off one foot. Do not pick up the foot or displace the hips or knees. Ground your standing leg, lift through the crown of your head, and let your body find its way into an integrated balance. Hold for a minute and repeat on the other side.
- To wake up the proprioceptors in your feet, stand on a folded blanket, towel or mat on one or both legs. Bear with initial shakiness and give your muscles time to organize themselves.
- For advanced osteoporosis, start with Simple heel raises holding on to a chair and work your way toward more advanced moves.
Forward bends and twists can be helpful, but know if they are good for you. Both moves are subjects of controversy in the Yoga community. Some people say avoid them at all costs, others say you are twisting and forward bending every time you put your socks on. Knowing your own limits is essential. In general:
- My personal preference is to do forward bends as axial extensions where bone density issues are a concern. That involves stretching the spine forward rather than rounding down. Keep your back straight, knees slightly bent. Going halfway with hands on the knees may be safer for you than going all the way to the ground.
- Vajrasana—a form of forward bend done standing on the knees – can add core strength and is generally a safer bet.
- Some gentle spinal twisting can provide a healthy challenge to the muscles and bones of the spine, but proceed with caution and a good teacher.
Avoid postures that create excessive pressure on intervertebral bodies.
- Headstand, plow and shoulder stand are risky, as is upward facing dog.
- Rolling up through the spine risks anterior compression and, for my money, delivers little benefit. Instead, ground your feet, extend through the spine, and lengthen your way up. Never miss an opportunity to create space.
- Seated forward bends on the floor can create a lot of spinal compression. Elevate your sacrum with a blanket or use a chair. For advanced osteoporosis consider other poses, such as apanasana (on your back, use your fingertips to guide your knees to your torso on exhale, release on inhale.)