Practicing Yoga with Osteoporosis

Osteoporosis translates to porous bone.  It is a disease process that results in the deterioration of bone tissue as measured by bone mineral density (BMD) and bone quality.  BMD is the ratio of minerals such as calcium, phosphate, bicarbonate, citrate, potassium, sodium, and magnesium relative to a bone’s mass.  Bone quality or bone structure refers to the intricate lattice work of the bone’s internal material of struts and crosspieces, similar to the support beams of a bridge or a building. 

Osteoporosis and Osteopenia

Osteoporosis occurs with low BMD and low bone quality, while osteopenia occurs with low bone structure and is often a precursor to osteoporosis.  Both lead to bone fragility and susceptibility to fractures, especially in the spine, hips, and wrists.  Kyphosis, or dowager’s hump, puts pressure on the spine, which leads to wedge fractures when an osteoporotic vertebrae collapses. A fall may break an osteoporotic hip, arm, or wrist. Simply put, osteoporosis breaks bones.

Osteoporosis and Broken Bones

While broken bones themselves are not lethal, the deluge of effects resulting from the break increase the risk of mortality.  Individuals with a broken spine or hips are subject to bedrest, which may lead to increased chances of infections, pneumonia, bedsores, weakened muscles, digestive ills, and isolation.  These conditions are what cause death in 25% of people with a bone fracture.  Another 25% of individuals with osteoporosis who get a bone fracture enter a nursing home and never leave (NY Times).

The Importance of Muscle Strength

Weight-bearing activities that build muscle strength are often recommended as well as activities that improve balance and coordination.  Increased muscle strength produces more bone mass.  When one muscles group opposes another muscles group, as in reciprocal inhibition, bones are compressed, twisted, and elongated, which stimulates the production of osteocytes, or bone-making cells.  Improving balance and coordination are recommended activities that reduce the incidence of falls leading to bone fractures.

Yoga Can Help

Yoga is a perfect activity that not only builds muscle strength, it also increases range of motion, improves posture, develops balance, helps with coordination, and reduces anxiety.  Dr. Loren Fishman conducted a 10 year study in an attempt to quantify the effects of yoga on BMD and bone quality.  He studied 227 individuals whose average age was 68 years.  Eighty-three percent of individuals in the study had osteoporosis or osteopenia and 109 had experienced some type of bone fracture prior to the study.  Dr. Fishman gave participants 12 yoga poses (see sequence below) to practice for 12 minutes every day. The study was completed in 2015 and for the individuals who were moderately or fully compliant, x-rays showed an increase in BMD in the spine, femur, and hip.  Furthermore, none of the 227 individuals participating in the study experienced an additional fracture during that time period!

In addition to increasing BMD, yoga improves posture, which helps prevent kyphosis and wedge fractures.  It improves balance, muscular strength, range of motion, coordination and it reduces anxiety.  Gentle, non-weight bearing twists give symmetrical pressure to the spine and increases blood and fluid flow to the region.  Forward folds and side bends should be avoided.  The following sequence is taken from Dr. Fishman’s 2005-2015 study, which showed increased BMD for students who practiced it regularly and from Lillah Schwartz’s sequence taught during the August 2015 retreat.

Yoga for Building Bone Health

  1. Sukasana (Easy Cross Leg Pose)– to center
  2. Chest opener on eggs, blocks, or rolled blanket –to passively open the chest and cente
  3. Alternate knee to chest – to open the hips and connect with the breath
  4. Supta Padangusthasana I (Reclined Hand to Foot Pose I) – to open the hips, lengthen the hamstrings and strengthen the quadriceps
  5. Traction Twist – to counterbalance Supta Padangthusana I, to lengthen the hip flexors
  6. Jathara Parivarthanasana (Belly Turning Pose)– with bent knees half way over 2x each side – to tone the abdominals and release the low back
  7. Setu Bhandasana (Bridge Pose) – with block between knees to lengthen the quadriceps and strengthen the hamstrings and gluteus muscles
  8. Matsyangasana (Fish Pose) - chest only, with bent elbows to actively open the chest and strengthen the upper back muscles
  9. Navasana (Boat Pose) – with bent knees to tone the abdominal muscles to increase balance
  10. Purvottanasana (Upward Plank Pose) – with bent knees, lift and lower hips with breath, then hold to open the chest and strengthen the upper back muscles, arms, and wrists
  11. Adho Mukha Svanasana (Downward Facing Dog Pose)– to traction the spine, strengthen the arms and legs, and transition
  12. Urdhva Muhka Svanasana (Upward Facing Dog Pose) – with hands on blocks to strengthen the arms, upper back, and leg muscles
  13. Adho Mukha Svanasana (Downward Facing Dog Pose) – to transition
  14. Uttanasana (Forward Fold) – to transition
  15. Tadasana (Mountain Pose) – to prepare for standing poses
  16. Utkatasana (Chair Pose) – legs only with block between knees to strengthen the ankles, legs, and perineum and increase balance
  17. Trikonasana (Triangle Pose) – to strengthen the ankles, leg muscles, and tone the spine and neck
  18. Prasarita Padottanasana (Wide Legged Forward Fold) – to counterbalance Trikonasana, traction the spine, and strengthen the ankles and leg muscles
  19. Dandasana (Staff Pose) – to strengthen the leg and back muscles and prepare for seated poses
  20. Marichysasana III (Marichy’s Twist) – to open the chest and give symmetrical pressure to the spine
  21. Savasana (Corpse Pose) – with blanket folded lengthwise under shoulder to passively open the chest, access the parasympathetic nervous system and integrate the sequence

References

Brody, J. E. "12 Minutes if Yoga for Bone Health." The New York Times 21 December 2015.

Dr. Fishman, L. and Saltonstall, E. Yoga for Osteoporosis. New York: W. W. Norton & Company, 2010.

Dr. Fishman, L. "Yoga for Osteoporosis: A Pilot Study." Topics in Geriatric Rehabilitation (2009): 244-250.

Dr. Smith, E. N. "Yoga U." n.d. https://www.yogauonline.com/yogau-wellness-blog/yoga-for-osteoporosis-interview-loren-fishman-md-and-ellen-saltonstall. Website. 1 May 2016.

Iyengar, B.K.B. Light on Yoga. New York: Schocken Books , 1966.

Schwartz, L. Transformation Yoga Teach Training, Prama Institute. August 2015.