Yoga for Osteoporosis, part 1

Several people in my chair yoga classes for seniors have been asking whether they can practice yoga if they have osteoporosis and how and whether yoga can be beneficial. The answer is yes, it can, with some modifications. I am particularly interested in this because I, too, have osteoporosis.

My story

In October of 2012, I was finishing up the second of three 2-week sessions comprising my yoga therapy training. One of the modules in that session dealt with osteoporosis. We learned of the dangers facing people with brittle, fragile bones – the possibilities of shrinking spines and of multiple fractures, sometimes caused by something as innocuous-seeming as a sneeze. My own bones – spine and hip – had been osteopenic for at least a decade, and just before flying to California for this therapy training, my gynecologist had performed a bone density scan, so I came home with some trepidation, only to find that indeed, my osteopenia had progressed to osteoporosis. Having been thoroughly chastened by what I had just learned, I was in a bit of a panic to try to figure out what to do. My gynecologist wanted me to take a twice-yearly drug called Prolia, but my insurance wouldn’t pay for it unless other cheaper drugs were tried and found to not be successful. So with some misgivings, I embarked on a course of Fosomax – a drug that, as I had learned, works by preventing osteoclasts, the “garbage clean-up” cells in your bones, from doing their work. But I felt I had no other good options, so I took it for 5 years, until my bone density scans finally reverted back to osteopenia, or better, at least for the time being.

What is osteoporosis and osteopenia?

Bone is living tissue so, like all cells in the body, new cells are created as old, tired ones are destroyed. When we are younger, the rate of new bone being created exceeds that of the rate of old bone being destroyed, so bone grows and becomes stronger. But at some point, usually in our 30’s, the process starts to reverse – the rate of new bone creation doesn’t keep up with old bone destruction. When that happens, our bones become less dense and start to become more fragile and brittle, so that the risk of fracture increases. Bone density tests measure the density of bone as compared to an average for young, healthy adults. If your bone density is more than a standard deviation away from that average, your bones are considered to be osteopenic, and once it is more than two and a half standard deviations away from that average, they are considered to be osteoporotic. If you have received a diagnosis of osteopenia, it’s important to take in enough calcium and vitamin D, minimize alcohol intake, and start doing some weight-bearing exercises if you haven’t already. This applies to osteoporosis, too, but you will probably want to start taking a medication to improve your bone density, and be extra careful to follow an exercise regimen that doesn’t expose your bones to a higher risk of fracture. More on that later.

How can yoga help?

When I received my diagnosis, I wondered if I should have just relied on yoga, but while yoga can help in many ways, it’s probably not enough to get your bones back to “normal.” It is, however, a great supplement to whatever medication you decide to use. It can help with balance, so you’re less likely to fall, with muscle strength, so that your stronger muscles can better support those fragile bones, and with alignment, so that your bones don’t crunch down on each other. Bones grow when they are stressed, so weight-bearing and some twisting yoga poses can help to build bone back.
In these next few posts, I’d like to focus on some ways yoga can help keep your bones healthy. Let’s start with…

Forward Bends

Forward bending movements – movements which bring the torso towards the legs – are generally contraindicated when osteoporosis occurs in the spine. This is because bending over can cause the inner (anterior) sides of vertebrae, which are less resilient than the outer (posterior) sides, to press into each other. In addition, many people have an exaggerated forward rounding of the spine, called kyphosis, that tends to increase with age, so even without deliberately doing a forward bending movement, people with kyphosis are already in a forward bend. (Did your mother admonish you to “stop slumping!”? Mine certainly did. I should have listened to her!) But with practice and attention, one can decrease kyphosis and even perform forward bends without fear of damaging vertebrae. The key is axial extension, which is a movement that lengthens the spine. If one practices with axial extension, the vertebrae will stay in, or start returning to, better alignment.
No one has a perfectly straight spine – our spines naturally form a double-S curve: the back of the neck curves forward, the upper back curves back, lower back curves forward, and the sacrum curves back. We need these curves to stay upright. But as we age, the curves become more pronounced. So to achieve axial extension, we need to work to flatten these curves.

Try this: start by sitting in a chair. Imagine a puppeteer sitting a marionette upright by pulling a string at the top of the marionette’s head. Think about the top of the head reaching the ceiling, and the sit bones grounding into the seat. Pull the shoulders forward, then up, then back, and then down – now the muscles around the shoulder blades should be tight, the chest lifted forward, and the upper back straighter. Tuck the chin without dropping the head – as though you are “translating” the head backwards. You might feel a stretch in the back of the neck. And…pull the abdominal muscles in, tipping the pelvis back a bit, creating a stretch in the lower back. You’re now sitting with a spine as straight and tall as possible.
Place your fingertips on the tops of the kneecaps. As you inhale, keep the fingertips on the kneecaps as you arch backwards slightly until your elbows straighten, keeping your attention on the back of the neck (tucking the chin so the back of the neck lengthens) and on your upper back (pulling the shoulder blades back and down). Cup your hands so that the heels of your hands and your fingertips are resting on your thighs. With that now long, tall, flat back, and continuing to lengthen up through the top of the head and pulling the shoulder blades downward, exhale, tightening the abdominal muscles so that the low back starts to stretch, and pull the fingertips and heels of the hands backwards as you lengthen the spine forwards. Try this movement a few times. Do you feel taller?

Whether your bones are osteoporotic, osteopenic, or normal, they can benefit from axial extension. In my next post, I will offer a practice that incorporates axial extension movements.