World Osteoporosis Day is observed on 20 October to spread awareness about the preventive measures of osteoporosis disease, its diagnosis, and the treatment.
In support of World Osteoporosis day we bring you everything you need to know about Yoga Practice – Do’s & Don’ts.
Can Everyone with Osteoporosis Practice Yoga?
That depends on the degree to which one has lost bone density and the types of exercise along with the range of movement that is safe. For e.g. Folding forward or twisting while the spine is in a C-shape is dangerous for the thoracic vertebrae made vulnerable by low bone density.
Note, those with osteoporosis or osteopenia should seek medical assessment and their doctor’s advice as to whether yoga asana is a good idea for them, and any specific movements they should avoid.
DO’S
When practicing yoga with osteoporosis, aim for the following poses and actions.
1. practice neutral-spine postures.
Women with osteoporosis should make neutral spine poses like mountain the crux of their practice and should work on aligning the spine optimally in these poses.
Tip the tailbone back enough that you create a curve in the lower back and bring your head back over your shoulders. Imagine a plumb line dropping from your ear down through your shoulders, hips, and ankles. Try to maintain this optimal spinal position during most postures and flows. Those with rounded upper backs who are unable to create a neutral spine should try to come closer to neutral as possible.
Yoga Poses to Practice: Mountain, reclining hand to big toe pose (using a strap), low lunge, the warrior poses, tabletop, and plank.
2. Focus on lengthening.
Having arranged your spine in its neutral or near-neutral shape, work to elongate it as osteoporosis leads to weakened vertebrae that can sometimes collapse to the point of fracture. Lengthening the spine creates space between the vertebrae, preventing or correcting that collapse.
Imagine lifting into an object—like a book or jug of water—balanced on the crown of your head.
3.Include poses that encourage the hands to bear weight.
Bring your hands to the mat! As noted, one of the advantages of yoga over other exercises is that bearing weight on the hands allows us to build bone density in the arms as well as the legs.
Yoga Poses to Practice: Tabletop, plank, forearm plank, chaturanga, reverse tabletop, and downward facing dog.
(Please note: Do not bear much weight on the hands if the upper back is rounded. In tabletop, work to indent the space between the shoulder blades, and only proceed to poses like chaturanga, plank, and downward facing dog once this is possible. Avoid arm balances like crow that call for a rounding of the back.)
4. Do Gentle Backbends.
Because osteoporosis is so often accompanied by thoracic kyphosis, it’s especially important to work on gentle backbends, which move the thoracic spine in and lift the chest, improving thoracic spine extension.
Even mild forward folds are not recommended for those with osteoporosis, but some mild backbending is fine. Why? because, the extension movement is much less risky than flexion because of the strength of cortical bone in vertebrae.
Yoga Poses: Bridge, sphinx, baby cobra, camel pose (with hands on your lower back), lying down over a foam roller or rolled-up blanket (placed horizontally under the thoracic spine), and restorative backbends. This practice for kyphosis is safe for many of those with osteoporosis.
5. Do mild sidebends and twists.
Varied spinal movement is important for preserving the health and strength of the vertebral bones. Remember, any pose that rounds the back should be avoided. Go only as far as you can without sacrificing spinal length. When twisting, go only as far as you can while maintaining a gentle inward curve in the lower back.
For example: Bend to the side by just a few degrees while standing or lunging, as well as in reverse warrior, gate pose, or while reclining in bananasana. Enjoy gentle reclining twists like “windshield-wipering” the legs from side to side. When doing more vigorous twists, keep a neutral spine (i.e., do not round the back), twisting by only a few degrees.
6. Move from pose to pose slowly.
To decrease the risk of falling, it’s important that students with osteoporosis move from pose to pose slowly. For e.g. Come up slowly from positions like half forward fold (bending the knees and bringing the elbows to the knees for a modified chair pose before rising to mountain pose) to decrease the risk of a head rush and a fall. Before stepping a foot back for a pose like warrior I or crescent, always make sure the front foot is well-grounded.
7. Challenge balance without comprimising stability.
Because a fall could mean a fracture for an osteoporosis patient, it’s vital to work on balance in yoga class. To avoid a fall, you should initially challenge your balance while making the most of the support available. In standing balance poses, use a wall support to steady yourself, or keep the toes of the foot you’re about to lift on the mat until you feel stable.
For example: Practice tree pose with your hand touching the wall, gradually lightening your hand on the wall when you are sure you are stable.
DON’TS
It is essential for yoga students with osteoporosis to avoid extremes in range of movement. The poses and practices below should be avoided.
1.Crunches or sit-ups.
While core strength is important to support the lower back, these poses require loaded lumbar flexion, placing a high demand on the lower back as you work to lift the weight of the upper body, leading to fractures in the thoracic or lumbar vertebrae.
Instead: Work on core stability in all neutral-spine poses by drawing the belly in and up on the exhale. From a lying down position, work the core by lifting and lowering the legs rather than the upper body, keeping the spine in its neutral position.
2. All poses that require spinal flexion (rounded-back poses).
Osteoporosis patients should avoid not only sit-ups and crunches, but all poses that require spinal flexion (rounded-back poses) because of the stress that puts on the lower back. This means steering clear of forward folds, even mild ones, and also avoiding hugging the knees in as you lie on your back—as you would for wind relieving pose or happy baby.
Rolling up to stand, a challenging movement should always avoid.
Skip uttanasana (standing forward fold) in favor of ardha uttanasana (half standing forward fold). In this “flat-back pose,” you might bring the hands to blocks, the seat of a chair, or to a wall, in order to maintain your optimal spinal shape. Choose upright seated poses like staff over forward folds like stretch of the west (leaning back if necessary to curve the lower back in toward the belly and lift the chest).
To stretch the hamstrings, instead of going deeper into a forward fold, practice lying down hand to big toe with a strap around the foot of the lifted leg. In all of these poses, focus both on keeping the spine in its neutral position and on lengthening.
3. Don’t Practice big backbends.
While some gentle backbending, with osteoporosis, big backbends like upward facing dog, wheel, bow, and camel pose with hands on the heels, can be dangerously compressive. The thoracic spine is the area of the spine at greatest risk for those with advanced osteoporosis.
4. Avoid Extreme twists and sidebends.
Trunk rotations cause torsional stress on the spine. The discs and vertebral bones are stressed most when in a rounded position combined with a big twist. For e.g. moving into a deep chair pose twist or a Marichi’s pose with your elbow to the outside of your thigh is off limits. Big sidebends often have an element of twisting to them and can be compressive too.
Instead: Stick with the milder twists and sidebends listed in the Do’s.
5. Do an inversion practice.
Those diagnosed with low bone density who have practiced inversions regularly throughout their lives and are able to keep their neutral-spinal alignment in these poses may be able to safely practice inversions such as headstand, shoulderstand, and handstand, but consult your doctor first.
If you do practice inversions, practice them at the wall in order to minimize the risk of falling.
For those who haven’t already been practicing poses like these regularly, this is not the time to start. The weakened, low-density vertebrae will not tolerate the compression [of these inversions].
Instead: For many of the circulatory and energetic benefits of inversions, practice milder inversions like downward facing dog, bridge, and legs up the wall.
6. Join fast-paced, competitive classes.
Stability is of the essence for osteoporosis women. Steer clear of the classes and the teachers that encourage you to move so fast you risk your balance.
Instead: Take hatha, Iyengar, gentle, restorative, yin yoga, or any alignment-focused practice.
Through asanas that are modified for greatest benefit, one can retain—and even regain—not only strength of muscle but strength of bone.