Osteoporosis and Exercise: Safe vs. Harmful Movements

Whether you have been recently diagnosed with osteoporosis or osteopenia, or have known for a while…there is so much that you CAN do for your bones!

If you don’t have a regular exercise routine…start now! Don’t Delay, Get Started Today!

If you already exercise, how do you if you are building bones or putting them at risk with the movements that you perform?

What is Osteoporosis?

Osteoporosis is a disease that leads to a decrease in the density and quality of bone. This causes bones throughout the body to become weak, fragile, and brittle putting the individual at an increased risk of fracture. Evidence reports that 1 in 3 women and 1 in 5 men 50 years and older will experience an osteoporotic fracture at some point in their life. Osteoporotic fractures are most commonly seen at the hip, spine, and wrist.

Osteoporosis has been referred as the “silent disease” due to the lack of signs and symptoms associated with it. You could be moving in ways right now that are creating damage to your bones and you don’t even know it.

Besides exercise, you can make changes to your lifestyle that can slow the deterioration of your bones: minimize alcohol consumption, quit smoking, improve body composition (less adipose and more muscle), proper nutrition to ensure adequate calcium and vitamin D (but also other essential vitamins and minerals), seek treatment for eating disorders, get moving, and improve your balance.

What types of exercise should you do:

• Weight bearing and the more impact that you can tolerate the better. Jogging is better than walking. Jumping is better than stepping up/down. Planks and push ups are better than using free weights. However, you may need to build up strength and tolerance to be able to perform the higher levels of impact.

• Muscle strengthening with resistance training. The heavier that you can lift, the better. Again, you will need to build up strength over time. But don’t stop progressively lifting more and more weight with excellent form, i.e. straight spine for squats and other lifts.

• Balance Training because falling increases your risk for breaking a bone. Train for both static (standing still on 1 leg) and dynamic (walking heel/toe) balance. Train to the level of your activities and beyond. That way you can keep progressing your activity level with confidence.

What types of exercise do NOT build bones:

• Water aerobics or swimming reduce weight bearing and impact. Though this may feel good for arthritic joints, these activities will NOT build bone.

• Cycling. In fact, the bent or rounded position of cycling has the potential to harm the spine.

• Lifting light weights or using low level resistance bands for 20-30+ repetitions. This level of resistance will not provide muscles strength gains, nor will it build bones.

• Doing the same exercise routine over and over again. You body like and adapts to novel movements so MIX it up!

Yoga may or may not BUILD Bones…it depends!

So may types of yoga exist. A gentle yoga class may be great to reduce your stress and rid the body of chemicals that keep you from building bone. However, the gentle movement will not stimulate bone growth.

If yoga is a new activity for you, it can help you find new movement in your joints and muscles and this is great as you progress to true bone building exercises. Yoga may also help you feel the activation of muscles that you haven’t felt before and help you bring awareness to the posture or position of your spine. Interoception, the ability to feel what the body is doing, will help you move in ways that keep your bones safe.

A more vigorous practice of yoga that includes strength training can help build bones. Again, you may need practice with the movements of yoga before you can progress to making a strength training type of exercise.

What you need to know to safely participate in yoga!

Caution is advised for individuals with osteoporosis who participate in ANY type of physical activity. However, caution does not mean you should stop moving all together. Movement is still key with a large emphasis on SAFE movement.

To promote safe movement during yoga, poses should focus on maintaining spinal alignment and avoiding forced spine flexion or rounding. Props such as bolsters, foam blocks, chairs, belts, and blankets can be utilized to assist with modifications during the session. There is “no one size fits all” in yoga, which is why modifications are necessary! This may require a consultation first with a Physical Therapist.  A Physical Therapist can help you modify exercise and yoga for safe participation.  Once you understand modifications and limitation, you and your yoga instructor can work together as a team to determine appropriate modifications that allow for safe participation in yoga.   

Individuals with osteoporosis or osteopenia should avoid movements that involve extreme end range of spine motion in forward bending twisting.

It is important to be mindful and aware of the position your body is in when transitioning in and out of poses. For example, when transitioning from lying on your back to sitting, the “log roll” technique is often recommended to decrease the stress to the spine. With appropriate modifications and education, individuals with osteoporosis or osteopenia can safely participate in yoga!        

Top 4 Modifications for Yoga

1.     Avoid sitting on the floor with unsupported rounded posture: Modify by sitting on a bolster with the hips positioned above the knees 

Elevate hips above knees in sitting to keep back straight

2. Avoid forceful forward bending of the spine to end range of motion

3. Avoid forceful twisting of the spine or hips to end range of motion

4. Be aware of your body position when transitioning in and out of poses

If you are interested in yoga but don’t know where to start, Dr. Stephanie has a few resources that can help guide you through the process! If you feel like you need more information and want to manage things on your own, you will enjoy Dr. Stephanie’s Build Better Bones package of classes. It includes 10 classes that are safe for your bones and will help you progress strength and mobility over time. Watch the lesson to learn more!

If you like the group setting and accountability to show up each week for exercise guaranteed to build better bones, join Dr. Stephanie’s online therapeutic movement studio: Nourish to Flourish.

If you like to get personal recommendations about your movements and focus on your specific goals, then give Dr. Stephanie a call to set up a private session today! Her ability to evaluate and treat clients with a holistic approach is a skill that many healthcare professionals have not fully grasped! Dr. Stephanie truly cares for her clients and spends the extra time digging deeper to determine the root of the problem. She will blend physical therapy with her expertise in yoga and exercise to come up with a plan that is right for you!

5 Ways to Practice Self-Care Each Day

I probably should have written about self-care months ago!!

Oh well...better late than never and as the pandemic persists self-care becomes even more important! In this email, I'm going to share a few of the small ways that I care for myself each day.

First... let’s talk about what self-care really is, because as a woman the thought of self-care (all too often) triggers...

...GUILT.

I know that I am not alone in this feeling. My favorite author and social science researcher, Brene Brown, tells a story in her book about feeling guilty for focusing on herself during a big project at work. When she shares this feeling with her husband, she realizes that he never feels guilty for focusing on work. Hmmm...

Another book that I am reading, "Burnout. The secret to unlocking the stress cycle", recently cued me into why I feel this guilt. Emily and Amelia Nagoski refer to the "Human Giver Syndrome", a common experience of women and how this syndrome is culturally enforced within our patriarchal society. The cultural “expectations” of womanhood tells us to always put others first and the result is GUILT when we even think about caring for self.

WHEW! Ok, so I am not alone in feeling this guilt AND there are some DEEP reasons for why I feel it.

Because of these deep cultural, societal, and generational expectations...this guilt is not overcome overnight. But one way to overcome this guilt and begin to care for yourself may be in small ways every day.

Overcoming the guilt of self-care may be THE most important step you can make towards pain relief.

Consider this...Do you have trouble consistently doing a pain-relief practice that you know will help? Maybe those exercises that you got from during Physical Therapy that you stopped doing even though they made you feel a little bit better?

I have heard this story TOO many times! So many times in fact, that stopping the exercises is probably MORE common that continuing them. So WHY?

The new insight about the "Human Giver Syndrome" makes me think that stopping something that you know is helping may just be...

...GUILT.

Deep-seeded, unconscious guilt could be the reason you don’t do something that you know will make you feel better. You don't care for your self because you have been "programmed" to believe that you should not put yourself first.

The guilt you experience when you think about self-care could be sabotaging you from healing your pain.

Again...you cannot overcome this guilt overnight. So let’s start small...

...with what you may already be doing but don't fully recognize as self-care.

What makes you feel good?

Look at your day and recognize... in what small moments do you experience JOY?

I will share a few of mine:

-Making and anticipating my hot drink in the morning (coffee or tea depending on my mood). This one is really important to me. I feel joy with a really tasty cup of warmth. I make sure that I have cream and honey and high quality coffee or tea. So not just any warm drink will do, but one that makes me feel good. And then I take time to sit and enjoy it.

-Preparing a healthy meal. The other day it was a crunchy salad that I was craving.

-A hot shower. Not the rushed one, but with just a little extra time to stretch

-Taking a moment to truly engage in conversation with my son or daughter.

-Eating a sweet treat...small and just enough to make me feel good without guilt.

But see how guilt can sneak in? Recognize it. Be fully aware of it. Be curious about why guilt sneaks in.

Now you share your small moments of joy. Comment below and let me know!

And if you don't mind, I will share some of the small ways you care for yourself in my next post.

Recognizing these self-care practices may just help someone else!

Nutrition to Reduce Pain

In this blog, I describe what I have learned over the last 17 years in exploring the impact of food on my own pain.  In 2003 I had a reaction to an antibiotic and subsequent severe lingering gut pain.  But this was just “straw that broke the camel’s back”, so to speak.  I had stomach pain as a child, bloating, constipation, and diarrhea as a young adult, and had been diagnosed with irritable bowel syndrome.  The high fiber diet prescribed, only made it worse.  Since the only answer from the medical community was medication, I decided to start investigating on my own.  I started in 2003 by eating gluten-free, which I did for 5 years.  I think that time along with the elimination of other foods, helped me heal my gut.  Now, I eat mostly organic; grass-fed eggs and meat; low gluten, dairy, and sugar; and minimally processed food.  Believe me, I can tell when I have had too much of the wrong thing!  Each time, this feeling motivates me back on track.  The relief that eating well brings, makes me want to stay on track!

These are the resources that I have followed the most in transitioning my eating habits:

·        Clean, by Alejandro Junger, MD (28-day detox)

·        Heal Your Pain Now, by Joe Tatta, DPT (21-day elimination diet)

·        Food, What the Heck Should I Eat?, by Mark Hyman, MD (just get rid of the bad stuff!)

Each describes a “functional medicine” perspective. I admit that I have jumped on the band wagon, that Food is Medicine!

Step 1:  Heal Your Gut

When the gut is inflamed and unhealthy, it cannot fully digest any food.  So partially digested food gets through the gut lining and triggers an immune system reaction which creates systemic inflammation.  Eating to heal your gut will decrease systemic inflammation and you may immediately feel a difference in your pain.

Eliminate the following from your diet for at least 3 weeks.  Others recommend that it will take 6 weeks.  It seems to depend on how long you have been feeling bad. 

• Gluten

• Dairy

• Eggs

• Yeast

• Processed food (Because most processed food contains one or more of the above, you might as well do it.  I’m talking about crackers, cereal, and pasta. This includes processed fats like vegetable, corn, soy and canola oils.)

Don’t rush back to eating all of these foods at once.  If you feel good after 3-6 weeks of elimination, bring back 1 food every 3-6 days.  If your symptoms return, you may want to consider eliminating the food completely from your diet.

Step 2:  Eliminate Foods that are Potential Allergens/Sensitivities

Our food system has evolved faster than we have.  The processes by which food is produced can cause inflammation.  For example, chemicals are added to processed foods that we can’t necessarily tolerate. If healing your gut didn’t produce the results that you are satisfied with, then you may need to eliminate more foods.

• Corn

• Soy

• Nuts

• Nightshades (tomatoes, peppers, potatoes, and eggplant)

• Citrus

Step 3:  Still not feeling great?  Sugar is another big irritant.  You should eliminate sugar (in any form, like maple syrup and honey) and really sweet fruit like bananas.

Too many Steps?

You could eliminate everything as suggested in Junger’s book, Clean.  I suggest reading the book first.  Then prepare your pantry and gather some recipes.  His detox diet is not easy but very worth the effort.  I still use smoothies and intermittent fasting suggested in book to feel better after a vacation or the holidays.

Step 4: Add anti-inflammatory foods and supplements.

I love a warm cup of tea and a delicious smoothie. I think of these as a tonic or health drink, especially when I use anti-inflammatory ingredients like turmeric and ginger (tea) or magnesium and ground flax (smoothie).

If this isn’t your preference, you can always use supplements for curcumin or magnesium.

We have to accept that are MANY things that we can do to heal our pain through a lifestyle health approach. For me, food has become a big part of that approach.

Namaste,

Stephanie

Comfort Yourself to Ease Pain

When I first heard a version of the meditation from Thich Nhat Hanh it touched me deeply and helped me look at my pain completely differently.

Find a comfortable position lying down or sitting supported in a chair to listen:

This meditation helped me heal the trauma surrounding my birth and adoption. In the late 60’s most adoptions were closed. The birth parents and adoptive parents had no contact. And to make the transition “supposedly” easier, the birth parents never had contact with the child. No holding, no feeding, and no contact.

In my case, from the day that I was born until the day that I was brought home by my forever parents, 18 days passed. I’m not really sure where I was during that time, but possibly the hospital nursery. When I began to explore the emotional impact of my adoption just a few years ago, I had some insight during the time in the nursery. I’m pretty sure that I cried. Picture the red faced screaming baby, occasionally gasping to get a breath and sleeping only when exhausted from crying.

I think that was me.

I have some evidence of this. My mom told me that she was told that the nurses held me as much as possible because I cried a lot. One day during a meditation this thought entered my awareness: “you cried weren’t heard”. And during a hypnotherapy session, I pictured this red-faced baby who I believe to be me.

So this meditation, the imagery that it invokes, allows me to hold and soothe that baby. It allows me to heal the years that followed in not feeling as though I was heard. It heals the small child within that needed validation of thoughts and ideas. It heals the teenager that felt the need to perform in band and choir with playing, singing and dancing. It heals the young adult that felt the need to continue her education as teacher so that she had the “letters behind her name” which gave value to what she said. It continues to heal me in relationships when I feel like I’m, again, not being heard.

With this meditation I can heal the past and I can let go.

This meditation allows me to see a different path. One where I want to be seen and heard for who I really am. Not the person that I thought I needed to be but that small innocent baby who has all the potential in the world to BECOME and LIVE out the gifts that were given to her by God.

This healing process in ongoing and I expect that it will continue for quite some time. I return to this meditation as a reminder to open my heart to myself. This allows me to open my heart to others.

My hope is for it to soothe you, to calm you, and to create space and love for yourself.

Namaste,

Stephanie

How I use the Chakras for Healing Pain

I use the Chakras to understand myself at a deeper level and to coach my clients to better understand why their pain WON’T GO AWAY.

Our body is energy. We breathe, eat, and sleep to gain energy. Our body then uses that energy through metabolism and circulation. The nervous system sends messages back and forth between the brain, spinal cord, and peripheral nerves using energy. This energy needs to flow freely within the body. Chakras are where energy is concentrated or focused within the body and are aligned anatomically with clusters of nerves (plexuses) and the vital organs that are using much of the energy (like your heart and lungs).

Chakras are where the energy of body, mind, and spirit merge and interact. For me this means that sensations in an area of the body, like pain, are consistent with specific emotional and spiritual life challenges.

Chakras are organized developmentally from bottom to top in that we must learn specific life lessons and move through specific emotions to evolve as a person.

1st = Root Chakra

This energy center is located at the base of the spine and it associated with where you make contact with the earth. So sensations from the feet up to the pelvis are associated with the root chakra, i.e. toes, feet, knees, hips, large bones of the body, and also the immune system.

The first sensation that you needed to feel as an infant was safety. If you are not safe, you are afraid. So the most common energetic block associated with the 1st chakra is FEAR.

What are you afraid of? Sometimes we have fear that we are not even aware of. It can come from how you were treated as a child or trauma that you experienced. Sometimes you have to dig deep to find the fear. But the one that I see and is more evident for people to understand is the FEAR associated with CHANGE. When I dig into a client’s story, their pain started with a big change in their life. Now not all change is bad, it just brings UNKNOWN and a certain level of fear. So getting a new job or retiring from a job you loved can create fear. MOVING, whether to a new city or to a new house can cause fear. Relationship change: becoming married, divorced or widowed or becoming an empty-nester is a big change. Financial change…either having MORE or LESS money can create stress. The fear can also be about knowing that you need to make the change and NOT doing it. You want to leave your current job, but afraid to leave. You want to get out of a relationship but again, afraid.

Feet hurt? Maybe you feel stuck in a situation, kind of like your feet are stuck in mud. You may know deep down what you need to do, but you can’t make the move to make the CHANGE.

Knees feel stiff? Fear paralyzes you and your joints. So your joints, especially of the legs become stiff.

Hamstrings tight? This may be the resistance to change that is happening or resistance in making the change you need to make.

Hip pain? Maybe you’re holding on too tightly to the way things used to be.

So how do you create more balance and flow of energy through your chakras? AWARENESS is the first step. I cannot say this enough. Create a practice of listening to your body, mind, and spirit. Now that you understand more about how FEAR affects the lower part of your body, notice when you feel the stiffness or pain. Notice when you have a sense of fear. Notice when you feel resistance to the change that is happening. Can you relate what you feel in your body to what you also think and feel emotionally or to a habit of thought and/or behavior?

If you are not sure how to work on the mind and spirit, then work on the body. Connect to your body! Use gentle movement of the feet, knees, hips and low back with awareness and compassion to get energy flowing again. Nourish your body with healthy food. Pay attention to how food makes you feel. Take a walk outside or through the woods. The Root Chakra connects you to and loves the earth.

You can use my Gentle Movement Video as a place to get started moving with awareness and compassion.

Namaste,

Stephanie

Slow and steady small steps toward better sleep!

Since reading ‘Why We Sleep” by Mathew Walker, I have been paying attention to both my quantity and quality of sleep.  I typically sleep 8 hours each night.  But based on how I feel getting up each day, I’m not sure that I always get the best quality of sleep.  In this book, he suggests the 11 tips for better sleep from the National Sleep Foundation.   I have seen other wellness experts posting these tips.  But I needed to pause and think about how to apply these tips to my own life.  So I started thinking about my sleep from the moment that I wake up!  Mostly it is about planning ahead, making some changes to the environment, and placing a high value on sleep.  Walker describes sleep as THE foundation of health, not just another pillar like nutrition and exercise.  Since the first time that I did an “overnighter” studying for exams in college, I have known that sleep is very important to me.

Don’t be overwhelmed by this list.  Take one small step at a time.  You (and your body) cannot adjust to all of these changes in a week or even a month.  Depending on how out of balance your sleep cycle is, you may need several months to make any significant change in your sleep.  As you read the list, think about which would be the easiest to change and start there.  Just don’t give up.  We have this notion that 21 days is enough to create a new habit, but it really takes more like 60 days. 

Just keep taking those slow and steady steps toward better sleep!

1.      Create a sleep schedule and stick to the routine.  Give yourself the “opportunity” to sleep 7-9 hours each night. So what does that mean for you?  If you need to be up by 6am, then you need to be calm, relaxed, and ready to fall asleep by 10pm. You may need to start getting ready for bed at 9am and include some calming practices in that hour leading up to actually falling asleep.

·        Take into consideration your tendencies, i.e. whether you are a night owl or a morning lark.  Can you adjust anything about your day to accommodate for your tendency?

·        Take into consideration your circadian rhythm.  We are supposed to be awake during the day and asleep during the night.  The chemicals in our body are regulated according to this rhythm whether our schedule is or not.

·        I tell my kids that I’m done at 9pm.  I can do anything for them up to that point but then I’m just NO GOOD! Maybe you need to let your family know your new plan.

2.      Don’t use an alarm to wake up!  What? In his book, Walker says that using an alarm turns on the “flight or fight” response of the nervous system.  So it can be a bad way to start the day.  Since all of my meditation and yoga is an attempt to stay in the “rest and digest” part of the nervous system, I don’t want to start the day with a jolt.  For many years, I didn’t need to use an alarm.  But recently, I occasionally need it. I almost always set it, but wake up before the alarm goes off. However, I also prioritize the 8 hours of sleep each night.

·        If you need an alarm (or hit snooze a few times), then think NOW how you can start your bedtime routine earlier.

3.      Drink water first thing in the morning and throughout the day.  Dehydration can disrupt your sleep.  And if you wait until late in the day to drink your fluids, your sleep will be disrupted by frequent trips to the bathroom.

4.      Move your body! 

·        You need to avoid sweaty exercise 2-3 hours before you go to bed.  So again, you need to plan for when you will get your physical activity.  The US National Guidelines say 150 minutes of moderate aerobic exercise and 2 sessions of strength training are needed each week.

·        If you exercise right out of bed, start with gentle movement and progress to full range of motion of your joints and spine.  End with a few core exercises to wake those deep muscles up.  They need to support you all day long.

·        If you want to improve overall physical performance (say you’re training for a race), then try exercise in the middle of the day.

5.      Stop drinking caffeinated beverages by 10 am.  I know, I’m sorry!  By the half-life (time the body needs to get rid of half) of caffeine is 12 hours.  So if you want to go to bed at 10pm, you still have some caffeine from your morning coffee affecting you.

6.      Get exposure to light early in the day.  Now that our mornings and evenings are dark, you need to plan when you get exposure to natural light for 15-20 minutes.  This helps keep our circadian rhythm in balance.

·        Avoid exposure to bright light in the evening.

7.      Take some time to create the right environment for sleep.  And think of this:  Your bed is only for sleep and sex! 

·        Get rid of the “bed desk”!  You shouldn’t be taking your work to bed.

·        How about the stack of books, magazines and articles that you “must read”?  Replace them with a journal, book of poems or prayers.  I keep non-fiction besides my bed because after a few minutes, I’m drifting away.

·        Check the temperature in your room.  You’re going for 68 degrees.  Your core temperature needs to be cool as you go to sleep.  And then it warms up through the night.  So blanket layers are always good.  That way you can remove them as needed to stay comfortable all night long.

·        We have so many little lights on from electronic devices.  Remove as many of them from your room as possible.  If you have light from windows, get light blocking curtains or shades.

·        Move you clock or phone away from your bedside table.  I do use my phone for guided meditation at night, so I put it in a drawer or on the floor face down so that I can’t see the light.

·        Make yourself comfortable!  How long have you had those pillows, sheets or even your mattress?  Maybe it’s time to replace a few things to make yourself more comfortable.

8.      Avoid alcohol in the evening and a large meal 3 hours before you go to sleep.

·        I know, you usually have the glass of wine after dinner as you relax and watch TV.  But alcohol can disrupt your sleep cycles.  You may fall asleep just fine, but you are not getting the quality of sleep that you need.  So maybe have your wine while you are fixing dinner, rather than after you eat.  Or better yet, give up wine on weekdays.

·        My family could make all the “early bird specials”.  My kids come home hungry, so I decided a long time ago to feed them dinner ASAP.  That way they aren’t snacking on empty calories from carbohydrates before dinner (Goldfish and Cheezits are the family favorites).

9.      Create a bedtime routine:

·        Stop using electronic devices 2 hours before you want to be asleep

·        Stop watching TV 1 hour before you want to be asleep.  No more falling asleep to the Late Show!  I have to tell you that I don’t watch TV that much anymore.  My family gathers on the weekends to watch a couple of sit-coms or maybe a movie.  But the regular evening shows just don’t appeal to me anymore.  Once I started meditating and realized the benefit of this detox for my brain, I didn’t want to put images or ideas into it from random sources.

·        Do what calms your nervous system!  Warm bath, deep breathing, guided meditation, journaling, reading something light, gentle movement, restorative yoga, or sex.  The hour before bed is time to connect to yourself and your partner.

10.   If you wake up during the night earlier than you want, give yourself 20 minutes maximum to fall back asleep.  If you don’t fall asleep, then get out of bed and do something that relaxes your nervous system.  So this is my main problem.  I wake up usually because of some noise in the house (kids cry out from a bad dream, husband snoring, etc) and I can’t get back to sleep.  This used to drive me crazy!  But now I stick to the 20-minute rule.  Then I get up and try:

·        To sleep in another bed.  Sometimes I feel like Goldilocks!

·        Using my Insight Timer meditation app (usually rhythmic music) to ease me back to sleep.

·        If something is really on my mind, I may just complete the task (usually on the computer), write down my great idea or add to my “to-do” list for the next day.  If this helps, you may want to try to journal writing or making your “to-do” list before you go to sleep.  Then it is out of your head and on paper.

Again, take it slow. Start by valuing the quality and quantity of sleep that you get each night.

Namaste,

Stephanie