Yoga for Osteoporosis: Let's Build Strong Bones

by guest blogger: Megan Winegar

At the time of the post Megan had just completed her final practicum as a Student Physical Therapist.

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Do you have osteoporosis or osteopenia? Are you looking for an exercise program that is both safe and effective at increasing bone density, strength, and balance? Yoga may just be the answer you are looking for! With a growing popularity of yoga practice, more individuals are participating in yoga on a regular basis as a form of physical exercise and mental relaxation.1 Indicating that it is now, more than ever, imperative for yoga instructors and students to understand the benefits as well as the need for modifications to facilitate a safe yoga practice for individuals with osteoporosis.2

What is Osteoporosis?

Osteoporosis is a disease that leads to a decrease in the density and quality of bone.3 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.3 Osteoporotic fractures are most commonly seen at the hip, spine, and wrist.3

Osteoporosis has been referred as the “silent disease” due to the lack of signs and symptoms associated with it.3 So how do you know if you have osteoporosis? According to International Osteoporosis Foundation, there are a number of risk factors that can increase your likelihood of developing osteoporosis. Modifiable risk factors are risk factors that you have the power of changing through lifestyle modifications. These risk factors include: alcohol consumption, smoking, decrease body mass index, poor nutrition, vitamin D deficiency, eating disorders, estrogen deficiency, sedentary lifestyle, and frequent falls.3

Along with identifying risk factors, specific tests can be performed to determine if you have osteoporosis. The most common diagnostic test utilized is the Dual-Energy X-ray Absorptiometry (DXA), which is a low dose X-Ray that is primarily used to measure bone density.3

If you are at risk of developing osteoporosis because of lifestyle factors or have been recently diagnosed, the time to act is now! Physical exercise, with focus on low weight bearing activities, can help build and maintain bone strength.2,3 Now let’s dive deeper into the benefits associated with yoga for individuals with osteoporosis.

Benefits of yoga for an individual with osteoporosis

Yoga is a great form of exercise for all individuals, including individuals with osteoporosis! The evidence supports that individuals with osteoporosis should participate in low level weight bearing activities in order to decrease risk of falls and/or fractures.2,3 Yoga offers a great benefit as it can significantly improve an individual’s strength, balance, postural control, muscular endurance, flexibility, and spinal mobility.2 Along with these improvements, yoga is also a low impact weight bearing activity that can help stimulate and maintain new bone growth, which is essential in treating and preventing osteoporosis.4 As you can see, there are a number of benefits associated with yoga and yoga can be utilized as an alternative treatment approach for individuals with osteoporosis! The time to take control of your health and wellness is now! Let’s build strong bones together!

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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 limiting backward bending and forward bending to middle range.5 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!2 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 motion such as forward bending, backward bending, and rotation of the spine as well as end range rotation of the hip.5 These movements are considered “contraindicated” due to the amount of stress that is placed on the spine and hip joint. Along with avoiding specific movements, it is important to be mindful and aware of the position your body is in when transitioning in and out of poses.5 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

Elevate hips above knees in sitting to keep back straight

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

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

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

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If you are interested in yoga but don’t know where to start, Stephanie has a few resources that can help guide you through the process! If you have risk factors and want to prevent bone loss or if you have osteopenia, the Bone Health Video is a great place to start. If you feel like you need more information but like to go it alone, you can purchase the Yoga for Better Bones Package, which includes an interactive presentation and the Bone Health Video for ongoing practice.

If you like to be face-to-face to focus on your specific goals, then give Stephanie a call to set up a private session today! Trust me, you will not be disappointed! I have personally had the opportunity to attend multiple one-on-one sessions with Stephanie during my six week practicum and the care she provides goes well beyond the standard practice. Her ability to evaluate and treat clients with a holistic approach is a skill that many healthcare professionals have not fully grasped! Stephanie truly cares for her clients and spends the extra time digging deeper to determine the root of the problem!

As always, remember that yoga is a judgment free and non-competitive activity to promote a safe environment for everyone to thrive in. Be kind to one another and support each other through the journey of yoga!

Peace be with you,

Megan

References:

1. Lee M, Huntoon EA, Sinaki M. Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management. Mayo Clinic Proceedings. 2019;94(3):424-431. doi:10.1016/j.mayocp.2018.09.024.

2. Norlyk Smith E, Boser A. Yoga, vertebral fractures, and osteoporosis: research and recommendations. International Journal of Yoga Therapy. 2013;23(1):17-23.

3. What is Osteoporosis? International Osteoporosis Foundation. http://www.iofbonehealth.org/what-is-osteoporosis. Accessed March 30, 2019.

4. Lu Y-H, Rosner B, Chang G, Fishman LM. Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Topics in Geriatric Rehabilitation. 2016;32(2):81-87. doi:10.1097/tgr.0000000000000085.

5. McArthur C, Laprade J, Giangregorio LM. Suggestions for Adapting Yoga to the Needs of Older Adults with Osteoporosis. The Journal of Alternative and Complementary Medicine. 2016;22(3):223-226. doi:10.1089/acm.2014.0397.

 

Tending Your Garden

I am planning a trip to the farmers market over the weekend.  According to the Ohio Farm Bureau, August is a great month for the fruit and vegetable harvest in Ohio!  Because I grew up in an agricultural county with a County Extension Agent Dad, I know a little about what goes into an abundant harvest.  It is HARD work!  Tending a garden is much like how we should take care of our own health: body, mind, and spirit.  There really are no shortcuts, it is about consistency and perseverance.

One such shortcut “attempt” is a chemical weed killer. This summer I put my proverbial foot down on the use of toxic chemicals to control the weeds in my flower beds and yard.  In past summers, my husband used Roundup to make our suburban house have acceptable curb appeal.  But it seemed that each year he needed to use more of the stuff to get rid of weeds in the same areas. I do admit there is some satisfaction of the nice clean edge of landscaping once those pesky weeds wither and die.  Granted, in previous summers I had trouble getting out there to pull the weeds because of lack of time or fear of straining my back while doing it.  This year was different! I read Mark Hyman’s book, “Food: What the Heck Do I Eat” and he explains the potential danger of glyphosate in our food supply, the chemical found in Roundup.  Why take a chance?  I’m motivated to keep toxicity out of my yard, I’ve dispelled the fear that I will get hurt, and I had a little time.  So I decided to try and stay ahead of the weeds before he could get out there with the sprayer.

What I noticed about the areas treated by Roundup in past summers, was the disorganized opportunistic mess of weeds that took over and spread to areas where beautiful green grass and flowers tried to exist.  The seemingly more potent weeds sneak in and spread.  As I was pulling these weeds, I thought about how this process in much like treating and experiencing Chronic Pain.

Taking opioids for chronic pain seemingly helps at first and provides satisfaction, much like looking at the bare ground where weeds once existed. But the pain returns and over time you may need more and more medication to decrease the pain.  This is explained in recent research that showed using opioids for chronic pain actually increased the sensitivity to pain resulting in the need for higher doses of medication.  I hope you get the irony here: the pain reliever ends up actually creating the need for more of the pain reliever!

Another parallel exists in the spread of weeds and pain.  Chronic persistent pain spreads beyond the original source of insult or injury due to changes in the brain called smudging.  Smudging is where the brain loses its ability to clearly define an area of pain.  For example, the original pain was in the neck, but after many years, you now have shoulder pain, elbow pain and wrist pain.  This spread of pain doesn’t indicate that you have injury in those areas of the body, but you have changes in your brain.  I always love listening to David Butler explain pain (probably because of the accent) and in this video he describes the complicated concept of smudging.  Thank goodness we have treatment tools available to affect the plastic nature of our brains so that we can reverse smudging.  Treatments like Graded Motor Imagery and practicing Left/Right discrimination are much like using the gardening edger along my flower beds and sidewalks.

Though pulling each weed out by the root is time consuming hard work, it is much more effective in the long term for week elimination.  And if you don’t mind the look or taste of these weeds, according to Bruce Ackley’s (another Extension Agent) book, some are also edible and provide essential nutrients.  Just like weeding by hand, the process of managing your pain with mind-body techniques; movement, activity and exercise; and maybe even counseling to address the emotional component can be HARD work.  Through the process you might also discover that the pain you experience has an important message. Working to relieve pain through hard work might lead to a discovery about your Self.  So like the weed that can also provide nourishment, your pain just might end up helping you understand your spirit or purpose.

I know, I know that’s deep stuff.  But the biggest most problematic weeds in MY garden have the deepest roots! 

Let me know if you need help tending your garden.

Namaste,