Yoga Heals: Osteoporosis

Osteoporosis is the deterioration of bone tissue which leads to weakening of bones and increased risk of fracture. The risk of fracture is a serious consideration as fracture to the hip or spine can result in permanent disability and complications which precipitate death.

Although it is generally agreed upon that prevention of osteoporosis is much more effective than treating it, there is evidence that yoga practice can improve bone density and strength even in more advanced states of osteoporosis and osteopenia.

Bones consist of living cells surrounded by non-living matrix secreted by and maintained by those cells. Disruption in hormones (whether due to aging, diet or stress) can affect the cells which produce and break down bone tissue, and also can affect the availability of materials used to build bones--notably, calcium, magnesium and phosphate.

Beyond meeting nutritional requirements to build bone and prevent their deterioration, physical activity also influences the process. Bones grow more dense, and stronger, as they respond to mechanical load (weight bearing) and the stress of movement. Muscles in contraction apply force to the bone tissues, and this force transmits a signal to the osteocytes (bone cells) to produce more matrix material so that the bone tissue becomes strong enough to resist the force. By improving muscle tone, we can improve bone density.

On its own, osteoporosis is not a life-threatening condition. However, predisposition to bone fracture, especially of the hip and spine, becomes life-threatening in the event of a fall. A fall that results in a broken hip can become a permanent disability, and potentially lead to further complications and death. Of all broken hips, more than 90% occur in adults with osteoporosis, and an elderly person who sustains a hip fracture is 5-20% more likely to die within the first year of the fracture than if no fracture occurred. The best way to prevent bones breaking during a fall is to prevent the falling. People who have been diagnosed with osteoporosis or osteopenia (thinning of bone tissue) are advised to practice safe balance and coordination activities to prevent risk of falling.

Yoga practice is uniquely suited as an exercise for the prevention and repair of osteoporosis. It takes as little as eight seconds of dynamic loading to initiate physiologic processes that prevent weakening of bones. Yoga poses (asana) are typically held from ten seconds to minutes at a time. In addition to promoting bone density, the poses and their alignment principles help prevent postural compensation patterns which lead to fractures in vertebral bodes. Yoga practice can also improve balance and awareness to reduce risk of falling.

Five Techniques for Osteoporosis

The primary physiologic goals of yoga practice for students with osteoporosis are to safely build muscle strength (which increases the pounds of pressure on the bone tissue and encourages bone strengthening), improve balance to prevent falls, and improve posture to reduce risk of fracture to the vertebral bodies.

For students who already have osteoporosis or who might have osteoporosis, asana should be done at a level which strengthens the muscles enough to place beneficial mechanical stress on the bone tissue, but not at a degree which could put fragile bones at risk. Students beginning a yoga practice should first consult with their doctors to determine its appropriateness, and then work with a qualified yoga teacher to ensure their alignment, movement and breathing are done in a way that is beneficial to their bodies.

Especially for new students, it is best to work with a qualified yoga teacher to determine which postures and other techniques will bring benefit without risking fall or over-stressing the bones. Working with an experienced teaching in Yoga Therapy or a Private Session is a great start. Depending on your needs and preferences, private sessions may be the best route, or the teacher may recommend a suitable group class.

Asana

Cat/Cow

Alternating extension and flexion of the spine improves muscle tone and coordination which brings more balance into the body and improves the density of the vertebral bodies.

Bhujangasana

Cobra pose helps to open the chest, balance and perhaps retrain the spine to reduce thoracic kyphosis, places weight on the hands, arms and pelvis and strengthens the arms and back of the body. If students have arthritis in their fingers or wrists, their hands can come further forward (and possibly into sphinx instead of cobra).

Virabhadrasana I

Both Warrior I strengthens the muscles and bones of the feet, ankles, legs and hips. It can also improve balance and core strength. If the student's balance is unsteady, it is advised to practice standing postures near a wall or sturdy chair so the student can receive support as needed.

Marichyasana III

This seated twist creates therapeutic compression and twisting for the spine which can strengthen the small, deep muscles of the back as well as the abdominus obliques. For students new to yoga, one variation is to stand with a foot on a chair or kneel in a lunge and to twist toward the bent knee.

Pranayama

Anuloma Viloma Pranayama

Alternate nostril breathing helps improve focus and coordination, which can help to prevent risk of falling. 

Tips, Contraindications and Considerations

Students in any physical condition should always be encouraged to practice standing or balancing postures near a wall or chair if falling is a concern. Those who have osteoporosis might prefer to practice seated in a chair to avoid risk of falling altogether. When used as support in a yoga class, chairs should be sturdy, and ideally placed on a sticky mat or non-slip surface with the back legs against a wall to prevent tipping or slipping.

Students who have or may have osteoporosis should take extreme care of alignment, especially in forward-bending postures, in which there is a tendency for new students to round the spine forward. Rounding the spine places a great deal of pressure on the vertebral bodies, which can potentially lead to hairline or crush fractures, especially if the same position (with the same alignment) is practiced frequently. Twisting poses can also place stress on the bones of the vertebra, especially if students lean forward or back while twisting.

Those at risk for osteoporosis or osteopenia are urged to consult with their doctor before beginning any new physical activity, and to work with a qualified yoga teacher when taking up a yoga practice. In the beginning, small classes or private sessions are recommended, as they will enable the teacher to better meet the student's needs.

Research

Research supports that yoga is an effective and safe way to improve bone mineral density after child-bearing years.

Studies have shown the usefulness of yoga in reducing hyperkyphosis (excessive rounding) in the thoracic spine, especially when the kyphosis is the result of poor posture and muscle tone, rather than actual fractures in the vertebra.

Additional Resources

Fall Prevention and Osteoporosis - American Society of Orthopedic Professionals

Teaching Yoga to Seniors: Essential Considerations to Enhance Safety and Reduce Risk in This Uniquely Vulnerable Population - Duke University

Yoga for Osteoporosis - YogaU Online

Yoga Poses to Prevent Osteoporosis and Osteopenia - Loren Fishman

Yoga for Osteoporosis: The Complete Guide
By Loren Fishman, Ellen Saltonstall