The Value of Yoga in dealing with Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to break.  If not prevented or if left untreated Osteoporosis can progress painlessly until a fracture occurs.  It is a disease that occurs when the bone making osteoblast action decreases and the bone dissolving osteoclast action increases.  It usually is a condition of ageing but other health factors can increase risk e.g certain medications, smoking, lack of exercise, chemotherapy to name a few.

Osteoporosis is usually diagnosed by a scan called a Dexa Scan - bone density is measured and compared with reference standards to see if the individual is at risk for fractures. Osteoporosis is usually treated with medication.
Bisphosphonates are one such class of medication and work mainly by keeping the body from breaking down bone, slowing down the action of the osteoclasts, the bone dissolving cells.  Like all medications there can be quite serious side effects and doctor and patient need to work together to get the most suitable medication for the individual.

The practice of yoga, used for purpose and modified to suit, has a role to play in maintaining and creating bone strength, helping to prevent Osteopororis or used when a diagnosis of Osteopoross is given. The use of yoga in dealing with building bone strength adheres to Wollfs Law –
‘Archetonic of bone follows the line of force to which the bone is exposed’ - more simply put, pressure on bone builds more bone.

So, the yoga practice offered needs to be weight bearing but also needs to be without excess force if working with Osteoporosis.
The yoga offered needs to provide both compression and tensile stress. Gravity increases compressive stress while our muscular effort increases tensile stress.  Holding poses for a certain length of time is important.  Recommended time to hold a pose to build strength is around 30 seconds.

In introducing yoga practice to people with Osteoporosis there are three key areas to start from:

1) Posture
2) Balance.
3) Weightbearing.

Posture: In teaching body awareness and creating good posture the ‘tilt of the pelvis’ is an important starting place. The length and strength of the hamstrings and hip flexors are important as the balanced action of these muscles is needed in maintaining the neutral pelvis . Also important in maintaining neutral pelvis is the balance of muscle length and strength between abdominal muscles and spinal muscles.

Balance
: Balance can become an issue as people age. Lack of ‘balance’ can take peoples confidence and pre dispose them to falls. Building confidence and co ordination is key as we introduce yoga to an older age group of students . These students need to build ’balance’ confidence. Get students to ‘bare’ their feet and feel and activate their feet where there are pressure sensors which help keep them balanced.
Introduce simple balancing postures that are achieveable and build up slowly to more challenging poses.

Weight Bearing: Strength poses can actually begin on the floor.Poses such as Setu Bandha , Salabhasana, Bhujangasana , Sphinx –Plank build strength in legs, spine, core , wrists and arms.  A series of Standing Poses like the Warrior Series and held for 30 seconds will also build strength in legs, spine, hips and arms.

Caution is also needed in some poses for people with Osteoporosis.  ‘Sit up’ type movements place a strong load ask on the front part of the veretebrae. This can can be dangerous for Osteporosis and is also dangerous for degenerative disc conditions. Plank is a good alternative to sit ups where abdominal strength can be developed without risk to the spine .Flexion of the spine is counterproductive for students with Osteporosis. Avoid Cat stretch and any other spinal flexion postures. In seated forward bends such as Janu Sirsasana and Paschimottanasana concentrate on elongating the spine, hinging from the hips just a little and avoid flexing the spine. Safe forward bends can be practised standing, facing the wall and are a suitable alternative for seated forward bends .The bend happens at the hips joint while spine elongates and maintains its alignment as body moves freely in space.
Avoid strong inversions too as these are also dangerous for brittle spines.  Twists are invaluable for the health and mobility of the spine but with Osteoporosis seated twists are problematic. Supine floor twists and standing twists are much safer.

Loren Fishman, MD is the medical director of Manhattan Physical Medicine and Rehabilitation in New York City, the author of eight books, and the author or editor of more than 70 academic articles and has done research into the value of yoga for Osteoporosis.  Yoga Trials were carried out by Dr Loren Fishman on Yoga for Osteoporosis in 2009.  18 patients were studied over two year period.   7 were the control group while 11 others practiced yoga poses.  The average age was 68.  Dexa scans taken before trials. A designed yoga programme was compiled, taught and then given to patients to continue on their own as a daily practice .Participants stayed in yoga poses for 20-30 secs. The routine took around 10 mins and consisted in 10 – 12 poses.  Scans taken again two years later to find:
• Nearly all of control group either maintained or lost bone.
• In the yoga group - 85% of yoga practitioners gained bone in spine and hips.
• A few had no change on their readings especially in their spines.
• There were no fractures
• There were no serious injuries

(research material for this article taken from ‘Yoga for Osteoporosis ‘ – Loren Fishman & Ellen Saltonstal)

Yoga may have a lot to offer the ageing population in improving balance, increasing range of motion, improving co – ordination, building bone strength and helping prevent Osteoporosis.  The practice of yoga is also valuable in addressing and helping relieve the anxiety that accompanies these physical and emotional ageing issues.  It is an holistic way of approaching the problem of Osteoporosis and other ageing issues that accompany this condition.

Ageing positively with Yoga

In todays yoga world, the practice of yoga appears to be mainly geared towards the young, the fit and active.  Practicing as a yoga therapist over the last twenty years, I have taught the young, the fit and active, able bodied, less able bodied, senior and very senior students.  I have to say teaching older students has been inspiring, rewarding and so exciting a journey for me.  All of them have taught me more than I ever could teach them.

I have found that by practicing yoga, older people wake up to their own power, their wealth of life experience, their tenacity  to deal with difficulty, tragedy and loss and their huge ability to see into the depth of Life and themselves.  They are not trying to improve their arm balances or perfect their Sun Salutation – they meet yoga from the perspective of a life skill.  They become aware of their posture and the importance of good alignment for their spines and discs.  They get to know the  freedom of joint mobility, the ease of stretching taut muscles and the sheer delight of deep relaxation and mental stillness.  They are able to laugh at themselves but with a kindness and a friendliness.

Let me start with my yoga therapy class in Donegal.  I have now been teaching these students for over four years.  The class is a chair based  yoga class, with some health issues presenting, one severe injury issue, and the usual joint and skeletal issues of getting older.  Students were quite apprehensive on that first day, as there were  a few serious injuries and serious health issues and of course  the students were older.  They were anxiously wondering what was this yoga all about and would they be able for it at all ? 

What has happened over the four years?  This class has become my advanced yoga class.  Their creation of aligned posture is precise  and accurate. Mental focus is achieved instantly with attending to the breath. Their joints move, glide even, with ease.  Their sense of their  own empowerment and confidence is tangible.  Their understanding of themselves and how they view the world has expanded. Their level of joy and delight in each others company is beautiful.  Their open heartedness and kindness to each other underpins the energy in the class.  One man, recovering from a serious injury when asked what the class meant to him replied ‘it’s the space you open up’.  Is that not an advanced  yogic expression?

The class presents a truly holistic experience, as no one is striving to become anything, no one is striving at all but there is advancement, achievement, there is a deepening and they are so awake, alive and empowered.

The chair practice has also moved onto the floor and there is such a sense of achievement and accomplishment, each one delighted for the other to see their progression.

No one is denying getting older and all that ‘older’ entails, from physical loss to emotional loss and all that lies in between.  But the group exudes joy, laughter, funny stories and the deep appreciation of life in each wonderful, lived moment and also a deep appreciation of each other.  My students are awake!

I have also taught more ‘senior’ seniors, where some students were in their nineties.  What has yoga to offer these students and can the practice empower them?

Sitting with good posture appeals to them all, as they sit all day.  They learn how to get up and down out of a chair by themselves, using skill rather than effort.  This is empowering  and builds such confidence.  Movement is challenging, as  they tire easily, so I have created the ‘story line’ - e.g when doing  joint movements such as wrist movements I ask if anyone remembers creaming margarine and sugar in making a cake with a wooden spoon.  Immediately I have interest and stories, while we do the action.  More stories emerge as we stir a pot of soup and I ask ‘What do you put into  your soup?’

We take a rest and stories are continued.  Even the quiet ones wake up to add their story.  The social engagement and being heard is as important and empowering as the physical movements.  Relaxation and breathing draw them all into a place of rest.  They sit better, they breathe better, they are alert yet relaxed.  Yoga adapted and modified to suit all audiences weaves its magic of empowerment, confidence,  self ease and always relaxation.

Another class is a local Active Retirement Group whose lives have been enhanced by the practice of Yoga.

I will share just one quote from a student after her first ever yoga class ‘This should be compulsory for everyone!’

This group want a handout so they can practice at home  - such enthusiasm!!

Older people are wise, they have seen a lot and have lived a lot, they say it as it is, nothing is held back,. This is so refreshing, open and honest. They salute their years with humour, pride and acceptance. Introducing yoga, that is relevant and achievable to them, inspires them and empowers them.

Yoga is not a one size fits all.  As a yoga therapist or yoga teacher it is up to you to make the yoga practice fit, to make it magical, to empower your students whatever age and whatever their condition. In return they will inspire you!