|Elasticity, Umberto Boccioni, 1912, Oil on Canvas, Milan, Italy|
by Ram Rao
Osteoporosis (from the Greek terms for "porous bones) is an age-associated degenerative condition characterized by decreased bone mass and increased bone loss resulting in significant weakness of the bone. This heightens the risk of broken bones among the elderly. The bones that are generally more susceptible to fractures include the spinal vertebrae, the hip bone, and the bones of the forearm, wrist, and shoulder. Reduced bone density and augmented bone loss occur to such an extent that a break can happen spontaneously, or due to a simple fall or a minor stress.
Individuals with osteoporosis often complain of chronic pain and a reduced ability to carry out normal activities especially after a broken bone. Osteoporosis is more common in women as they tend to lose more bone density following menopause and associated low levels of estrogen. Additionally, osteoporosis is also associated with other conditions like alcoholism, anorexia, hyperthyroidism, kidney disease, or with certain medications that accelerate the bone loss including, chemotherapy, proton pump inhibitors, certain classes of steroids. Excessive smoking and sedentary lifestyle are also risk factors for osteoporosis.
A dense bone mass does not provide protection against fracture, unless the bone fibers are structurally laid down to provide greater strength and stability. Thus, both density and structure are necessary for bone health. A bone mineral density (BMD) test provides a snapshot of the bone health. The BMD test result is compared to the peak bone mineral density of a healthy 30-year-old adult and is provided as a T-score. T scores between +1 and −1 are considered normal. A T-score between −1 and −2.5 indicates that the individual has a low bone mass (osteopenia) with chances of fractures being high. A T-score of −2.5 or lower indicates that the individual has osteoporosis. The greater the negative number, the more severe the osteoporosis.
The general impression is that if you have osteoporosis, exercise will exacerbate bone loss and increase the risk of fractures. Actually, exercise goes a long way in strengthening and protecting the bones. People who exercise have fewer fractures and have on average less bone loss. In general, aerobics, weight-bearing endurance exercise, resistance exercise, and stability and balance exercises strengthen muscles, improve bone strength and increase BMD in subjects with osteoporosis. Physical exercise compresses, twists, or elongates bone cells and, in the process, the bone cells get stimulated to produce more bone mass. In addition, physical exercise restructures the bone fibers, thereby strengthening and stabilizing the bone. Thus, people with osteoporosis and who have a regular physical exercise program are more stable due to improved bone and muscle strength and are less likely to lose their balance, thereby reducing frequent falls and preventing any osteoporosis complications.
Interestingly, yoga is both an endurance training as well as strength training system. Resistance training or strength training involves a lot of muscular contraction that helps build the strength and size of skeletal muscles thereby providing functional benefits. Breath practice is an integral part of yoga which increases lung capacity. This in turn delivers more oxygen to the body and helps with overall performance and efficiency and also enhances tissue repair.
A sustained yoga practice also loosens the hip flexors, lubricates joints, and stretches the hamstrings — all of which help develop a longer stride and smoother, steadier pace. Holding a certain yoga pose for a long time requires discipline and commitment. This helps in strengthening the bone and skeletal muscles and the practice of simply holding the pose may help to overcome the fear of falling or pain. Yoga also helps to strengthen and protect the spine, shoulders, wrists, and hips by using the body’s own weight as resistance to build strength and balance that may trigger increases in bone mass. Since yoga poses pull and stretch the bones from every conceivable angle, yoga strengthens and stabilizes the bone fibers thereby resisting greater amounts of challenges.
Other important ways in which yoga benefits people with osteoporosis include improving balance, muscular strength, range of motion, and coordination, thereby reducing the risk of falling; yoga practice may also lessen the fear and anxiety about falling. However, people with osteoporosis need to take proper precautions and protect the bones since simple movements done improperly can result in fractures. Private instruction with a qualified yoga teacher will ensure that the poses are done safely, correctly, and with proper alignment. Some of the dos and don’ts regarding yoga for osteoporosis include:
1) Start slowly with simple yoga poses, and gradually build up length of practice and level of difficulty. Be careful to not push yourself beyond your limits.2) To successfully build bone mass, consistently practice yoga for osteoporosis for a minimum of 30 minutes a day, five days a week.
3) Back bends like the Cobra, Sphinx and Bridge strengthen the spine in the elderly. For people with osteoporosis, backbends need to be done gently without overarching the back. Supported backbends are not only safe, they provide the same benefits. This is supported by empirical studies.
4) Bridge pose and Shoulder Stand not only stretch the spine but also stimulate the thyroid gland, which regulates the endocrine system and encourages bone growth.
5) Warrior poses strengthen the thigh bones and muscles thereby providing more stability.
6) If you have some disk issues or other spine problems, twists are contraindicated. If it is just osteoporosis, gentle twists using simple movements without force, not combined with forward bending of the spine, are helpful to strengthen and stimulate vertebral bone growth. Simple twist pose (Parvirtta Sukasana) is an example of a safe pose twisting pose.
7) Avoid certain bends. Forward bends increase the risk of fracture of the thoracic spine. Instead, tip forward from the hip joints while bending the knees and keep the spine straight. Supine poses such as reclined leg stretch are great ways of stretching the hamstrings and gluteal muscles without damaging the spinal vertebrae. Side bends that require supporting the entire body weight with hands can be damaging to the wrist bones. Using proper supports like the block or belt, mudras and gentle arm movements are more useful as they help build shoulders, arm, and wrist muscles and keep the joints mobile.
8) Inversions need to be avoided. Instead, restorative poses such as the Legs-Up-the-Wall pose provide similar benefits.
9) Alignment is key when teaching people with osteoporosis to get the best and safest results.
For more on yoga for osteoporosis, please refer to Dr Loren Fishman’s research papers in which he has written extensively about yoga as an adjunct to medical treatment of osteoporosis (http://sciatica.org/yoga/12poses.html/).
Rammohan (Ram) Rao comes from a family of Ayurvedic practitioners and Vedic teachers in India tracing back to the illustrious Vedic-acharya Rishi Kaundinya (although Ram admits he cannot do the Eka pada or Dwi pada Kaundinyasana). With a doctorate in Neuroscience, Ram was a Research Associate Professor at the Buck Institute for Research on Aging. He focused on various aspects of age-associated neurodegenerative diseases with emphasis on Alzheimer’s disease. In addition, Ram completed the academic training at the California College of Ayurveda (CCA) and received his certification as Clinical Ayurvedic Specialist. He has been a faculty member of the California College of Ayurveda and teaches in their Nevada City location. Ram is also a dedicated Hatha yoga practitioner and is a Registered Yoga Teacher from Yoga Alliance USA. In his spare time he offers consultations in YAMP techniques (Yoga, Ayurveda, Meditation & Pranayama). Ram has published several articles in major Yoga/Ayurveda magazines and has been a featured speaker in several national and international meetings and symposia. He is a member of the National Ayurvedic Medical Association (NAMA) and is on the Research Board of the Association of Ayurvedic Professionals of North America (AAPNA).
This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.
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