Showing posts with label osteoporosis. Show all posts
Showing posts with label osteoporosis. Show all posts

Friday Q&A: Forward Bends and Osteoporosis

12:21 | Labels: , , , , ,

Standing Forward Bend (Uttanasana)
One of our readers left the following comment on our post Featured Sequence: Mini Sun Salutation:

I am surprised you are including a deep forward bend. Research supports avoiding forward bends in osteoporosis and osteopenia and considering there are over 54 million people with osteoporosis and many don't know they are osteoporotic it seems safer not to teach forward bends for healthy aging. I think we have a higher percentage of yoga practitioners who fit the risk profile....slight, female, white, especially if they had a restricted diet in their younger years. 

This reader is concerned about practitioners who may have osteoporosis doing deep forward bends as we showed in our Mini Sun Salutation. And, indeed, for those with OP or even undiagnosed OP (they have it but don’t know it yet) forward folds hold the potential of increasing the risk of the most common fracture in those with OP: a wedge fracture of the thoracic spine. So, if you fall into this camp, I’d recommend modifying your standing forward bends by allowing your knees to bend as much as you need to help release your pelvis over the thigh bones as you bend, and maintain a more neutral alignment of your spine as you go down. That means avoiding rounding your upper back in the area of your thoracic spine.

I have a student in one of my class in her late 60s with recently diagnosed OP, and we discussed her modifying her forward bends in just this way for poses such as Standing Forward Bend (Uttanasana) and Widespread Standing Forward Bend (Prasarita Padottansana), and she has been diligent about doing so.

Having said all that, I’d like you to keep in mind that our blog is not just for older adults who might have or be at risk for OP—or any condition for that matter. So, the Mini Sun Salutation post was really just an opportunity for us to share with you a basic common modern yoga practice that you can refer to as needed. We will try to add in a few more cautions to these sequences in the future, but you should always read our posts on yoga poses and sequences through the lens of your own personal situation, and take good care of yourself by making any modifications to the poses to better serve your needs. And if you are uncertain as to the safety or appropriateness of any YFHA recommendations, check things out with your local teachers. 

—Baxter

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Cautions for Bone Strength Practice

15:16 | Labels: , ,

by Nina

On Tuesday we posted a sequence designed by Baxter Featured Sequence: Bone Strength Practice. Since then we've had a couple of questions from people about whether the sequence is safe for people who have osteoporosis or osteopenia. We've added a warning to the original post, but for those of you who have already read that post, we're posting the warning here as well. 

Cautions: The Bone Strength Sequence was designed for those with no evidence of osteoporosis or osteopenia. If you have either of those conditions, be mindful to avoid the forward folding action of Cat/Cow pose (the Cat position), although the hands and knees position will lessen the potentially negative force on your thoracic vertebrae quite a bit. Otherwise, the sequence should be safe.


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Featured Sequence: Bone Strength Practice

16:11 | Labels: , , ,

by Baxter


As part of my continuing series of special sequences, I’d like to offer a sequence for building stronger bones. To start, please see one of my previous post on osteoporosis Healthy Bones for Men and Women Alike. When practicing the poses I have chosen for the sequence today, remember some of the suggestions I made in that previous post: 

“The research data that shows that we can stimulate new bone growth along lines of stress by holding poses for between 8-72 seconds is, for me, the pivotal nuance to add to the yoga practice you are already doing. Because of this, I have been working recently with holding postures for 30-60 seconds, depending on the physical demands of a given pose (for example, holding Downward-Facing Dog for 60 seconds, while holding Hand to Foot pose (Hasta Padangustasana), a much more demanding pose on many levels, for 30 seconds.” 

So, you will want to experiment with holding your poses in that 30-60 second range. The other key concept to keep in mind relates to the following: 

“Remember that engaging opposing muscle groups while doing the pose increases the stimulation of the underlying bone cells that make new bone (this is essentially an isometric contraction around a joint). So, in Downward-Facing Dog I consciously engage the muscles around all the joints I can think of.” 

In standing poses, I am not only taking advantage of the weight bearing part of the pose, the feet and legs, but using this isometric muscle contraction around the shoulder joints, for example, and in the contraction of the muscles of the back spine to assist in keeping the posture actively upright. So, if you want to add more poses to the sequence, you can include any of your favorite standing poses and apply these two principles for bone strengthening.

Cautions: The Bone Strength Sequence was designed for those with no evidence of osteoporosis or osteopenia. If you have either of those conditions, be mindful to avoid the forward folding action of Cat/Cow pose (the Cat position), although the hands and knees position will lessen the potentially negative force on your thoracic vertebrae quite a bit. Otherwise, the sequence should be safe.

Warm-Up

Cat/Cow: This pose warms up your spine and its joints, as you are also bearing weight on your wrists, the second most commonly fractured area in people with OP. Start on your hands knees, with a blanket or other padding under your knees. On your inhale arch into a gentle backbend, and then on your exhale round your spine towards the ceiling. Repeat for about six rounds. 

Hunting Dog: This pose a great one for building strength in the wrists and spine. See Hunting Dog Pose for basic instructions. Be mindful to keep your chest lifting towards your shoulder blades, especially on the side where your hand is on the ground. And strongly reach your lifted arm and shoulder blade forward, as you reach the lifted leg backward. After you come out, be sure to shake out the wrist of your supporting arm.
Downward Facing Dog: Because you are bearing weight on hands and feet and really working around the hip joints, the third most commonly fractured joint in the body, this is a great pose for building bone strength. From hands and knees position, come up into Downward-Facing Dog pose. See Downward-Facing Dog Pose Variations  for variations that might work best for you. 
Downward Dog Variation
High Plank Pose: This is another great pose for your wrists as well as your arm bones, and also for your spine as it engages the muscles attached to your spine. Start in Downward-Facing Dog pose, and then shift your shoulders forward until your shoulder joints are directly over your wrist joints. Keep your ribcage lifting up towards your shoulder blades and your elbows strong and straight. The rest of your body should be in a Mountain pose-like shape, so you need to keep your core and legs engaged, while maintaining a natural curve in your lower back. To come out of the pose, swing back to Downward-Facing Dog, then to hands and knees. Afterward, give your wrists a good shake out and brief rest. 

Active Poses

Extended Side Angle Pose: This is a great pose for your legs and hip joints, your bottom wrist joint, and your spine. You could substitute Triangle or Warrior 2 pose here, if you prefer those standing poses. From Mountain pose, step your feet wide apart, turn your right foot and leg out 90 degrees and kick out your back heel an inch or so. Bring your arms up parallel with the floor and bend your front knee. Then side-bend your hips and torso over your front leg and put your right hand on a block on its highest height, placed snug up against the outside of your front shin. Swing your top arm up and overhead, completing the side angle from your back leg through your torso and into your top arm. Push down firmly into the block with your bottom hand and feel your right shoulder blade firm into your chest and slightly down toward your waist. Reach your top arm and shoulder blade strongly forward towards your fingers. Be sure to actively engage the muscles around your mid-spine to strengthen your mid spine area. Come out of the pose on an inhalation, relax your arms at your sides, and repeat on the other side. 

Warrior 1: This a good pose to strengthen the spine, as it contracts the back muscles that pull on the vertebrae of the entire spine. See Warrior 1 Pose for instructions. You will use this pose to transition into your next pose.
Warrior 3: This pose adds in a balance challenge to weight bearing on the standing leg and isometric work on the lifted hip and along the spine. See Warrior 3 Pose for instructions and easier variations. Since the  pose can be quite challenging, start with shorter holds and gradually work up to 30 seconds or more. 

Forearm Dog Pose to Forearm Plank Pose: See Downward-Facing Dog Pose Variations for instructions on Downward-Facing Dog pose with Headstand Arms for instructions. From that pose, move into Forearm Plank by swinging your shoulders directly over your elbows and bringing your body parallel with the floor. When you come out of the pose, release down onto your belly in a prone position.
Locust: See Locust Pose for instructions. Even though those instructions are for dynamic Locust, practicing this pose dynamically will give you a good way to ease into full, static Locust pose, in which you lift both legs, your chest and your head and hold the pose for 10 seconds to start. Gradually add more time until you can do a 30 second hold. Rest for a few breaths before moving on. 
Simple Seated Twist: It is theorized that twisting helps nourish the spine—movement of the spine helps maintain the health of the discs—and also strengthens the bones themselves as your back muscles pull on the bony insertions of the spine. If you already have osteoporosis, you may need to be a bit more cautious, so I recommend that you twist to a bit less than your potential maximum. Start by sitting in a comfortable crossed-legs position, on a prop such as a folded blanket if needed. Sit tall and on an exhalation, rotate your chest and upper belly to the right, placing your left hand on your right knee and your right hand on the floor behind you. Stay for 30-60 seconds before releasing and changing the cross of your legs and twisting to other side. 

Bridge Pose: This pose will engage your back body muscles, so it's a good one for strengthening your spinal vertebrae as well as your legs. Starting on your back, bend your knees to come into Constructive Rest pose, with your feet about four inches from your hips. Warm up by lifting your hips up as you inhale and lowering them down when you exhale, up to six times. Then inhale and stay in the pose for 30-60 seconds, breathing gently in and out the entire time. Press down evenly into your feet, and lift both from your hips and the lower tip of your breastbone. Optionally, you can turn your upper arm bones under the pose, being mindful not to put strain on your neck. On an exhalation, release your arms and come out of the pose.

Before moving on to Relaxation pose (Savasana), take a moment to do bring your knees to your chest or rock your knees and hips side to side to release your back muscles. 

Cool-Down

Savasana: If time permits, take a generous 10-minute rest before heading into your day. Bring attention to your bones and imagine them heavy, dense and strong. 



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Friday Q&A: Kyphosis (Dowager's Hump)

13:21 | Labels: , , ,

Q: I teach chair yoga for older people. Several of my students have pretty bad kyphosis, a rounded curve in the upper back. They are not yet into a dowager's hump but they are on the way. When we do down dog with a chair, their upper backs are very humped. If I have them try to do cat/cow stretches with hands on the chair seat, their upper backs barely move. I have suggested that they try to lie on their backs with a small blanket roll under the bottom tips of the shoulder blades. Do you have any suggestions for how they might try to reverse this curve or at least stop it from getting worse?

A: This is an interesting question: what to do with the student who has kyphosis of the thoracic spine, the part of the spine in the area of the rib cage? What can we do as yoga practitioners to prevent the progression of the spinal changes we are seeing, and is it possible to reverse the excessive posterior curve in the upper back?  And should we be more attentive to this area when we are younger and possibly avoid this kind of change in the upper back (yes!)?

As we have discussed in the past, the normal anatomy of the spine involves a gentle, undulating set of curves from head to tail. From the backward curve of the back of the skull, as we move into the cervical (neck) spine, the spine curves forward toward the front of the body.  As we travel down into the thoracic (rib cage area) spine, there can be a natural backward curve, although in indigenous peoples and from ancient sculpture there is evidence that minimal curve in this area might be a healthier variation (see the work of Esther Gohkale). As we proceed further south and enter the lumbar (lower back) spine, the spine curves toward the front of the body once again. Finally, the sacrum curves backwards to complete the serpentine trail of the spine.

According to the Mayo Clinic website (I love these folks!):

“Kyphosis is a forward rounding of your upper back. Some rounding is normal, but the term "kyphosis" usually refers to an exaggerated rounding — sometimes called round back or hunchback. While kyphosis can occur at any age, it's most common in older women where the deformity is known as a dowager's hump.” 

Today, I am interested in kyphosis that occurs in older adults. In my experience, I have encountered this pronounced curve in both older men and women. The Mayo clinic notes that it occurs more often in women, likely due to the earlier onset of osteoporosis (OP) in women. What’s the OP connection?

The most common site of fracture in people with osteoporosis is the spine, and more specifically the thoracic spine. The typical fracture in the area is called a wedge fracture, in which the body of the vertebrae, that kidney bean-shaped biggest part becomes so thin that the front part collapses, and when seen from the side, it looks like a wedge. If you get several of the vertebrae in a row doing that, then the whole upper spine begins to bow forward like the Kokopelli image.
In some instances this will result in stiffness and difficulty maintaining an upright posture, and for some pain will also arise. Along with pain, in more severe cases of kyphosis, the change in spinal curve can affect your lungs, nerves, and other tissues and organs. So we need to do at least one important thing before we start moving these students of our reader around a lot: have them see their family doctor for an X-ray of the thoracic spine to see if fractures have already happened and get a DEXA scan to rule out OP if this has not been done. Once you know their OP status, you can make better decisions around yoga poses and practices.

Two other important factors that can contribute to kyphosis in older adults are disc degeneration (we have written about this, too) and cancer and cancer treatments (which can weaken the vertebrae and contribute to fractures as well).

Your western doctor may recommend certain treatments:
  • If there is OP present, medications to treat osteoporosis might be prescribed.
  • If pain is present, pain relieving meds could be recommended. 
  • If the person’s condition is compressing a nerve or causing some other significant problem, surgery to fuse bones could be suggested, but the risk of complications is high and tends to minimize this option.
  • Physical therapy exercises are prescribed to improve flexibility in the spine, as well as ones to strengthen the abdominal muscles to help support better posture.
Obviously, this last area, improving flexibility of the spine and strengthening abdominal muscles, is where yoga practice could be helpful.

If you don’t yet have a copy of Loren Fishman’s book Yoga for Osteoporosis and you are working with older adults, perhaps today’s the day to order it! It is a good resource of suggested poses and ways of doing them that you will likely find invaluable. A valuable piece of advice from the book regarding patience with these students is:

“Although yoga can be slow, requiring months or even years to achieve major effects, the trip is pleasant…”

So, with patience in mind, in regards to the reader’s observations, I’d suggest that for Downward-Facing Dog with the chair, if they are putting the hands on the seat of the chair, bring them up to the back rung, and if already on the back rung, do a higher version of Half Dog Pose at the Wall.
Half Dog Pose at the Wall
Let them bend their knees a bit and focus on lengthening their spines to whatever degree they can pain free. Even if not much seems to be happening in Cat/Cow pose, keep doing it anyway. I like the effect of dynamic movements like that for loosening tightness up gently. Along those lines, have them stand in Mountain pose with their backs to the wall, perhaps with the kyphosis lightly touching the wall. Then have them inhale one arm forward and up overhead and exhale it back down. Repeat with the other arm. Do several sets of these. The mere act of taking the arm overhead will begin the encourage extension of the upper back, exactly what you are looking for here, and strengthen the upper back muscles that assist in this goal. You could obviously do this sitting as well. 

If they can easily get down to the floor for Savasana, I find that no lift is needed under the thoracic spine, but a lift is definitely needed under the head so it stays level with the chest. Over-extending the neck has its own set of worries you don’t want to cause! In that reclining position, you can again have them work the arms as we did in Mountain pose.

To strengthen the abdominals, you could create a variation of Boat pose (Navasana) done sitting at the front edge of a chair, lifting one bent leg up a few inches and holding it in position for a few breaths, then lowering that foot to floor and repeating with the second leg. Again, if they can get to the floor and you can teach them Locust pose (Salabasana) or even one-legged Locust (which takes the spine into extension), you can have them do that at home or even in bed if they have a firm mattress.
One-Legged Locust Pose
I’ve already gone on a bit too long today, but I do believe that by intervening now and getting these people to practice at home as well as in class, you have a good chance of stopping the progression of the kyphosis and in some cases, where no wedge fractures have altered the anatomy, maybe even helping to reverse it! Please let us know how things go.
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Friday Q&A: Back Stretches and Inversions for Chair Yoga

17:27 | Labels: , ,

This week, we have a follow-up question to our Friday Q&A on chair yoga (see Friday Q&A: Chair Yoga) from one of our readers who actually teaches a chair yoga class

Q: I teach a chair yoga class which cannot go to the floor for healthy aging. How can I do a safe inversion or back stretch that does not stress the osteopenic back?

A: If you teach chair yoga, many students are older or infirm and not able to transfer from standing or sitting in a chair to the floor, where you might have them do any number of reclining poses that could stretch the back or approach an inversion, like Legs Up the Wall pose (Viparita Karani). 

If by “back stretch” you mean a forward bending action of the spine, like in Standing Forward Bend (Uttanasana), in light of possible osteopenic or osteoporotic spine, you need to be careful with most forward folding positions (see What is Ostepenia and How Can Yoga Help?).  It is not hard to do a seated version, however, if that is what you are looking for. One of my favorites that is fairly shallow and would not create too much force on the vertebrae of the spine would involve placing a second chair in front of the first, facing it away from you. Then ask your students to tip as much as possible from the hips and place their crossed forearms on the top seat back of the chair in front of them. This is similar to seated forward fold we showed for our Office Yoga series (see Featured Pose: Chair Forward Bend).

If, however, by “back stretch” you are referring to a back-bending action, then there is a bit less concern of hurting the spines of students with OP.  In seated Cat/Cow pose, the Cow variation is a nice, easy backbend shape that most could do in the chair. (See Featured Pose: Chair Cat Pose.)
Or, have the students stand behind the chair, use the top back rung for their hands for balance purposes and do a gentle standing backbend from Mountain pose (Tadasana).

As for inversions, this may be a bit tougher. You could have them put their chairs against the wall, and if they still have good hip mobility of rolling the pelvis over the femur bones, you could do a Downward-Facing Dog version with the hands on the seat of the chair, walking the hips and feet back into this higher version of regular Downward-Facing Dog, but with a slight downward slant from hips to hands. Make sure they bend their knees as they walk forward towards the chair at the end of the pose, and rise up slowly monitoring for any lightheadedness or dizziness. (See Featured Pose: Downward-Facing Dog (Chair Version)).
And you could show the class how to do Legs Up the Wall pose on the ground, demonstrating it for them, and suggesting they try this at home in their beds, swinging the legs up the headboard side of the bed if the bed is up against a wall. I’d have them only stay for 2 minutes or so at first, as you will not be there to monitor them. Of course give them all the usual precautions regarding inversions and high blood pressure and glaucoma, as the older your crowd, these conditions are more common. I hope these suggestions give you things to consider. And armed with the information from our posts on OP, you can be creative in your approach to working with your chair yoga classes.

—Baxter



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