After one of my classes, a student approached me and asked about Osteoporosis (OP) and forward bends. Their doctor had told them that although yoga is good for OP, forward bends should be avoided. This sparked my curiosity and prompted me to do some research about the subject. I found several good articles which helped me come to some conclusions about teaching students with OP or osteopenia (weakened bones, but not OP yet). Of the bunch, I found several good ones that I think deserve a good read. Two of these in particular, I really think have a good perspective.
I started with “Osteoporosis and Forward Bends: New Research Suggests Need for Caution by Kathleen Summers, MD, PhD, RYT500.” http://preventyogainjury.blogspot.com/2013/02/osteoporosis-and-forward-bends-new_16.html I feel this article was the most informative as to why forward bends are advised against for women with OP. In this article Kathleen evaluates a study done in 1984 about how women with OP can actually be harmed by forward bends. Part of this is because the torque on the spine produced by the forward flexion can cause injury. The study didn’t evaluate technique, rather simply the practice of yoga in general. Kathleen draws the conclusion, as I have, that technique is everything. At the end of the article she has some really great thoughts about how proper form such as bending from the hips and avoiding forward curvature of the spine during bends can make forward bends relatively safe for those with OP.
Another article that I thought had a really great point of view was “How to do yoga if you have Osteoporosis by Rachel from Fusion Massage & Movement. http://yogawithnadine.com/2012/08/01/how-to-do-yoga-if-you-have-osteoporosis/ Rachel is someone dealing directly with OP in her own life and practice. She has some great modifications for basic poses such as Standing Forward Bends, Down Dog, Seated Forward Bends and Child’s Pose. Personally, I believe that she has a great point of view as someone who is dealing with the disease in her own body. Most of the other articles I read were either from doctors or very reputable yoga teachers, but not from anyone with the disease.
To sum up the research and the conclusions from the articles… I have a few suggestions for those who have OP or osteopenia and would like to practice yoga and still feel protected:
1. Forward Bends: don’t avoid these completely, but make sure you have proper form. When bending forward, make sure you are bending from the hip. Place your hands on your hips and hinge forward. Keep your back as flat as possible and stop bending forward if you feel your spine start to bend. You can place your hands on your legs to support yourself as you hinge forward.
2. Backbends: According to every article that I read, backbends are good for OP or osteopenia. The extension of the spine puts pressure on the bone, but not in a damaging way. In fact, it is the only spinal movement that has no contraindications. (Rachel – Fusion Massage and Movement) As long as you follow the normal precautions laid out by your instructor and back off whenever you feel pain or discomfort, backbends appear to be relatively safe.
“When bone cells get stimulated through being compressed or twisted or elongated, they produce more bone mass until that bone gets strong enough, to resist the pressure. At that point the pressure no longer distorts the bone, and the bone-making cells stop making more. What a wonderful feedback system. In osteoporosis, the bones bend more, so pressure is more effective in stimulating the cells to make bone.” (Yoga for Osteoporosis – An Interview with Loren Fishman, M.D. and Ellen Saltonstall)
3. Cat/Cow: This is a very popular flowing movement used in most beginner classes and many advanced classes. If you are not familiar with the asanas, Cow is a gentle backbend (http://www.yogajournal.com/poses/2467) while Cat is a rounded forward bend (http://www.yogajournal.com/poses/2468). As we have learned previously, this rounded forward bend should be avoided with OP. Instead of rounding the spine into Cat, flow from a neutral spine in tabletop to Cow (backbend) and then back to a neutral spine. You will get the benefits of flowing with your breath and the benefit of the gentle backbend while protecting your spine from the damaging effects of the curved forward bend.
4. Child’s pose: (http://www.yogajournal.com/poses/475) Although this pose feels REALLY good, it isn’t very good for OP. Instead of relaxing down into this pose, try flipping this pose over and hugging your knees into your chest instead. You will still be able to relax and open your lower back while allowing your back to maintain an un-rounded spine. Another modification would be to try putting your forehead onto a block as you sink your hips back into child’s pose (http://www.yogajournal.com/basics/1452). This modification, while it isn’t as protective of your spine as flipping the pose over, will prevent overt rounding of the back.
Another great modification suggestion for child’s pose from a friend of mine was Legs up the wall. (http://www.yogajournal.com/poses/690) While this modification isn’t feasible in the course of a flowing Vinyasa class. When starting off in Child’s pose
Ultimately, it all comes down to how you feel and what you are comfortable doing. I encourage you to do your own research and to find what poses and modifications speak to your own practice and body. Please feel free to leave me a message if you have any questions or comments. Below are the articles that I researched and found useful. As always, be gentle with yourself and enjoy your yoga.