Yoga and Osteoporosis

Current treatments for osteoporosis include pharmaceuticals, nutritional intervention and physical therapy. But what about YOGA?? Yoga as an intervention has excellent accessibility. There is minimal to no cost related and minimal training required. The ‘side effects’ of yoga include improved ROM, improved strength, improved gait, improved posture/balance and decreased anxiety.

Ready for some shocking facts??

• Currently osteoporosis affects ~200,000,000 individuals worldwide.

• Per year in the United States, there are over 700,000 spinal fractures and more than 300,00 hip fractures.

• Of the annually 2 million individuals who experience a hip fracture: 25% will die within a year and an additional 25% will never be discharged home.

• Roughly $19 billion is spent annually in related health care costs.

So what can we do??

Current treatments for osteoporosis include pharmaceuticals, nutritional intervention and physical therapy.

• Pharmaceutical therapies include: bisphosphonates and serum estrogen receptor manipulators whose common side effects include gastrointestinal distress.

• Nutrition intervention often includes Vitamin D and calcium supplementation.

• Physical therapy consists primarily of weight bearing activities and resistance training. Only 28% of women started bone therapy within a year of diagnosis as reported by the Clinical Interventions in Aging.

But what about Yoga??

Yoga as an intervention has excellent accessibility. There is minimal to no cost related and minimal training required. The ‘side effects’ of yoga include improved ROM, improved strength, improved gait, improved posture/balance and decreased anxiety.

Yoga uses a mixture of 1 – 4 limbs to support body mass against gravity. This translates to upper and lower extremities being utilized as weight bearing support for the body. Since upper extremities do not normally bear load, this use during yoga practice may be classified as high impact for the upper extremities (more research is needed). Generally, there is little to no jumping performed during yoga practice. Jumping results in a higher impact classification. This means that faster paced, advanced asana classes have potential to be classified as a high impact activity. That being said, even low impact, weight bearing exercise has been shown to positively influence bone health.

Dr. Loren M. Fishman from Columbia University began researching the correlation between yoga postures and maintaining bone density in individuals with osteopenia or osteoporosis in 2005. A follow-up study was done in 2016 showing that 12 minutes of prescribed yoga regimen actually reversed osteoporotic bone loss.

Fishman’s 2016 follow up study included everyone who performed the yoga sequence more than 50% of the prescribed amount of every day. Qualitative evidence indicates improved bone quality. Results showed effective reversal of bone loss of spine and femur, with weaker correlations of positive effects of the hip as indicated by DXA scan. “Poses were chosen specifically to produce torque and bending of the proximal femur, compression of the pelvis and twisting of the lumbar vertebral bodies.” This twisting, bending and compression have been shown to stimulate osteocytes. Osteocytes are the most commonly found cell in mature bone tissue. When performing certain yoga postures, opposing muscle groups must simultaneously engage in order to “hold the pose”. This activity of opposing muscle forces generates activity in osteoblasts and osteocytes which encourages bone density.

Yoga is easy to instruct, learn and perform. Please see the following pictures and descriptions for the yoga poses studied by Dr Loren Fishman.

Happy practicing!

Tree

• Standing on one leg, place the sole of the opposite foot on either ankle, calf or thigh

• Avoid placing sole of foot directly over knee joint

• Palms may press together in front of the chest or reach overhead

Triangle

• Step legs 2 – 3 feet apart

• Rotate front foot so it is perpendicular to back foot, toes of front foot point forward, both knees are straight

• Abduct arms to shoulder height

• Reach front arm forward as opposite hip draws back

• Front arm reaches down, hand rests on either shin or foot

Warrior Two

• Step feet 2 – 3 feet apart

• Rotate front foot so it is perpendicular to back foot, toes of front foot point forward, front knee is bent, back is straight

• Abduct arms to shoulder height, palms face down

• Shoulders draw down, chest open

• Lift through the top of the head

Side Angle

• Step feet 2 – 3 feet apart

• Rotate front foot so it is perpendicular to back foot, toes of front foot point forward, front knee is bent, back is straight

• Front forearm to thigh, or hand to floor

• Opposite arm may reach either overhead to sky or in line with head parallel to g

Twisted Triangle

• Step legs 2 – 3 feet apart

• Toes of both feet point forward

• Abduct arms to shoulder height

• Rotate chest so that back arm reaches forward

• Then reach down towards the floor of front foot

• Hand may rest on floor or block for support

Locust

• Lay facedown, arms are by sides, palm face down

• Lift up torso, legs and arms

• Scoop chin in, while lengthening muscles on the back of neck

• Gaze is low to avoid excessive extension of neck

Bridge

• Lay on back, soles of the feet on the ground, hip width apart, fingertips are able to touch heels

• Lift hips into the air while drawing knees together

• Option to either press palms into ground or to clasp them together under bod

Supine Hand to Foot 1

• Lay on back, one leg is flat on ground, other leg is in the air

• Either hold on onto foot with hand or use strap

• Keep raised leg straight without being fully locked out, keeping muscles engaged

• Shoulders actively draw to ground

Supine Hand to Foot 2

• Lay on back, one leg is straight on ground, other leg is abducted from body

• Either hold on onto foot with hand or use strap

• Keep abducted leg straight without being fully locked out, keeping muscles engaged

• Shoulders actively draw to ground

Straight Legged Twist

• Seated on the ground, one leg is straight, opposite leg is bent to chest

• Keeping both hips on ground, twist to side of bent leg

• Maintain length in spine

Bent Knee Twist

• Seated on the ground, one leg is bent, ankle of opposite leg is on the outside of thigh with knee to chest

• Keeping both hips on ground, twist to side of top leg

• Maintain length in spine

Corpse Pose

• Lay flat on back

• Arms either palm face up by sides, or place palms on chest and/or stomach

Resources

1. Brody, Jane E. (2015) 12 Minutes of Yoga for Bone Health. The New York Times (2015)

2. Fishman, Loren M. (2009) Yoga for Osteoporosis: A Pilot Study. Topics in Geriatric Rehabilitation 25. (2009) 244-250.

3. Lu, Y., Rosner, B., Chang, G., Fishman, L. (2016) Topics in Geriatric Rehabilitation 32. (2016) 81-87. DOI: 10.1097/TGR.00000000000000085

4. Siris, E., Yu, J., Bognar, K., DeKoven, M., Shrestha, A., Romley, J. (2015) Undertreatment of osteoporosis and the role of the gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clinical Interventions in Aging (2015) 1813 -1839. DOI: http://dx.doi.org.ezproxy.uvm.edu/10.2147/CIA.S83488

Wilcox, S., Hager, R., Lockhart, B., Seeley, M. (2012) Ground Reaction Forces Generated by Twenty Eight Hatha Yoga Postures. International Journal of Exercise. (2012) 114-126.

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