Article – Yoga for Osteoporosis: Supporting Strength, Bones, and Balance
Have you or a friend been diagnosed with osteoporosis or “osteopenia”?
If so, you have plenty of company. The startling facts:
- approximately 10 million Americans have been diagnosed with osteoporosis
- another 44 million have low bone density, placing them at increased risk of bone breakage
- One in two women and up to one in four men will break a bone in their lifetime due to osteoporosis
- For women, the incidence is greater than that of heart attack, stroke and breast cancer combined.
-Source: National Osteoporosis Foundation
I have a special interest in this topic because I have osteoporosis in my spine. So do many of my students. I regularly practice strengthening and balancing and have written articles about balance improvement. I want my students and myself to get strong and prevent breaks and falls!
Try safely practicing balance on all kinds of surfaces. First visit to France. Tree Time!
My classes and workshops focus on these practices (and more) created from years as a yogini, my specialty certification as a “Yoga for Healthy Aging” teacher, and participation in web seminars, reading, and study of yoga for osteoporosis.
Frankly, osteoporosis as well as yoga for healthy aging have been my obsessions for the last 8 years.
So I share my experience, and EVIDENCE about the benefits of starting or adding yoga for your bone strengthening/fall prevention repertoire.
You’re also provided links to some resources to learn more about this condition.
Approximately 8 years ago I was convinced by my health care provider to have my bone density measured. This was the first time I learned of the DEXA scan (Dual-energy X-ray absorptiometry). My insurance covered the costs.
My previous impressions about osteoporosis?
This is a disease suffered by very, VERY old people.
Imagine my shock that my scores on the screening indicated osteoporosis in the lumbar spine and “osteopenia” in the hip.
At my follow-up visit, my health care provider seriously and earnestly showed me a drug company sponsored plastic model of healthy and strong bone. Along side of it: a model of a weak, thin osteoporitic bone.
The implication was: if I didn’t immediately comply and take the drug, my bones would become brittle, thin, and I’d crumble like a tortilla chip.
This provider wrote me a prescription for Fosamax. I dutifully filled it. Then, because like many of you I am nosey and curious, I researched the drug and side-effects.
And made the personal decision to not follow the prescribed drug protocol.
As of this writing, I still haven’t changed my mind about my decision (more about why later in this article.) I urge you to fill any prescriptions with an eyes wide open approach, weighing risks and benefits. Obviously, every person is different and you will find a great deal of information on “Dr. Internet”.
But PLEASE look at the sources and your choices critically before you decide on treatment. Discuss with health care and related experts such as nutritionists and endocrinologists.
Eureka! Hooray! A Yoga Protocol for Osteoporosis
Since I already practiced yoga, I decided to dig into the terms “Yoga AND Osteoporosis” on Google.
I quickly found Dr. Loren Fishman’s website. Dr. Fishman is a physician and professor, as well as a long time practitioner of Iyengar Yoga. He had performed a small analysis of yoga asana (poses) for bone-building with excellent results. I discovered that he was recruiting volunteers for a larger study.
I was invited to join the study, sending the required blood tests and bone density information to NYC, and faithfully practiced the yoga protocol.
We were provided a chart to record our yoga for bone-building practices.
I also shared the information with some yoga practitioner friends, one in New York who subsequently also became part of the study.
The protocol includes 12 poses to be held for about 30 seconds on each side. Three modifications for each pose are provided. For example, in this post, you will find modifications for downward facing dog, one of the poses included in the study.
Dog modification at the wall.
Many more details are available on Dr. Fishman’s website, in Yoga for Osteoporosis by Dr. Fishman and Ellen Saltonstall, as well as in my classes.
So, how can yoga strengthen your bones?
The selected yoga poses recruit opposing muscle groups, through which tension and stress are safely applied to the bones in the poses. This dynamic tension stimulates bone growth evenly and symmetrically.
Simply put, “asana” or the physical poses of yoga, require using our own muscle strength. Strength and bones then improve with practice.
Additionally, regular yoga practice improves flexibility as well as balance for fall prevention.
Yoga does not require heavy equipment, is portable, and as Dr. Fishman points out, has proven side effects such as better balance, lowered anxiety, and lowered blood pressure!
Variety and Novelty
Happily results were an improvement at the hip in my follow up DEXA test.
Because our bodies adapt to doing the same movements repeatedly, it is well known that we need to keep elements of variety and novelty to our exercise in order for strengthening to occur. In that way, not only our muscles and bones remain stimulated, but so do our brains.
As I am somewhat of a variety junkie, I am a proponent of adding appropriate yoga to your repertoire of bone building, or starting yoga with a suitable class. Dr. Bell and Nina Zolotow have provided a terrific summary about building strength and yoga.
Modified plank pose for core strength.
Ultimately, I adapted my personal yogasana (physical) practice to my diagnosis. For the students in my Balance, Bones and Core classes, I’ve done the same and added further yoga practices such as safe impact, balance practice, core strength, restorative yoga for stress, meditation, and breath work.
And there’s more…
I haven’t quit lifting free weights (in fact I am working with a wonderful trainer Chris Litten to target my program) and doing moderate impact cardio with my good ol’ exercise dvds.
Why? Again, I love yoga and variety. It’s all good.
Important Further Reading
-Check out this must-read NPR story “How a Bone Disease Grew to Fit the Prescription” to learn how the history of the connections between drug companies, DEXA manufacturers, and Medicare reimbursement has contributed to the recent prevalence of bone density screening.
–Review this informative exchange about yoga and osteoporosis with my Yoga for Healthy Aging teacher Baxter Bell, M.D. and Loren Fishman M.D on the “Yoga for Healthy Aging blogspot.
-Women’s Health Network: Osteoporosis Fact Sheet . Eye opening.
New Recommendations about Osteoporosis Drugs: Dr. Fishman’s response
Recently the American College of Physicians (ACP) issued New Guidelines for bisphosphonates. From the press release:
“Physicians should prescribe generic drugs to treat patients with osteoporosis whenever possible and they should discuss the importance of medication adherence, especially for bisphosphonates,” said Jack Ende, MD, MACP, president, ACP.
As an expert physician, I asked Dr. Fishman for his reaction to the ACP guidelines.
Thank you Dr. Fishman and to Carol Ardman for allowing me to share your response.
Bold added for emphasis.
“The ACP guidelines for treatment of osteoporosis are, in my view. clear, straightforward and, so far as they go, accurate. However three relevant considerations have been omitted:
- No non-drug therapies are mentioned. We have done a 743-person study, of whom 241 completed the entire protocol, in which a series of 12 yoga poses done for 12 minutes daily raised femoral and lumbar spine DEXAresults to levels of significance and comparability with bisphosphonates’ initial year of treatment.
- The chief negative consequence of osteoporosis – fracture – requires either poor posture (spine) or a fall (hip, femur or spine). Although the medications do little for either posture or balance, yoga improves posture and balance, and additionally extends range of motion, raises strength, refines coordination, and lowers anxiety, all known contributors to poor posture, and falls.
- The ACP defines osteoporosis as “a systemic skeletal disease characterized by decreasing bone mass and microarchitectural deterioration [bone quality] of bone tissue that leads to an increased risk for bone fragility and fracture.” It also states that “Dual-energy x-ray absorptiometry (DEXA) is the current gold standard test for diagnosing osteoporosis in people without an osteoporotic fracture.”
Yet the DEXA scan records only bone mineral density, and sheds no light on microarchitectural structure at all. Indeed the DEXA is the accepted gold standard, but since an estimated 30% – 70% of any bone’s strength (resistance to fracture) is said to be in the bone microearchitecture, and not the cortical portion of the bone which the DEXA reports), the ACP might do well to recommend inclusion of bone quality measures in a more clinically meaningful measure of osteoporosis, even though no such measure is standardized at this time.
It should be noted here that in a qualitative estimate, yoga appears to improve both the number of trabeculae and their thickness.”
Yoga reinforces safe alignment in everyday activities, manage stress and anxiety, and supports balance throughout your day. I regularly have my vitamin D3 levels monitored, and I suggest you do so as well. In my particular case, I take a supplement called Bone-Up (note: I receive no “kickbacks” from the manufacturer) specifically suggested by my endocrinologist after blood monitoring. Bone-Up includes calcium, magnesium and vitamin K3 in one supplement.
Seniors and adults standing or sitting in a circle, passing beanbags and bouncing small balls to each other in continuous group rhythm. Shared smiles and laughter a part of the experience one may enjoy in weekly small group sessions. Terry Tinney and Anne Wheaton show participants in this class some new exercises they can try as a group, and practice at home between their weekly Body Basics Bal-A-Vis-X group sessions.
Bal-A-Vis-X is a series of 300 Balance/Auditory/Vision eXercises, all of which are deeply rooted in rhythm. The exercises range from one hand tossing and catching one sandbag to both hands bouncing and catching four BAVX balls in a specified sequence. The exercises address visual tracking deficiencies, auditory imprecision, memory, balance and anxiety issues. Some of the exercises combine bags or balls with feet patterns.
Bal-A-Vis-X when done consistently and properly, under the guidance of skilled practitioners, enables the mind-body system to experience the symmetrical flow of a pendulum. It engenders focus. In group settings the exercises, promote self-challenge and foster peer teaching, and it’s a lot of fun!
Terry Tinney and Anne Wheaton are both sanctioned Trainers and Practitioners for Bill Hubert’s Bal-A-Vis-X Program.
Recently retired from teaching in the Amphitheater School District, they wanted to continue to support the learning and well being of children as well as adults. They started a business called Integrated States LLC. They have a studio in Oro Valley. Terry and Anne work with senior groups, hold private sessions, and give one and two day trainings.
Come give our Body Basics Bal-A-Vis-X class a try!! The class will run through July! Friday’s at 10:00 a.m, come be a part of the FUN!
To learn more, visit: IntegratedStates.com or call Anne at 520-609-1710, Terry at 520-609-1708
To learn more about Bill Hubert, visit: Bal-A-Vis-X.com
1. What was the reason you decided to go to a trainer?
I was playing a lot of doubles tennis, and as I turned 70 felt that my game was getting weaker. Rather than accept that it was just an inevitable part of aging, I wanted to improve my game and develop core strength
2. Did you consider or participate in any other form of treatment for your reason before seeking a trainer? Examples: physical therapist, acupuncturist, medication
I got monthly massages to address various muscle pains. Also did weekly Restorative Yoga to keep ‘stretched.’
3. How did you hear about BodyBasics?
I mentioned my desire to do strength training to my massage therapist, who said that my friend and previous therapist was going to Body Basics and was very impressed. (Thanks, Mom Fletcher!)
4. Did you evaluate other gyms or trainers before deciding on coming to Us? If yes, what were other places missing that BodyBasics was able to provide?
I have such respect for both of these massage therapists, that I just accepted the recommendation.
5. Ultimately, why did you choose BodyBasics over other options?
The measurement and evaluation approach to developing an exercise and training program for me was very impressive. I come from a background of assessment and performance measurement in organizations and liked the individual, detailed approach that tailored my program to my needs and personality. Goals-based planning and continuous tracking for improvement definitely increases the possibility of success.
Body Basics is also great about supporting the motivation to improve and the sharing of helpful research and continuous learning.
6. What goals did you have when you started at BodyBasics?
I wrote on my intake form that I wanted to increase muscle strength in my arms; keep my spine and hips/knees strong, i.e. prevent injury. I also wanted a good cardio workout to maintain my arterial health, since I have arterial disease. I quickly learned in the first few sessions that I also had balance issues that were probably affecting my game and my growing carefulness in pursuing some activities.
7. How long have you been training at BodyBasics and what specifically have you achieved over that interval?
I’ve been coming twice per week for about 5 years. I feel amazingly different. I have increased my core strength, gained strength in my arms and legs, improved my posture, and for the most part avoided injury. Injury is par for the course in tennis at my age. When my muscles or tendons did act up, I’ve found the staff at Body Basics to be good at pointing me in the right direction for diagnosis, helpful in creating a routine to address the issue, and providing support for me in sticking to a healing regimen.
8. What current goals are you pursuing with your trainers at BodyBasics?
I want to continue to get stronger and maintain the progress I have made. I no longer accept that aging corresponds to inevitable deterioration and loss of the ability to improve my tennis game, my active lifestyle (still gardening, hiking, rafting and kayaking) and my overall health. My cardiologist is very happy with my continued health. I want to be an inspiration to my younger family members and friends.
Tennis requires good knee and hip strength. I want to continue to protect knees and hips while building strength. Recent workouts on stair-stepping have given me new abilities to climb steps. Exercises to build hip strength and flexibility have helped heal and protect against a bout of sciatica pain. Balance exercises have greatly improved my abilities to hike over rocky beaches and mountain streams without slipping. I’ve had some amazing ‘catches’ where I could actually watch my brain coordinate my body to avoid a catastrophic fall.
9. Any additional words?
I also have grown to appreciate the team spirit and team learning and collaboration at Body Basics. There is an easy sense of camaraderie and good, supportive humor among the trainers. Different folks have different training strokes, and provide different insights. I love learning from each of them.
It’s also been great to work with a primary trainer who is so dedicated and supportive. I’ve learned so much from her and enjoy sharing our new insights, especially as they relate to the all-important mind-body relationship. Suffice it to say, I’d be lost without Body Basics. Probably, I would be convincing myself that I should just take up Pickle ball (not a bad sport, but not as aerobic and strategic as tennis), and start using various techniques to propel myself up stairs and sticking to the flat easy trails and sandy beaches.
Thanks for being there!
Welcome New and Returning Clients
The greatest compliment we can receive is a referral from one of our clients or allied health network!
Bonnie Golden ~ referred by Jaimie Perkunas, owner of Yoga is Therapy
Norm Golden ~ referred by his wife Bonnie Golden
Tony Hinkens ~ referred by a friend
Robert Delaney ~ referred by Dr. Tait, owner of Rejuv Medical Southwest
Shout outs are about us voicing victories we witness you all having at BodyBasics. We’ll keep it to our top 5 each month.
Jill Owen ~ for receiving unsolicited accolades prompted by her pec development while recently undergoing a mammogram!
Bobbie Raine ~ for ongoing improvement in balance as measured by both her inline stance progression and her blue box stepping!
Barry Bursey ~ for nailing his body weight squat pain free for the first time in decades!
Virginia Piper ~ for adding another layer of focus in her workouts leading to more time dedicated to getting stronger!
Tracey Anderson ~ for making a solid acquaintance with her middle back muscles!
Recipe – Mango Cardamon Frozen Yogurt
As the weather gets warmer, I find my craving for cold treats beginning to heighten. But fear not! There’s no need to turn a cold shoulder to your sweet tooth. Try out this tantalizing take on a mango lassi. It’s creamy, sweet and made with no added sugar!
- 3 cups frozen mango
- ¼ cup plain, unsweetened yogurt (may need up to ¾ cup)
- 1 ½ teaspoons pure vanilla extract
- ¼ teaspoon ground cardamom
- 1 pinch sea salt
- Combine all ingredients into a blender. Blend at high speed until smooth and creamy. Stir and press the mixture as needed to aid the blending process. Add additional yogurt ¼ cup at a time as needed if the mixture has difficulty blending.
- For soft serve consistency, serve immediately.
- For firmer ice cream consistency, pour mixture into a loaf pan and freeze for 2 hours.
- Line a large baking sheet with parchment paper.
- Chop 4 mangos into 1 inch chunks: Find the tallest point of the mango and cut in half, avoiding the tough core. Continue holding the mango at its tallest point and cut down, along the core removing the two remaining strips, with peel attached. Remove the peel from these two strips using a small/pairing knife. Holding the mango halve in the palm of your hand and use a pairing knife to cut a crisscross pattern (try not to cut through the peel). Flip the mango half inside out by pushing the rind-side up. Remove the chunks of mango from the peel using a paring knife. Chop up any larger pieces as needed.
- Spread chopped mango out on the baking sheet and freeze for 12 hours, or overnight.
- Once mango is frozen, complete steps 1 through 3 above.
For a dairy-free alternative, substitute yogurt for full-fat coconut milk.
Recipe provided by Nourishing Results, visit their full website at www.nourishingresults.com
Video – Monster Walk
Chris, Kris, Myrya, Kristian, Lance, Rachel, Mike, and Ben