Yoga For Osteoporosis

Osteoporosis (from the Greek “porous bone”) is a disease in which the density of the bones decreases, making them more susceptible to fracture. Osteoporosis is a condition characterized by decreased bone mass, degradation of bone tissue, and disruption of bone microarchitecture. In this article, we’ll detail how science-backed Yoga techniques can help with osteoporosis.

Osteoporosis

Osteoporosis is commonly referred to as a “silent” disease since the loss of bone density is not readily apparent. As a result, a patient may not be aware that she has the condition until she breaks a bone or notices her upper back rounding as a result of asymptomatic vertebral fractures. It affects Caucasians, women, and the elderly (1).

Osteopenia & Osteoporosis

Osteopenia, often known as “bone poverty,” is a condition in which bone mass is low but not low enough to be diagnosed as osteoporosis. Osteoporosis is often preceded by, but not always followed by, this condition. In spite of the fact that lower bone density increases the risk of fractures (which most commonly occur in the spine, hip, and wrist), more fractures occur in those with osteopenia than in those with osteoporosis, largely due to the fact that a greater number of people have osteopenia than osteoporosis (2).

Osteoporosis can be divided into two major divisions based on the factors that influence bone metabolism

Primary Osteoporosis

Osteoporosis Type I Involution

It is also known as postmenopausal osteoporosis, and it is caused by a lack of estrogen in the body. Because women are more prone to osteoporosis than males, the men/women ratio is 4:5.7. Women make up a large proportion of persons with reduced bone density.

For women, a decrease in estrogen levels around the time of menopause causes them to lose bone mass more quickly and significantly. It can be caused by a decrease in testosterone levels in men, which typically begins around the age of 70. Additionally, certain drugs (particularly steroids), medical problems (such as rheumatoid arthritis and eating disorders), and genetic factors can also play a role in osteoporosis (3).

Osteoporosis Type II Involution

Senile osteoporosis is a term used to describe the loss of bone mass caused by the ageing of cortical and trabecular bones as people get older (3).

Secondary Osteoporosis

Osteoporosis can be caused by many different conditions, drugs, and lifestyle changes. Other risk factors include family history, smoking, short and thin stature, a sedentary lifestyle, a lack of calcium, vitamin D, or protein, and an excessive intake of alcohol or sodium, among other health-related issues. When it comes to osteoporosis and osteopenia, the standard medical recommendations include medication, calcium, and vitamin D supplements, avoiding alcohol or tobacco, and drinking plenty of water to avoid falls caused by dehydration (3).

How Yoga can help with Osteoporosis

Osteoporosis is a significant, serious health challenge that offers Yoga therapy an important opportunity to serve both the public and the health care community. Yoga using Wolff’s law and isometrically opposes powerful groups of muscles attaching to the same bone, thereby greatly increasing the stress on bone and the consequent stimulus for bone strengthening (4).

Yoga Beneficial for Osteoporosis in people of all ages

Yoga, when practiced with dynamic moderate to high levels of intensity, has been shown to improve BMD and balance in people of all ages. Better BMD and balance can help to reduce the risk of osteoporosis-related fractures, as well as the morbidity and mortality that comes with them. Yoga has the potential to be included in physical therapy practice; however, additional research is needed before yoga can be included in clinical practice and standards. Patients with impaired bone, such as osteoporosis, should avoid vigorous or competitive yoga sessions, according to experts in another comprehensive review (5).

Osteoporosis is a global public health problem that affects people all over the world. Researchers have discovered that practicing yoga can help to prevent and reverse bone loss. Balance, improved posture, and increased range of motion, strength, and coordination are all possible outcomes of yoga, all of which may help to reduce the risk of falls and fractures. Yoga may also help to enhance flexibility and strength. Once mastered, the practice of yoga can be continued in a safe and costless manner for the rest of one’s life (4).

Yoga Beneficial for Osteoporosis in Older People

According to recent study, exercise in general and yoga, in particular, have been shown to increase BMD and bone quality, a metric that accounts for the protective effect of bone cartilages and corresponds with fracture risk. The trabecular component of bone contributes 30–70% of bone strength and resistance to fracture. Yoga is safe, inexpensive, and can enhance musculoskeletal health by improving balance, posture, range of motion, strength, and coordination. All of these variables lower the chance of falls and stooped posture, which causes fractures (6).

Studies reveal that persons with osteoporosis or osteopenia risk spinal fractures while twisting or bending forward. However, research show that practises such as yoga help to develop core strength, prevent falls, and improve bone density. The study recommends that osteoporosis patients include resistance and balance training to their normal fitness routine.

Overall pelvic and spinal strength promotes balance and posture. These help osteoporosis patients avoid falls and fractures. Encourage yoga practices that align the spine. These elements make regular tasks easier and reduce the danger of falls (6).

Yoga Beneficial for Osteoporosis in postmenopausal women

Yoga can also help you gain bone density by strengthening your muscles. According to DEXA scans, recent research on yoga and osteoporosis suggests that practices increases bone absorption. Following a 6-month yoga program that included weight-bearing and non-weight-bearing poses, breathing exercises, and meditation, bone density in osteoporotic, postmenopausal women improved. Weight-bearing exercise, in general, promotes your body to produce new, healthy bone, which is beneficial (7).

Yoga Beneficial for Osteoporosis in younger people

Bone problems are on the rise in younger people. Stressed, unbalanced lives are likely causes. Due to drastic changes in lifestyle, such as late-night working, alcohol consumption, smoking, and poor dietary habits, osteoporosis has been lowered from 50-60 years to the too late 30s. It is difficult to regain bone mass once it has been lost, thus maintaining its strength and density is crucial. Yoga can help in this situation.  Yoga practice has been shown to improve posture, reduce emotional and physical stress, and boost self-esteem. It is possible to improve bone health (8).

Yoga Poses, Breathing Exercises for Osteoporosis

According to a study,12 yoga postures are used to improve bone health and BMD in osteoporosis, poor bone density, and healthy bone (4).

Tree Pose (Vriksasana)

The purpose of this exercise is to stress the proximal femoral shaft and neck laterally. This pose strengthens the body’s stamina and concentration while also stretching the hips and legs. The lateral forces acting on the proximal femur were measured and found to be enhanced by 60% when the foot is positioned anywhere on the vertical leg. Pressures are equally raised whether the foot is placed high on the thigh or low on the ankle (Lu et al., 2016). Avoid placing your foot squarely at the level of your knee. This is significant in the treatment of hip and femur osteoporosis.

Contraindications – Inbalance, plantar fasciitis, recent total hip replacement (anterior approach), gluteus medius rupture, recent ankle sprain are all contraindications.

Props – A yoga mat, a wall, and a yoga block are all recommended (for workarounds).

Special advice – Maximally abduct bent leg for balance; put it above or below but not on the knee joint.

How To Practice

1. Stand parallel and perpendicular to the coronal (frontal) plane with your feet.
2. Exhale as you abduct the right leg, positioning the right foot far up on the left medial thigh, pointing downward.
3. Complete your inhalation by abducting both arms until your hands are squeezed together above your head and your biceps are positioned behind your ears.
4. With your fingertips, reach upward; pull your pubic bone forward to lengthen yourself even more.
5. Maintain this position for a few calm, even breaths. Complete exhalation as your arms return to their original positions.
6. Reduce the height of your right foot to the floor.
7. Maintain a steady position with your feet under your hips and your ankles, hips, shoulders, and ears on a single plane.

Triangle Pose (Utthita Trikonasana)

The purpose of this study is to determine the effect of anterior–posterior stress on the proximal femur.

Contraindications – Imbalance, pubic fracture, adductor or hamstring strain, recent total hip replacement are all contraindications (anterior approach).

Props – A yoga mat, a wall, and a yoga block are all recommended (for workarounds).

Special advice – Keep your knees straight and your torso parallel to the wall behind you

How To Practice

1. With your back to a wall, stand with your feet 3 feet apart and sidestep. Turn your right foot and leg parallel to the wall, but face away from the wall with your torso. 30° inward toward the right with the left foot.
2. With your arms extended to the right, incline your entire torso to the right.
3. Inhale, straighten your legs, and stretch your spine. Exhale with your hips shifted to the left. Make sure you bend your hips, not your waist.
4. Maintain a long and parallel torso on both sides. Avoid collapsing, but instead, lengthen the spine horizontally as your thighs broaden. Curl your tailbone inward and in toward your chin.
5. Your right hand should be on your ankle or block. Straighten the left arm. Lean lightly against the wall if you are unsteady.
6. Your left shoulder left ribs, and left waist should all be rolled back and up. Maintain a firm grip on your legs. 
7. Rotate your torso upward, from the right groin expands, while the left groin contracts.Radiate energy outward via your entire body, including your limbs and spine. Stretch both side-to-side and head-to-tail.
8. Inhale and exhale before rising.

Warrior II Pose (Virabhadrasana II)

Balance is promoted by torque at the femur, hips, and spine, as well as a leveraged force at the femur.

Contraindications – Hyperlordosis, spondylolisthesis, spondylolysis, severe lumbar stenosis, recent complete hip replacement, plantar fasciitis.

Props – A yoga mat and a chair.

Special advisory – Do not stoop the back leg. The forward knee should be aligned with the second toe.

How To Practice

1. With your feet 412 feet apart, bend the right knee to 90 degrees while keeping your arms horizontal.
2. Extend your back leg from ankle to hip and rotate it.
3. Pull the lower belly button in and up.
4. Maintain this position by stabilizing your pelvis, raising your torso to its upright position, and retracting your shoulders back until they are just below your hips.
5. Increase thighs width as you advance the pubis.

Side-Angle Pose (Parsvakonasana)

The purpose is to create torsion in the femur, hip, and spine, which helps to improve posture and balance.

Note – This will help the inexperienced person learn the postures and use the chair and other props safely if balance or weakness is an issue.

Contraindications – Ischial bursitis, coccygodynia, recent complete hip replacement, plantar fasciitis.

Props – A yoga mat and a chair

Special advice – Align toes, bent knee, and hip; press lateral bent knee and biceps together.

How To Practice

1. Lie down in a chair with your legs spread widely apart. Manually separate your buttocks from your thighs.
2. Extend your right leg to the side and position your foot directly behind your knee.
3. As you lean to the right, lay your left forearm on your left thigh.
4. Stretch the left leg to the left, maintaining the toes and knee facing forward. The majority of your weight will now be supported by your right hip.
5. Curl your tailbone diagonally down toward your left foot, at the same angle that your whole body is now leaning.
6. Open both legs and lift your spine from the pelvic core.
7. Lean forward with your left hand on your hip and your left shoulder rolled back.
8. Alternatively, turn your torso to the left until you are able to hold the back of your chair with your left hand while maintaining a straight posture.

Twisted Triangle Pose (Parivrtta Trikonasana)

The purpose of this twist is to apply circumferential pressure on the spinal bodies.

Note – Make one huge full-body twist from the heel of the rear foot to the nape of the neck. Better balance and more even twist distribution throughout the body, allowing one portion to compensate for another and act as a “safety valve” if needed. However, in sacroiliac joint derangement and after posterior approach hip replacement, thighs rotation should be stopped at 90°.

Props – A chair, a block, and a wall for the basic and advanced versions.

Contraindications – (absolute) pregnancy in the second and third trimesters, (absolute) posterior total hip replacement, (relative) herniated lumbar disc, acute sacroiliac joint derangement, severe spinal (facet) arthritis, and colostomy.

Special advice – Make sure that both feet are properly planted on the ground to avoid any imbalance.

How To Practice

1. Stand with your feet 3–312 feet apart, turn your left foot 90 degrees outward, and your right foot 30 degrees inward.
2. Extend your arms horizontally, palms facing down.
3. Take a deep breath and relax.
4. Exhale and bend forward, turning the right hip forward and placing your right hand on the floor or a block lateral to your left foot as you rotate to the left.
5. As you stretch your spine, scissor your legs together.
6. Draw your right shoulder back and your right chest forward into the plane created by your legs’ junction. Make your torso long and thin.

Locust Pose (Salabhasana)

It strengthens extensors and presses the posterior spine components.

Props – None.

Contraindications – Colostomy, GERD, spinal stenosis or fusion, Harrington rod, Cotrel-Dubousett, Scottish Rite or tethering surgeries, anterolisthesis, facet syndrome, pregnancy in second or third trimesters.

Special advice – Maintain contact between the navel and the mat to avoid hyperlordosis (excessive lordosis).

How To Practice

1. Lie down on your back with your arms at your sides and your hands facing down. Extend your arms and legs as far as you can.
2. Lift from the nape of your neck and the backs of your knees to complete the movement.
3. Gently push your ankles together, take a deep breath, and raise your arms parallel to the ground.
4. Relax your stomach muscles; clenching them will cause the arch to be reduced.

Bridge Pose (Setu Bandhasana)

The purpose is to encourage the posterior components of the whole spine.

Props – A yoga strap to keep the upper arms together.

Contraindications – scoliosis, facet syndrome, spinal stenosis, anterolisthesis, spondolysis, spinal surgical hardware such as Harrington rod, CotrelDubousett, Scottish Rite or tethering procedures.

Special advice – Keep the legs and feet parallel to the ground. As you take a deep breath, relax your neck, throat, and jaw. Avoid squeezing the buttocks too hard or dragging the arms away from the shoulders during this exercise.

How To Practice

1. As you lie down on your back, spread your feet hip width apart and parallel to the floor, flat on the mat.
2. Your arms should be parallel to your body, with your palms facing up.
3. Take a deep breath and curl your sitting bones down and apart to ensure that your pelvis remains open.
4. Pull your arms back into your shoulder sockets as you exhale.
5. As you take a deep breath, lift your hips and chest. Put each shoulder beneath your ribs and toward the spine as soon as you are able, so that the tops of your shoulders rest on the mat.
6. Intertwine your index and middle fingers behind you. Straightening your elbows will allow you to press your arms down while thrusting your torso upward.
7. Point your knees straight forward, lift and stretch your tailbone toward your knees, and repeat the movement.
8. Maintain a comfortable length between your buttocks and your waist without pinching them hard.
9. Strenghten your sides and centre from your throat all the way out through the legs; press your feet away from you without moving them, lifting your torso and bringing your chest closer to your throat.
10. Gently exhale as you draw to a halt.

Supine Hand To Big-Toe I Pose (Supta Padangusthasana I)

The purpose is to exert leveraged pressure on the femur, hips, and lumbar spine.

Props – A yoga strap.

Contraindications – ischium bursitis, hamstring tear, adductor tear, and piriformis syndrome.

Special advice – Pull your hip away from its point of origin in your torso.

How To Practice

1. Lie supine (face up) with your legs straight out horizontally in front of you. Do not use a cushion to support yourself.
2. Press the right leg down; elevate the left thigh to vertical with the knee bent, and press the right leg down.
3. Lie down on the left side of your body and either grab the foot with both hands or hold either side of a strap that wraps around your elevated foot right beneath where the ball of your foot is located with both hands.
4. Grip the right wrist with the opposite hand, or walk your fingers up the strap to the top of the buckle as far as you can. Expanding your reach allows you to keep your elbows in a straight position and your shoulders a little higher off the mat.
5. Make sure your quadriceps in both legs are tight, and bring your shoulders down to the floor.
6. Tighten your quadriceps muscles.

Supine Hand To Big-Toe II Pose (Supta Padangusthasana II)

The purpose is to relieve lateral pressure on the femur, hips, and lumbar spine.

Props – A yoga strap.

Contraindications – It is not recommended for patients with ischial bursitis, hamstring tears, adductor tears of certain hernias, or piriformis syndrome.

Special advice – Pull your hip away from its beginnings in your body.

How To Practice

1. Lie supine (face up) with your legs straight out horizontally in front of you. Do not use a cushion to support yourself.
2. Press the right leg down and out to the side, while abducting the left thigh out to the side.
3. Maintaining a straight left knee, either grip the big toe with the left hand or holding a strap that wraps around the abducted foot slightly behind the ball of the foot are the two options for holding the strap.
4. Either move the leg further away from the body or walk your fingers up the strap as far as you can.
5. Using both legs, tighten the quadriceps and bring your shoulders down to the mat.
6. Tighten your quadriceps muscles.

Straight Leg Seated Twist Pose (Marichyasana III)

This pose, which twists the neck, rib cage, and lumbar region, encourages bone formation except at the wrists.

Props – Yoga strap for beginners and intermediates.

Contraindications – Recent ruptured disc, torn gluteus medius, severe scoliosis, spinal fixation with Harrington rod, Cotrel–Dubousett, Scottish Rite or tethering procedures, fusion procedures, or ankylosing spondylitis.

Special advice – Be mindful of your posture while you breathe in, and remember to straighten your spine; when you exhale, twist a little more at the thoracolumbar junction, moving your entire torso in the process. Adjust the pelvis with a blanket if needed. To avoid stressing the intercostal muscles, gently increase the pose’s intensity while twisting from the lowest rib.

How To Practice

1. Sit with your legs straight ahead.
2. Pull your buttocks and upper thighs apart with your hands.
3. Inhale to expand your chest and lift your spine. To maximise lift, place your hands on the floor alongside you.
4. Place your right foot flat on the mat near your inner left thigh.
5. Firmly press the left leg down; stretch the sole of the foot.
6. Inhale again, then exhale turning to the right.
7. Extend your left upper arm past your right knee Arm straightening 8. Inhale and rotate the spine inwards and upwards. Wrap your left lower ribcage to the right to lead the twist.
8. Wrap your left arm around your bent right leg.
9. Wrap your right arm over your waist and secure it with a strap.
10. Inhale and elevate your right shoulder. Exhale, press your left foot down, and twist your left chest to the right.
11. Keep a steady breath and a calm, concentrated mind while in the pose.

Bent Knee Seated Twist, Or Half Lord Of The Fishes Pose (Ardha Matsyendrasana I)

This allows for more rotation and a larger stimulation to every main fracture site.

Props – a blanket and a strap

Contraindications – Rotator cuff tear, ruptured lumbar disc, late pregnancy, torn gluteus medius, scoliosis, ankylosis, vertebral fixation by rods or wires, vertebral fracture, and colostomy are all contraindications.

Special advice – Keep both ischial bones on the mat, or place a blanket under the elevated one, to prevent them from moving.

How To Practice

1. Stretch your legs out in front of you on a folded blanket.
2. Widen your thighs and buttocks.
3. Bring your left foot outside your right hip. To start, bend your right knee and place your right foot on the outside of your left leg, shin vertical. Hands-on right knee.
4. Inhale; raise your spine and press down on your pelvic bones.
5. Exhale; turn to the right, elbow outside knee.
6. Raise your right forearm and hand to the floor behind you.
7. Inhale and straighten your spine to get taller. Exhale while twisting and walking your right hand behind you to the left.
8. Look behind your right shoulder. The spine and head should be vertically elongated.

Corpse Pose (Savasana)

The purpose is to minimize effort, relax and assimilate, and solidify benefits.

Contraindications – late pregnancy

Special advice – After the initial setup, stop fussing and fidgeting and instead become settled. This is the most challenging pose because it necessitates mental concentration (Iyengar, 1962).

How To Practice

1. Maintain a peaceful and distraction-free environment.
2. Fold a blanket to support a slight arch in your thoracic spine, roll another to support your legs, and fold a third to support your neck and head. An eye cover may help you relax and block out external disturbances.
3. Lie on your back, arms by your sides. Keep your shoulders flat on the floor while wearing a chest-supporting blanket.
4. Turn your legs inward to broaden your pelvis, then relax and allow your feet roll apart.
5. If you have a tight lower back, lengthen your buttocks away from the waist.
6. To open your chest, softly tuck your shoulder blades into your spine.
7. Maintain a long neck and a level chin and forehead. Then, slowly move your focus from head to toe, allowing each portion to fully relax.
8. If your mind generates ideas, simply observe them without becoming emotionally involved. Be a kind witness. You may recall an event, recall a person, or make plans. Try not to follow the thoughts, but just watch them come and go. Trust the letting go process.
9. Followed by 5–10 minutes of peaceful repose (at least 2 minutes), deepen your breaths and slowly stretch your arms and legs.
10. Take your time getting up, and honor any yoga-related changes or advantages you may experience. Remember your deepest intention, to affirm your progress and healing.

Avoided Yoga Poses for People with Osteoporosis

According to National Osteoporosis Foundation, some poses or movements should be avoided at all costs. These are (9) –

• Avoid forward folds and rounding. This compresses the front of the spine, causing osteoporotic fractures.
• Precautions should be used when standing. Assist any pose that puts you at risk of falling.
• Avoid deep twists and hip bends, especially when your bodyweight or your teacher’s hands-on help is involved. Compression and twists put weak bones in danger of fracture.
• For beginners, avoid rigorous yoga practice. Avoid unintentional twisting or falling when changing poses. Find a good teacher to help you align.
• Avoid anything that hurts or feels wrong. Never push a position through pain.

Conclusion

Yoga has the potential to enhance your energy level in two ways. First and foremost, it aids in the reduction of stress, which can deplete your vitality. Secondly, because yoga is about linking breath with movement, it encourages you to take deeper breaths. Your cells receive more oxygen as a result of all of your focused breathing, which aids in your awakening process. Serval research concluded that yoga positions were associated with enhanced emotions of vitality and self-esteem. Osteoporosis can cause you to lose confidence in your own physique, as well as to be concerned about your health. In addition to relieving anxiety, yoga can help you feel more at ease with your own physique.

References and Further Reading on Yoga For Osteoporosis

1. https://pubmed.ncbi.nlm.nih.gov/11176917/
2. https://www.orthobullets.com/basic-science/9032/osteopenia-and-osteoporosis
3. Cosman, F., de Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis international, 25(10), 2359-2381.
4. Fishman, L. M. (2009). Yoga for osteoporosis: a pilot study. Topics in Geriatric Rehabilitation, 25(3), 244-250.
5. https://juniperpublishers.com/jyp/pdf/JYP.MS.ID.555649.pdf
6. Sivaramakrishnan, D., Fitzsimons, C., Kelly, P., Ludwig, K., Mutrie, N., Saunders, D. H., & Baker, G. (2019). The effects of yoga compared to active and inactive controls on physical function and health related quality of life in older adults-systematic review and meta-analysis of randomised controlled trials. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 1-22.
7. Motorwala, Z. S., Kolke, S., Panchal, P. Y., Bedekar, N. S., Sancheti, P. K., & Shyam, A. (2016). Effects of Yogasanas on osteoporosis in postmenopausal women. International journal of yoga, 9(1), 44.
8. https://www.livemint.com/news/business-of-life/yoga-for-bone-health-1541207619352.html
9. https://cdn.nof.org/wp-content/uploads/2016/05/Safe-Yoga-NOF-Flyer-2016.pdf
10. Photos – https://www.dimensions.com/
11. Photos – https://chadyoga.wordpress.com/asana-galleries/asana-lying-down/

Author