Bikram Yoga and Osteoporosis
We would like to believe that our bones will always be as strong and healthy as they were in our youth. Unfortunately, around the age of 30 we all reach peak bone mass. Our job at that point is to maintain at all costs as much bone as we can. Osteoporosis is not limited to women, but a much more common diagnosis. Bone loss begins for most women in perimenopause, but bone loss numbers jump dramatically during menopause due to dropping levels of estrogen and progesterone.
Bone density is no joke. The figure on the left shows healthy bone; the figure on the right shows osteoporotic bone. No one wants to enter their golden years on fragile pins. Luckily, there is hope.
In addition to a healthy diet high in calcium and Vitamin D, yoga can be an excellent tool in helping maintain peak bone mass, slow bone loss and prevent fractures. Yoga is a weight bearing activity that creates torque on the bones to help build bone density, much in the same way you build muscle strength, through Wolff’s Law. Bones get stronger and stay strong when they are called upon to do more.
Yoga also helps to improve balance to prevent falls as we age. Improving spinal alignment reduces the risk of wedge fractures in the vertebral bodies that lead to that stereotypical, kyphotic, osteoporosis look. Yoga improves flexibility, lubrication of the joints and range of motion, all of which contribute to preventing the most common hip, wrist and vertebral fractures associated with osteoporosis.
In a University of Southern California and Orthopedic Hospital of Los Angeles study published in June 2010, Bikram Yoga practitioners had above average bone mineral density at the lumbar spine, hip and in total body scores. Even more impressive, each of the subjects had a total body calcium Z-score one standard deviation above the norm for their age and ethnic cohort. These findings led researchers to suggest that Bikram Yoga may hold promise in preventing or arresting bone loss in women.
While yoga can be extremely helpful in preventing or stopping bone loss, some yoga postures are risky for individuals with osteoporosis or osteopenia. There is no reason to practice with fear, but a healthy dose of caution is wise. Individuals with osteoporosis or osteopenia should use the following guidelines:
Limit Flexion of the Spine. Flexion=Forward. Avoid deep forward flexion like plough pose or shoulderstand and limit flexion in poses like all versions of the head-to-knee poses or rabbit. In a Bikram Yoga class, you can still execute the poses, but bend forward at the hip joint, not with the spine and avoid the chin-to-chest compression. A pose like Padahastasana should be done with the back flat, even if the trunk is far away from the thighs (no more Japanese Ham Sandwich) to ensure that the forward bend occurs at the junction of the femur and pelvis and not in the spine. Head-to-knee pose can be done in the Ashtanga tradition where the back is kept flat as shown here.
Backward Bending Increases Bone Density. Work your back bends to help keep your vertebrae strong and healthy as you age. In cases of extreme osteoporosis, deep back bends or extreme hyper-extension of the neck may need to be avoided. Move slowly with strength and awareness.
Twist with Moderation. The flat bones of the body like the ribs can be prone to breakage. Spinal twists are a great addition to your practice, but don’t try to be the girl from the Exorcist. Everything in moderation.
Avoid Challenging Inversions or Arm Balances. Once diagnosed with osteoporosis, your bones are not as strong as they were. Most breaks come as a result of a fall. Now is not the time to try to perfect one-armed handstand. Move your body with care and awareness.
Avoid Postures that Weight Bear on the Neck. The spongy vertebral tissue in the neck is prone to fracture. No plough or shoulderstand pose. Headstand should only be attempted if you are adept at the posture and can bear the body’s weight in your forearms and not the top of your head. Rabbit pose is not appropriate for individuals with osteoporosis.
Sit with Good Alignment. Sitting is an activity that puts a lot of pressure on the spine. When sitting or standing, align the shoulder over the hip and the ear over the shoulder to accentuate the natural curves of the spine and utilize the inherent strength in the spine.
The more frequently you practice, the better you feel. See you in class!