Caitlin McArthur, MScPT, physical therapist and doctoral candidate, department of kinesiology, University of Waterloo, Ontario, Canada.
You know that weight-bearing exercise such as walking strengthens your bones. But there’s growing evidence that yoga—already pretty popular for making muscles stronger and more flexible, reducing stress and improving brain health—may also be an effective way to prevent osteoporosis. It even can strengthen bones if you already have osteoporosis.
But not all yoga shores up skeletal health. The wrong kind of yoga moves may actually put your bones at risk.
To learn the best way to use yoga to strengthen bones safely, we talked to Loren Fishman, MD, a physiatrist at Columbia University in New York City who has practiced yoga for more than 30 years, regularly prescribes it for his patients, and is the coauthor (with Ellen Saltonstall, MA) of Yoga for Osteoporosis.
“Yoga actually puts more stress on bones than weight-bearing exercise,” Dr. Fishman explains. “The poses require opposing one group of muscles against another, which generates more force on bones than other types of activity.”
He recently put the practice to the test in a study of 227 participants, 202 of them women. Their average age was 68, and 83% had lower-than-normal bone density, based on lab tests. Following an instructional DVD, they practiced 12 poses specifically designed to strengthen bone at least every other day for two years.
Results: The program significantly improved bone density in the spines and femurs (thighbones)—about 9%. Hip-bone density showed improvement, too, but it was not statistically significant. “What’s particularly encouraging about these results is that in the two years preceding the study, there was a decrease in bone mineral density at all three sites—spine, hip and femur,” says Dr. Fishman. It’s a pilot study and the first of its kind. In addition to bone density, notes Dr. Fishman, the study showed improvements in bone quality—the internal structure of bone. “That inner structure provides between 30% and 70% of the bone’s resistance to fracture,” he says.
There’s another, perhaps even more important, way that yoga can help, Dr. Fishman emphasizes—by improving balance and thus preventing falls that lead to fractures. It is falls and fractures, after all, that lead to disability—and often loss of independence. “Most fractures are the result of poor posture or a fall,” he says. “Not only does yoga improve posture, it also improves balance, range of motion, coordination—all factors that contribute to the risk of falling.” Pills and injections can’t provide these types of benefits.
For skeletal health, Dr. Fishman recommends Iyengar yoga, which focuses on proper alignment of the body—rather than Vinyasa-type yoga, which moves quickly through a series of asanas, or poses…or working up a sweat with Bikram or hot yoga. Iyengar yoga is a particularly good choice if you already have osteoporosis, because it’s safe. But it’s a great practice for anyone who wants to improve posture, strength, balance—and bone strength. (You can find a practitioner in your area on the Iyengar website.) If you want to practice the 12 bone-building poses designed by Dr. Fishman, you can order the DVD for $25 from Sciatica.org.
If you do have low bone density or actual osteoporosis, it’s particularly important to choose the right kind of class—and practitioner. Caitlin McArthur, MScPT, a physical therapist and doctoral candidate in the department of kinesiology at University of Waterloo in Ontario, has been researching how yoga can be adapted for people with osteoporosis. “People with osteoporosis should focus on alignment and control in poses—rather than pushing themselves beyond what their bodies can do,” she says.
She recommends sticking with yoga poses that focus on slow, controlled movement and on balance, proper muscle use, body alignment and sensory awareness rather than pose intensity. “You want to focus on keeping the spine aligned rather than bent forward,” she explains. These include poses you do while lying on your back (Bridge, Corpse), on your stomach (Crocodile, Sphinx, Locust) or while standing (Warrior, Mountain, Chair). She advises against poses that require complete flexion, extension or rotation of the spine (Child’s Pose, Spinal Twists, Ragdoll, Saw and Plow) and those that involve pushing your hip outward in an extreme way (Thread The Needle, Pigeon). These kinds of moves can put excess stress on the vertebrae, and there have been cases in which patients doing these kinds of poses have actually experienced spine fractures.
With a properly trained instructor, however, even some of the “avoid” poses can be made safe, notes McArthur. That’s especially true if you use props such as blocks, blankets and bolsters. “For example, rather than let your forehead touch the floor in Child’s Pose, which flexes the vertebrae in the neck, you can use a block to prop up your head and keep it in line with your spine.”
One option is to seek out a class that is designed for older people—and run by an instructor who has training in how to adapt yoga exercises for people with osteoporosis. McArthur explains that these skills aren’t taught in most entry-level yoga teacher education. You want an instructor who will work one-on-one with you to tailor poses to your abilities. (On Dr. Fishman’s Sciatica.org website, you can also find a list of practitioners who are trained in yoga for people with osteoporosis.)
Another route: Work with a physical therapist who has experience with osteoporosis and a knowledge of yoga. You can start by looking for a physical therapist with a specialty in geriatric or orthopedics on the website of the American Physical Therapist Association. When you find one, ask if he/she has yoga training, too.
Finally—and importantly—go slowly and gently. Don’t be tempted to compete with your human pretzel classmates. But don’t be afraid either. Over the past 10 years, Saltonstall and Dr. Fishman have worked with many people, mostly over age 65, almost all of whom had significant osteoporosis—helping them put in more than 100,000 hours of yoga—without a single case of fracture or, indeed, serious injury of any kind. Says Dr. Fishman, “My colleagues and I are amazed and encouraged to learn that yoga can help those with bone loss take charge–and significantly lower their risk for dangerous fractures.”