Osteoporosis: Safe Exercising and Yoga Tips

Bridging the Gap with Physical Therapy and Yoga Therapy

By: Meryle Richman, PT, DPT, MS, CST, RYT – 500 Hours, Advanced Teacher of Therapeutic Yoga

As an active baby boomer, I have become an advocate for living a healthier lifestyle and bridging the gap between physical therapy and yoga therapy. WHY?  I would like to continue to enjoy being active with walking, hiking, bicycle riding, exercising, and practicing therapeutic yoga. After having been diagnosed with osteopenia and having had two total knee replacements, I continue to be active by integrating the therapeutic tools of body awareness, modified exercise, and yoga. According to the American Physical Therapy Association (APTA), “The right exercises and good habits can keep bones strong and prevent or reverse the effects of osteoporosis”.⁶  For healthy bones it is important to maintain a physically active lifestyle, eat a balanced diet, which  includes calcium and vitamin D, and integrate the therapeutic tools discussed in this article.^{1, 2,3,6} 

What to know about Osteoporosis and Osteopenia?

Definition and Prevalence:

Osteoporosis is a disease affecting approximately 10.2 million men and women in America.  It is the progressive loss of bone mineral density. Bone loss over time results in the bones becoming weak and brittle and leading to the increased likelihood of fractures, and bone deformation. ^1.   Eighty percent of those with Osteoporosis are women over 65 years and are at much greater risk than men for Osteoporosis.  When bone density is low but not low enough to be classified as Osteoporosis, the condition is called osteopenia, which can be a precursor to Osteoporosis are also at risk.  Other risk factors include women who are white or Asian, postmenopausal, cigarette smoking, sedentary lifestyle, and some medications.^1,2,6

If the condition is not addressed and treated, Osteoporosis can lead to a hunched forward posture and the formation of a hump, in the middle back and decreasing height. This poor posture can contribute to the increase of falling because the person’s center of gravity is shifted forward. ² Weak and brittle bones increase the likelihood of fracture during falls or fractures of the spine.  Some symptoms that may be caused by osteoporosis include back pain, lost height, and decreased mobility. Anyone over 65 or postmenopausal women should be screened for Osteoporosis even if symptoms are not present. Doctors will perform bone density scans to rate the person’s bone density and determine their diagnosis based on that scan. ^1,4

Exercise is one of the important keys to help prevent the changes in posture, help restore loss of body height, increase muscle strength with an emphasis on core strength and improve balance to reduce the risk of falls.

If you have been diagnosed with osteopenia or osteoporosis here are some tips for: Exercises to Avoid, Safe Exercises to Do and Modified Yoga Tips:

Types of Exercises to Avoid:

• Avoid any type of exercise that emphasizes trunk bending and rounding back. Side-bending and trunk twisting should be done with caution⁵

• Avoid stomach crunches or sit-ups. Use caution when working out in the gym on any seated exercise machine. The rule of thumb is to avoid machines that cause increased compression on the spine

Safe Exercises to Do:   

• Weight bearing exercises such as dancing, walking, at a moderate pace, a slow jog, climbing stairs, and low impact dancing and racquet/pickleball (with caution). Walking promotes weight bearing through the hip joints. Avoiding high intensity aerobics classes or activities involving a quick change of direction

• Walk outdoors on different surfaces and try using hiking poles for improving posture and to provide a weight bearing experience for your arms

• The treadmill is a good source of exercise and use a comfortable incline when you walk

• Practice balance exercises, while holding onto a chair or at a wall for support if needed

• Use a core exercise program for upper and lower back musculature. Work on core stability in all “neutral – spine” poses by drawing the belly in and up on the exhale. When lying on your back, work the core by lifting and lowering the legs, rather than the upper body, and keep the spine in its neutral position ⁷

• Walk 3-5 times weekly for 20 – 30 minutes, and gradually increase to 40 minutes

• Standing exercising with light/medium weights (2 – 3 times weekly is ideal), as exercises that work against gravity are more effective in stimulating bone growth. The weight should be an amount that you can lift 10 – 12 repetitions without strain, 1 -2 sets⁷

• In cases of advanced osteoporosis, check with your doctor as “non-weight-bearing activities such as swimming, water aerobics, biking - may be the only exercise that the bones can tolerate”⁷

Modified Yoga Tips:

• Avoid bending forward type asanas (postures) and discuss with your yoga therapist how to modify poses. In this case, keep knees slightly flexed and hinge forward from your hips with a flat back

• Practice “neutral-spine postures” or body alignment by being mindful and using body awareness with emphasis on the position of the neck and back. This is ideal to practice in “Mountain Pose”, especially when transitioning to different postures. Use props (such as blocks or straps to assist in poses). “Tip the tailbone back enough that you create a curve in the lower back and bring your head back over your shoulders. Imagine a plumb line dropping from your ear down through your shoulders, hips, and ankles. Maintain this optimal spinal position during most postures and flows”⁸

• Practice safe poses that includes gentle backbends which moves the thoracic spine in and lifts the chest. This can improve thoracic spine extension. Mild/gentle side bends and twists are recommended for preserving the health and strength of the vertebral bodies of the spine⁸

• Practice being aware of the pose you are in and “feel” the sensation of your breath. If you are holding your breath or breathing too hard the pose might not be the right pose at this time

• Improve balance by practicing postures at a wall or use a block for support in a balance pose

• Focus on “lengthening the spine”, as this creates space between the vertebrae and imagine “your head like a helium balloon and floating upwards towards the sky”

• Include poses that encourage the hands to bear weight (tabletop, sphinx, modified plank, and tadasana. Poses can be modified with weight bearing on forearms or use rolled washcloths to support wrist/fingers and wrists are straight

Always consult with your physician before beginning an exercise/yoga program if you have osteopenia/osteoporosis, are at a high risk for falls or prone to fractures or have a medical condition that might affect your ability to exercise. Prevention of Osteoporosis begins with a healthy lifestyle including screening, exercise, and nutrition. Supplementation to support bone health can be prescribed by a doctor.⁴  

Maintaining good posture throughout your life can lead to a healthier spine and prevent muscle imbalances. When faced with Osteopenia and Osteoporosis getting proper medical advice can prevent the progression of the disease.^1,4  This information is designed to teach you proper safety techniques and is not designed to teach an exercise or yoga program.

References:

1. National OP foundation, www.nof.org/osteoporosis
2. Meeks, Sara Walk Tall. Triad Publishing Company (FL); 1st edition (June 15, 1999)
3. Bassey E. Joan, Exercise for prevention of osteoporotic fracture. Age and Aging. Nov. 2001:29-31
4. Rahmani, Poupak, Morin, Suzanne. Prevention of osteoporosis-related fractures among post menopausal women and older men. CMAJ. 2009:181; 815-820.
5. Information used and/or adapted from the course Osteoporosis: A Comprehensive Treatment Strategy with permission of Sara Meeks Seminars, P.O. Box 5577, Gainesville FLA
6. American Physical therapy Asssociation: http://ww.apta; Physical Therapist’s Guide to Osteoporosis
7. Yoga and Osteoporosis: The Do’s and Don’t’s.https://yogainternational.com/article/view/yoga-and-osteoporosis-the-dos-and-donts
8. “The Back- Pain Secret: The Real Causes of Women’s Back Pain and How to Treat Ithttps://www.amazon.com/Back-Pain-Secret-Cause-Womens-ebook/dp/B01KFF5496,”
9. The International Alliance of Yoga Therapy, https://www.iayt.org