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Yoga for

Better Bones THE COMPLETE GUIDE

Safe Yoga for People with Osteoporosis

MARGARET MARTIN, PT, CSCS


Yoga for Better Bones Safe Yoga for People with Osteoporosis

www.melioguide.com

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Yoga for Better Bones. Safe Yoga for People with Osteoporosis. Š 2011 by Margaret Martin. ISBN Number: 978-1-105-14843-9 Find us on the Web at www.melioguide.com To report errors, please send a note to info@melioguide.com All photos are Š 2011 by Richard Martin and are property of and developed by MelioGuide. All of the content in this book is owned by MelioGuide and is protected by worldwide copyright laws. The trademarks, service marks, trade names, and trade dress featured in this book are protected by the laws of Canada and those of other countries and jurisdictions around the world.

Notice of Rights. All Rights Reserved. This book may not be reproduced, in whole or in part, including illustrations, in any form (beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and except by reviews for the public press), without the written permission from the publishers. For information on getting permission for reprints and excerpts, contact Richard Martin at info@ melioguide.com

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Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2. Anatomy and Movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Movements of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3. Four Things About Yoga and Your Bones . . . . . . . . . . . . . . . . 27 1. Does Yoga Build Bone? . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. Certain Yoga Poses Increase Fracture Risk . . . . . . . . . . 30 3. Choosing a Yoga Teacher Who is Right For You . . . . . . 32 4. You Are Responsible for Your Bone Health . . . . . . . . . . 33

4. How to Have a Bone Healthy Practice . . . . . . . . . . . . . . . . . . . 37 Engage Your Postural Muscles . . . . . . . . . . . . . . . . . . . . . . 38 Follow These Safe Yoga Practice Guidelines . . . . . . . . . . 38

5. How to Modify Your Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Standing Forward Bend Pose . . . . . . . . . . . . . . . . . . . . . . . 44 Lunge Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Downward Facing Dog Pose . . . . . . . . . . . . . . . . . . . . . . . . 46 Standing Wide Leg Stretch . . . . . . . . . . . . . . . . . . . . . . . . . 47 Straight Leg Runner’s Stretch . . . . . . . . . . . . . . . . . . . . . . . 48 Table, Cow and Cat Poses . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Cobbler’s Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Head to Knee Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Seated Forward Bend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Seated Wide Angle Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Child’s Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Pigeon Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Standing Half Moon Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Triangle Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Sun Salutation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Camel Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Warrior III Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Lying Poses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

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6. Yoga Poses to Avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Upward Bow or Wheel Pose . . . . . . . . . . . . . . . . . . . . . . . . 66 Headstand Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Plow Pose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

7. Our Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 8. Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 9. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 10. Copyrights and Notice of Rights . . . . . . . . . . . . . . . . . . . . . . . 77 11. About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 12. Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

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1. Introduction

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hould you practice Yoga if you have osteoporosis or low bone density? Absolutely. However, it has been my experience that many Yoga classes are taught for the average population without consideration for students with osteoporosis or low bone density. This book is dedicated to showing you how to safely practice Yoga if you have osteoporosis or low bone density. (In this book the term “low bone density� includes people who have been diagnosed with osteopenia.)

My Motivation for Writing This Book I am a Physical Therapist by training and profession. Many of my clients practice Yoga. Wherever I lived or travelled, I would attend a class in an attempt to understand the attraction Yoga had to many of my clients. Unfortunately, I did not like what I saw in most of the Yoga classes I attended. Many of the chronic and acute back pain conditions I see in my clinic are the result of repeated forward stresses on the spine. In many of the classes that I attended, the Yoga instructor introduced poses that brought people into the same negative patterns of movement that I was trying to reduce in the lives of my clients. I decided that I had better develop my Yoga expertise so that I could credibly encourage my clients to modify the problematic Yoga movements I saw during my travels. That lead me to become a Yoga teacher and to write this book. But, before I get further into that story, I should tell you about my journey into the world of osteoporosis.

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My Personal Osteoporosis Journey My clinical work started in 1984 in Newfoundland, Canada. At that time I worked as a traditional Physical Therapist by day and YMCA fitness instructor in the evening. Toe touches and forward bends were a standard part of the exercise warm up at the YMCA. That same year, Dr. Mehrsheed Sinaki of the Mayo Clinic, began her study on the effect of particular exercises on bone. Her study demonstrated that the forward-bending movements I made part of my warm-ups at the YMCA fitness classes increased the risk of fracture among people with osteoporosis. It was not until the late 1990s, while working as a Physical Therapist in California, that I became aware of her work and started down the path of developing safe exercise programs for people with osteoporosis. A move back to Canada allowed me to focus my practice on educating individuals on the effect of exercise on bone. I had a personal interest in osteoporosis because my mother, mother-in-law and sister-in-law all have osteoporosis. With the support of my husband and the encouragement Marion Weldon, a Physical Therapist in Toronto who had spent years teaching classes on osteoporosis education, I launched my online osteoporosis exercise service, MelioGuide Exercise for Better Bones Program, through my web site www.melioguide.com. After launching the website, fellow Physical Therapists and other movement specialists started asking me to teach them how to treat clients with osteoporosis through exercise.

In 2007, I launched MelioGuide’s Building Better Bones training for health care professionals. My material was reviewed and approved by Osteoporosis Canada. They liked it so much that they launched a similar course! Between live and online courses I have trained over 1,000 health care professionals across Canada, the US and Asia. One of the students that attended my Building Better Bones course was Jayelle Lindsay. Jayelle is a Physical Therapist who has dedicated her career to teaching Yoga. Jayelle encouraged me to incorporate Yoga into the MelioGuide exercise program and share this important information with Yoga instructors and individuals practicing Yoga.

My Yoga and Osteoporosis Journey Jayelle and I collaborated on a short ebook, Yoga for Better Bones. This ebook demonstrated Yoga poses that should be modified for (and those that should be avoided by) people with osteoporosis. I made the ebook available only to clients who signed up for my MelioGuide Exercise for Better Bones Program. Jayelle went on to develop a training program for Yoga teachers. In 2011, I completed my Yoga Teacher Training. During the course, I was asked by the instructor and several fellow students (each with low bone density) to present my ideas on Yoga and osteoporosis. 10


In the weeks following my presentation I noticed a significant improvement in postural alignment during practice, especially among classmates who had been diagnosed with osteopenia. This experience demonstrated to me that even a small amount of information on posture and Yoga for people with osteoporosis could go a long way to improving their Yoga practice. It encouraged me to revise, update and expand the original Yoga for Better Bones publication and turn it into a published book that many people could access. And here it is!

About This Book This book will teach you how to practice Yoga safely. It is about understanding how your bones respond to stress in both a positive and negative way. It is also about understanding why modifications should be introduced in the Yoga practice for someone concerned about the health of their bones. The early chapters of this book are written to provide you, the reader, with information on anatomy, physiology and the movement behind the Yoga poses so that you can better understand the suggested modifications. The intent is not to create a sense of fear or to discourage people from practicing Yoga. In fact, this book should make you more confident in your practice of Yoga. I assume that the reader is familiar with Yoga poses and their nomenclature. If you are not completely familiar, then you can refer to dozens of how-to manuals and websites on Yoga.

Five Things This Book Provides 1. The latest information as to whether Yoga builds bone. 2. Key elements that are needed in any exercise regime to stimulate bone to build. 3. Knowledge you need to customize your Yoga practice. 4. The poses to avoid, the poses to modify and the poses you might consider dedicating more time to. 5. The confidence knowing you can continue to enjoy a safe Yoga practice for many years to come.

How This Book Is Organized This book is organized so that you first learn the important basics about your body – specifically, your bones and how movements in Yoga affect your bones – before we get into modifications and adjustments you should make to poses. Time is spent discussing specific strategies to follow so that you have a bone healthy Yoga practice.

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»» Chapter 2 – Anatomy and Movement: Parts of the body affected by osteoporosis and Yoga are identified and reviewed. Spinal movements are then discussed to deepen your understanding of modifications presented later in the book. »» Chapter 3 – Four Things About Yoga and Your Bones: Does Yoga build bone? What are the most studied and proven ways to naturally build bone? This chapter reviews what we currently know about these topics and more. »» Chapter 4 – How to Have a Bone Healthy Practice: Strategies that can be incorporated into your Yoga practice to make it more bone friendly. »» Chapter 5 – How to Modify Your Practice: This chapter describes the most popular Yoga poses and the suggested modifications to make them safer. »» Chapter 6 – Yoga Poses to Avoid: Several Yoga poses should be avoided if you have osteoporosis or low bone density. They are presented here. »» Chapter 7 – Our Model: The models for my books and publications have all been diagnosed with low bone density, osteopenia or osteoporosis. Like you, they are seeking out the safest way to build bone that allows their bodies to support them in an active lifestyle for years to come. In this short chapter I present our model’s biography. »» Chapter 8 – Acknowledgements: A number of people have provided considerable support and made contributions to this book. They are listed here. »» Chapter 9 – References: A list of key reference material used while developing this book are found here. »» Chapter 10 – Copyrights and Notice of Rights: Legal rights associated with this book. »» Chapter 11 – About the Author: If you would like to learn more about my professional journey, you will find it here. »» Chapter 12 – Suggested Readings: A list of articles of interest on my blog. The articles that I suggest supplement the content in this book.

A Message for Yoga Teachers Most of your class participants come to your Yoga class after spending (or before spending) a day hunched over their computers or performing other tasks in a forward slouched position. Over eighty percent of adults suffer back problems as a result of slouching. This can be easily avoided by activating and strengthening the spinal muscles during your class. The posture of each of your students will improve and the risk of fracture will be reduced. Go to www.yogaforbetterbones.com if you are interested in furthering your training in this important area.

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2. Anatomy and Movement

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his chapter covers basic anatomy and physiology related to low bone density and osteoporosis. Specifically, you will get a review of the anatomy of the spine, the hip, the core musculature and the hamstring muscles. There is also a detailed explanation of the different types of bone. It also discusses movement of the spine as it relates to Yoga. Spinal movements are discussed. A tutorial for each movement is presented so that you can become familiar with each of the movements. This chapter covers a number of important concepts. What you learn in this chapter will be applied in the balance of this book and in your Yoga practice. The better your understanding of the concepts in this chapter, the more motivated you will be to make changes to your Yoga practice and your movement patterns in general.

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ANATOMY The Spine The spine is a remarkably engineered pillar of vertebrae that encases our spinal cord. Each vertebrae is separated by discs that act as shock absorbers. Ligaments and muscles provide stability and movement. The design of our spinal column allows us tremendous freedom of movement and strength. There are twenty four vertebrae in the spine. Most people have seven vertebrae in their neck, known as cervical vertebrae. These vertebrae create a gentle cervical lordosis. Twelve vertebrae in the upper and mid back, known as thoracic vertebrae, make a gentle outward curve known as a thoracic spine kyphosis. Five vertebrae in the lower back, known as lumbar vertebrae, create the lumbar lordosis. These gentle curves in your spine are normal and add to the strength of the spine. Figure 1 shows the location of the different vertebrae and the curves in the spine.

Figure 1 The Spine

Each vertebrae has it’s own name. The first vertebrae in your neck, counting down from your skull, is referred to as C1, for first cervical. The second vertebrae is referred to as C2. The C indicates cervical and the 2 represents the order from the top. This continues down to C7. The nomenclature at the thoracic spine changes to T1 through to T12. In the lower back, the vertebrae are referred to as L1 through L5. See Figure 2. There are two main sections of the vertebrae. The front (the part that is on your stomach side) is referred to as the body of the vertebrae. The back part that you can feel if you run your hand down the middle of your back is called the spinous process. Viewed from the side the spine is divided into an anterior column and a posterior column. See Figure 3 on the next page.

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Figure 2 Vertebrae of the Spine


The anterior column, which is composed of the body of the vertebrae and the disc, supports the majority of the weight of the body. The discs act as shock absorbers between each vertebra. Along with the vertebrae, the discs allow us to move freely forwards, backwards, from side to side. The structure supports rotation and combinations of all movements. Body positions (postures) have an affect on the forces generated on the body of the vertebrae as well as the discs separating them. Sitting postures are far more compressive on the spine than standing postures. Long periods of sitting are not healthy for your spine. Picking up a weight from the floor in a seated position creates more loading on the spine than picking up the same load from a standing posture. This is not a good type of loading and I’ll explain more about this in the next chapter.

Figure 3 Columns of the Spine

The Hip The diagnosis of osteoporosis or low bone density is usually based on the results of a DXA (Dual-energy X-ray Absorptiometry) test (also known as the bone mineral density test). The DXA test measures the density of bone in four lumbar vertebrae, L1 to L4, as well as your hip bone or more precisely, the top portion of your thigh bone. During the DXA test, different areas of the hip are measured. One of those areas is the “neck” of the femur. It is referred to as the neck of the femur because, like your neck, it connects the head of the femur to the shaft or body of the femur. See Figure 4. The neck of your femur and the area just below it are common fracture sites because of the high percentage of soft bone located there. (More about soft bone when we get to the section below, Types of Bone.)

Figure 4 Neck of the Femur

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The Core Getting to know the muscles of the core is “core� to creating stability in your spine. Visualize your core as a cylinder of pressure that sits in front of your spine. Your pelvic floor is the bottom of the cylinder and your diaphragm is the top. The walls of the core cylinder are your transversus abdominals, oblique abdominals and spinal muscles. Breathing with your diaphragm and gently tightening your pelvic floor and deep abdominals increases the stability of your spine during your Yoga practice.

The Hamstrings There are many muscles that influence your ability to move fluidly but the one muscle group that has the most impact on moving safely are your hamstrings. Your hamstrings are a group of muscles that attach from your pelvic bone (ischeal tuberosity) to below your knees. If your hamstrings are tight, your forward bending movement will be very limited and unless you bend your knees you will be forced to bend from your spine. See Figure 5.

Figure 5 Hamstring Muscles

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3. Four Things About Yoga and Your Bones

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f you practice Yoga and you have been diagnosed with either low bone density (osteopenia) or osteoporosis, there are four things you should know about Yoga as it relates to your bone health: 1. There is no research that has conclusively demonstrated that Yoga builds bone. 2. Research shows that certain movements within Yoga poses can increase your risk of fracture. 3. It is highly probable that your Yoga instructor does not have the knowledge or time to modify your program to accommodate the health of your bones. 4. It is your responsibility to make sure that your Yoga routine is safe for your bones. In this chapter, I address each of these points in detail. By the end of the chapter you will have a better understanding of what you have to do to have a safe Yoga practice.

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1. DOES YOGA BUILD BONE? There have been few studies looking into the effect of Yoga on bone. The most recent study, which is now in its second phase, is being conducted by Dr. Loren Fishman who is the Director of Manhattan Physical Medicine and Rehabilitation in New York and author of Yoga and Osteoporosis. In his preliminary study only thirty-one of the original one hundred and seventeen participants complied with the Yoga routine they were given. Of the thirty-one, only eleven participants completed the full two-year protocol. Although the study size was small, there were some encouraging changes in the bone mineral density test of the eleven who practiced daily. However, this preliminary study is too small to draw a definitive conclusion on Yoga and bone development. I hope that the second phase of Dr. Fishman’s study yields results that demonstrate that Yoga can build bone. While there is no research conclusively demonstrating that Yoga can build bone there is substantial research proving that there are two types of exercises that build bone.

What Stimulates Bone Building? The two proven exercise approaches to building bone are: 1. Strength training 2. Weight bearing There are dozens of studies with thousands of compiled participants supporting these findings. While chess and Sudoku are healthy exercises for our minds they do nothing for our bones. To stimulate bones to build, we need to subject them to stress. The bones of our skeleton are a living tissue. Like our skin, our bones strengthen when exposed to gradual, repeated stresses – so long as they are the right type. Standing on one foot, walking, and stair climbing all cause more weight to be borne through the foot, leg and hip and thus create stronger bones in the lower body.

Strength Training All skeletal muscles in our body are attached to bone. Some attach directly, but most are attached through tendons. Muscles play a key function in creating movement through contraction. When a muscle contracts it creates tension in the tendon which in turn creates tension in the lining over the bone. Strength training can occur with an external weight (such as a dumbbell) or an internal weight (such as the weight of your body while you do a push up). Researchers still do not know the intricate details of how this occurs but they have shown in hundreds of studies that the bone 28


4. How to Have a Bone Healthy Practice

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n the earlier chapters I covered anatomy, the movements of the spine and some of the issues you need to consider if you have osteoporosis or bone density and practice Yoga. In this chapter I discuss how you can develop a Yoga practice that is bone healthy. Specifically, I discuss the following issues in detail: 1. The fundamental guidelines or principles. 2. What to emphasize in your practice. The practice of Yoga includes many styles and approaches. Although your specific style may not be reflected in these photographs, you are encouraged to apply the information appropriately. The most commonly practiced Yoga poses are addressed. Sanskrit names have been referenced from the Yoga Journal’s website at www.yogajournal.com. You are encouraged to visit that site to cross reference the poses. Before we get into specific yoga poses (we cover these in Chapters 5 and 6), we need to discuss some very important general guidelines and principles. These guidelines should be the foundation of your bone healthy yoga regimen. Let’s start with the first principle that I think is important to follow for someone with osteoporosis or low bone density. The first principle is to engage your postural muscles when you practice Yoga.

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ENGAGE YOUR POSTURAL MUSCLES I encourage you to practice your Yoga with a strong focus on engaging your deep postural muscles all the way down to the bone. As you do your poses, your postural muscles should be active and should feel them involved in the movement. Research on the rate of vertebral fracture recurrence confirms that strengthening back muscles has a big payback. Studies have shown that people who have had an osteoporotic fracture of the spine can delay the onset of a second fracture by five years. Whereas people who do not strengthen their back muscles fracture again within five months! Here is an example of what I mean by engaging your postural muscles in Yoga as applied to the first part of the Sun Salutation. A detailed illustration is presented on page 56 of this book. »» Begin with how you stand at the top of your mat. Ground or root your feet to create an equal and opposite force that moves up your spine through the crown of your head. »» Distribute your weight equally through your feet. »» Make sure you knees are unlocked while you are standing. »» Gently tighten your pelvic floor and deep abdominal muscles or your lower tummy. »» Elongate your spine. Feel the muscles along your spine support you. »» As you raise your arms allow your rib cage and shoulder blades to follow the lengthening of your arms above your head. »» As you go into the first forward bend, deeply bend from your hips and knees. Do not sacrifice your spine to get your fingertips or palms to the floor. »» Make the focus of the bend a lengthening of your spine. »» Keep your shoulder blades together to assist you in maintaining the length of your spine. You may consider bringing your arms to your side or sliding your hands down your thighs to provide your back with more support until your postural muscles are stronger.

FOLLOW THESE SAFE YOGA PRACTICE GUIDELINES As I mentioned earlier, my intent is not to scare you away from Yoga practice or any other form of exercise. Rather, it is to empower you with the knowledge you need to practice safely. I want you to (re)connect with the Yoga journey and not to focus so much on the end result (how close your pose looks to those demonstrated by Yogis who have above average flexibility). The following suggestions are the foundation to your bone healthy yoga regimen:

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5. How to Modify Your Practice

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eople with osteoporosis or low bone density should practice Yoga with a focus on maintaining elongation (or axial extension) of the spine. Elongation allows you to avoid flexion of the spine. Elongation also reduces the compression that can occur with poses that involve side bending and twisting. In this chapter the modifications for a number of popular Yoga poses are identified. For each of the poses the popular English name and the associated Sanskrit name are provided. Where appropriate, photo illustrations of the pose demonstrate safe and unsafe practices.

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STANDING FORWARD BEND POSE Uttanasana Uttanasana, or Standing Forward Bend Pose, requires modification for most students. In order to maintain spinal elongation, especially in the thoracic area, it is helpful to bring the shoulder blades together. The spine should not flex forward to the point where the rib cage makes contact with the thighs. The pose requires a deep bend of the hips. People with short (tight) hamstrings will also need to allow deep bending at the knees. Props are also helpful but are not a replacement for engaging the postural muscles.

Safe

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Unsafe


LUNGE POSE Ardha Mandalasana Caution should be used to avoid flexion through the mid back when placing the hands on the floor. The Lunge can be modified by placing the knuckles or finger tips on the floor instead of the palms. If this is uncomfortable, then props such as yoga blocks can be used under the hands. An elongated spine needs to be maintained.

Safe

Unsafe

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DOWNWARD FACING DOG POSE Adho Mukha Svanasana Modifications to the Adho Mukha Svanasana, or Downward Facing Dog Pose, include: »» Knee placed in flexion position to compensate for tight hamstrings. »» Placing the hands on a wall or seat of chair.

Safe

Safe

Unsafe

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STANDING WIDE LEG STRETCH Prasarita Padottanasana Prasarita Padottanasana, or Standing Wide Leg Stretch, can be safely performed when forward flexion is done from the hips and not the spine. Use of blocks, a stool, or a chair seat will allow the practitioner to keep the spine elongated as she bends forward from the hips and knees.

Safe

Unsafe

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STRAIGHT LEG RUNNER’S STRETCH Parsvottanasana Modify the Parsvottanasana, or Straight Leg Runner’s Stretch, to maintain an elongated position for the spine. This may involve bending the forward knee or using props. Avoid flexing the spine to bend forward.

Safe

Safe

Unsafe 48


6. Yoga Poses to Avoid

E

vidence has shown that extremes of flexion in the spine, extremes of compression, and side bending or rotation can lead to irreversible damage to the vertebrae in persons with osteoporosis or low bone density. Yoga poses that cause these extremes should be avoided. Likewise, the high percentage of soft bone in the neck of the femur makes it more susceptible to fractures (remember we talked about this in detail in the Anatomy section). Poses that create excess load on the neck of the femur should be avoided. This short chapter covers several Yoga poses you should avoid if you have osteoporosis or low bone density.

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UPWARD BOW OR WHEEL POSE Urdhva Dhanurasana The Upward Bow or Wheel Pose involves a significant amount of extension through the spine and is best not done. However, you can still benefit from extension poses. I encourage you to practice the modified Camel Pose presented in Chapter 5.

HEADSTAND POSE Sirsasana Even though Sirsasana (or Headstand Pose) should be avoided, the preparation stages leading up to the actual pose can be practiced safely and are beneficial to the student.

PLOW POSE Halasana The Halasana (or Plow Pose), illustrated to the right, cannot be practiced without putting the spine in a flexed position – causing significant compression. Therefore, this pose should be avoided.

Plow Pose – Unsafe

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7. Our Model

J

an kindly gave us a number of hours out of her busy schedule as an educator, downhill skier, and a Yoga teacher. Jan was recently diagnosed with Osteopenia or low bone density. She was encouraged to make the unsafe poses she did for us her last ones.

Jan Matthews

I also suggested she slow down a little on the ski hills – she did a Masters Training Camp in the Alps last spring!

Her safe poses were limited by her flexibility. Certainly if you have more flexibility and wish to go deeper into a pose without compromising your spinal position, you can safely do so. However, I encourage you to get feedback from a teacher a friend or to use a mirror. Focus less on the depth of the pose and more on the journey getting there! Thank you, Jan.

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8. Acknowledgements

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special thank you to Jayelle Lindsay, PT, MCPA for helping me develop this book and reviewing the material in detail. Jayelle attended one of my MelioGuide Building Better Bones continuing education courses for health professionals. Jayelle is a Physical Therapist and a Certified Yoga Teacher with over 30 years of experience in movement re-education. She is a graduate of the University of Western Ontario and is currently the director of Living Yoga & Health in Guelph, Ontario. Jayelle began teaching Yoga in 1991 and continues her studies in yoga and movement with a variety of teachers. She has offered trainings in Anatomy for Yoga Teachers and has presented programs at the Kripalu Center in Massachusetts. A special thank you has to go to our wonderful model, Jan Matthews, for setting aside the time for the photos and her patience during the photo shoot! Jan worked with us to make sure that the photos clearly demonstrate the correct (and incorrect) pose positions. Finally, I would also like to thank the following individuals for their comments on the poses: »» Victoria Blue, Registered Yoga Teacher. Victoria has been diagnosed with osteoporosis and has learned to modify her Yoga routine to accommodate her osteoporosis. »» Diane Casey, Physical Therapist, Certified Strength and Conditioning Specialist, and Yoga Instructor. »» Michelle Fraser, Physical Therapist and Yoga Instructor. »» Meena Sran, Ph.D, Physical Therapist. »» Wendy Katzman, Physical Therapist, DPTSc, OCS. Assistant Clinical Professor, Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco.

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9. References

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number of journals, articles and periodicals were consulted as I developed this content. The following is the complete list of reference materials, including books, journals, articles and web publications.

Betz S. Modifying Pilates for Clients With Osteoporosis, Inner Idea 2007 Bohr H., Schaadt O. Bone mineral content of the femoral neck and shaft: Relation between cortical and trabecular bone. Calcified Tissue International. Vol 37, No. 4 July 1985. Fishman L, Saltonstall E. Yoga for Osteoporosis, WW Norton, March 2010. Gokkaya O NK, et al. Reduced aerobic capacity in patients with severe osteoporosis: a cross sectional study. Eur J Phys Rehabil Med. 2008 Jun;44(2):141-7. Huntoon EA, Schmidt CK, Significantly fewer refractures after vertebroplasty in patients who engage in back-extensor strengthening exercises. Mayo Clin Proc. abstract 2008 Jan;83(1):54-7 McGill S, Low Back Disorders. Evidence-Based Prevention and Rehabilitation. Human Kenetics 2002 Nachemson AL, The Lumbar Spine, An Orthopedic Challenge, Spine 1976 Sinaki M, Mikkelsen BA. Postmenopausal Spinal Osteoporosis: exion versus extension exercises. Arch Phys Med Rehabil 1984;65(10):593–6. Ross, P et al Pre-existing Fractures and Bone Mass Predict Vertebral Fracure Incidence in Women, Annals of Internal Med. 114 (11): 919-923 1991

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Wilson SE. Development of a Model to Predict the Compressive Forces on the Spine Associated with Age-related Vertebral Fractures. Cambridge, Mass: Massachusetts Institute of Technology; 1994 “Fast Facts� NOF, January 1, 2009 http://www.nof.org/osteoporosis/diseasefacts.htm The Role of Physical Activity in Bone Health: A New Hypothesis to Reduce Risk of Vertebral Fracture. Phys Med Rehabil Clin N Am 2007 (18) 593-608

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10. Copyrights and Notice of Rights

Copyright Notice Yoga for Better Bones. Safe Yoga for People with Osteoporosis. Š 2011 by Margaret Martin First Edition ISBN Number: 978-1-105-14843-9 Find us on the Web at www.melioguide.com To report errors, please send a note to info@melioguide.com All photos Š 2011 Richard Martin All photos are property of and developed by MelioGuide. All of the content in this book is owned by MelioGuide and is protected by worldwide copyright laws. The trademarks, service marks, trade names, and trade dress featured in this book are protected by the laws of Canada and those of other countries and jurisdictions around the world.

Notice of Rights. All Rights Reserved. This book may not be reproduced, in whole or in part, including illustrations, in any form (beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and except by reviews for the public press), without the written permission from the publishers. Please respect my work! For information on getting permission for reprints and excerpts, contact Richard Martin at info@ melioguide.com

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11. About the Author

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argaret Martin believes that all health care professionals should practice what they preach. Margaret’s professional journey has taken her from Newfoundland to British Columbia to California and back to Ontario. She has worked in hospitals, clinics, industry and on the golf course. In her twenties and thirties, she did triathlons and week long bike trips. Feeling the affects of age when she entered her forties, Margaret started lifting weights. She complimented her weight lifting with Tai Chi. She continues to practice and learn Tai Chi. She also maintains a regular running and swimming schedule. She is just entering her fifties and is now training for a body building competition. Her favorite activities include weight training with her 16 year old son and swimming and biking with her 19 year old daughter. When she is not busy exercising and attending to her family she manages her private Physical Therapy clinic, Function To Fitness, in Ottawa, Ontario. Visit www.functiontofitness.com to learn more about her individual consultation services. Margaret is also the founder of MelioGuide – the source for exercise prescriptions for people with low bone density and osteoporosis. MelioGuide offers the Exercise for Better Bones Program – an online exercise prescription for osteoporosis. MelioGuide also offers Building Better Bones – a continuing education program on the treatment and management of osteoporosis for Health Professionals. Visit www.melioguide.com to learn more about MelioGuide. She is indebted to her husband for his continued support for her personal and professional endeavors.

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12. Suggested Readings

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n case you want to learn more about bone health and what you can do to protect and build your bones, I encourage you to visit my blog at MelioGuide.com. It is located at blog. melioguide.com. There is a Search box on each page where you can type in your inquiry. The following pages includes a list of articles that I have posted that I think you will find informative. Keep in mind that I am always adding new articles to my blog. If you want to get on my email list, sign up for one of my free courses on osteoporosis. I offer a course for clients and another for health care professionals.

Topic: Osteoporosis Exercise Is Walking Good Enough to Build Bone? http://blog.melioguide.com/2011/is-walking-good-enough-to-build-bone/ How Exercise Affects Your Bone Composition http://blog.melioguide.com/2011/how-exercise-affects-your-bone-composition/ Exercise for Women with Osteoporosis – Age is Not a Barrier http://blog.melioguide.com/2010/exercise-for-women-with-osteoporosis-age-is-not-a-barrier/ When Exercise Increases Your Risk of Fracture http://blog.melioguide.com/2010/can-exercise-increase-your-risk-of-fracture/

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Topic: Physiology and Anatomy Bone Quality and Osteoporosis http://blog.melioguide.com/2010/bone-quality-and-osteoporosis/ Bone Architecture and Its Relevance to Bone Quality http://blog.melioguide.com/2010/understanding-bone-architecture-and-its-importance-related-tobone-quality/ Is Your Neck Pain Caused by Osteoporosis? http://blog.melioguide.com/2011/is-your-neck-pain-caused-by-your-osteoporosis/ Bisphosphonates and the Risk of Femoral Fracture http://blog.melioguide.com/2011/bisphosphonates-and-the-risk-of-femoral-shaft-fractures/

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Yoga for Better Bones