Adapting Our Practice as We Age: Taking Osteoporosis Seriously by Marisó de Colsa
For more than 10 years I had a strong yoga practice, learning and doing all kinds of advanced poses. I was great at deep forward bending, able to place my head to my shins, bringing my leg behind my head. I had a strong, dedicated practice… until I fractured my spine, precisely an anterior compression wedge fracture on the T9 vertebrae (at the level of the bottom of the shoulder blades on the front of the vertebrae)
I did not know back then that when we have porous bones, we should be especially cautious with deep forward bends. Poses that involve rounding the back and twists with forward bends are especially dangerous. Microfractures happen over many years, with no pain. The bones take the load, but “chip/crumble” a little bit at a time. Then comes the day when we place an extra load on a daily activity or we do a pose without engaging all the core muscles and the unthinkable, unexpected, and painful fracture happens, and our life takes a steep turn.
My interest in writing this article is to raise awareness that Osteoporosis is something we should not take lightly. Fractures are real; they do happen. I want to prevent others from going through what I had to go through and to encourage teachers to advise your students. I was personally under the impression that my bones were getting stronger with yoga, in fact my bone density numbers have been better every passing year. The truth is that regardless of the bone density number, if there is porosity, the bone will eventually not hold when exposed to certain angles and loads.
In the Iyengar system, we are so careful with so many conditions. We know how to adjust for knee issues, lumbar, cervical spine, high blood pressure, glaucoma, pregnancy; you name it, long list of conditions! We are trained as teachers to modify poses for all these conditions. Never, in my many workshops and studies of 12+ years, have I heard of any precaution for osteoporosis. I had to learn the hard way. Not to blame my teachers, it was just not a condition that anyone mentioned, and honestly, I was not concerned about it back then, nor had I asked my teachers what to do about it.
It was not until the fracture happened to me that I started researching and studying yoga for Osteoporosis. I consulted my senior teachers who I saw once a year for special workshops. Both Rebecca and Dean Lerner gave me excellent advice and some resources to understand more about it and to cope with the long recovery, including mentally accepting that my asana practice couldn’t be again what it was. It took me more than a year to recover and feel myself again.
I would not like anybody to experience a fracture when it could be preventable. I have dedicated a lot of time to studying and formally educating myself on the subject. I would have loved to have the information I have today back when I was diagnosed with osteoporosis. I have now made it my mission to share the information with others, and I now teach with this specialization.
Osteoporosis is a silent disease and it is very prevalent especially in women after menopause. In the US, millions of Americans – 54 million to be exact – have low bone density or osteoporosis. In fact, about one in two women and up to one in four men over the age of 50 will break a bone due to osteoporosis. The disease causes an estimated two million broken bones every year. (ref: Bone Health and Osteoporosis Foundation). Worldwide, according to the WHO (World Health Organization), over 21% of women are affected by the disease, about 6% of men are affected. The great majority of individuals at high risk (possibly 80%), who have already had at least one osteoporosis-related fracture, are neither identified nor treated. (ref: International Osteoporosis Foundation)
Thinning of bones and osteoporosis
Losing bone mass is one of the many degenerative changes that comes with aging, alongside loss of muscle mass, loss of range of motion, loss of balance, vertebrae disks shrinkage, etc. If affected by osteoporosis, the thinning of bones happens more rapidly.
Osteoporosis is defined as a systemic skeletal disease characterized by micro architectural deterioration of bone tissue. Determined with a DEXA BMD (Bone Mineral Density) scan with T score of -2.5 or lower. Osteopenia is the precursor of osteoporosis, DEXA scan between -1 and -2.5.
How can Yoga help us?
As we know, Yoga helps us improve posture, balance, and range of motion, but what exactly does it do for our bones? Compression and tensile stress and static and dynamic loading stimulate bone growth and quality. Staying in a pose for at least 30 seconds while engaging the muscles (hugging the bones with our muscles) is proven to be the most beneficial. One of my resources is Dr Loren Fishman, who studied with Mr. Iyengar. He has run pilot studies and published medical papers showing the benefits of Yoga for Osteoporosis. You can find more at sciatica.org
But we must be careful…
There is definitively no doubt that Yoga is good for us at many levels. However, when we have osteoporosis, we must modify our practice. Don’t wait until you suffer a fracture! Here are some of the modifications to keep in mind:
No deep forward bends
No forward bends with a curved back (i.e. Bakasana, Lolasana, Bhujangasana)
No forceful twisting or twisting where the upper back would not be fully elongated
Inversions only if you can come in and out without rounding the back
No sun salutations, other than transitions on the floor (i.e., down dog, up dog, chaturanga)
Back bends are very beneficial but stay away from the extreme ones (i.e Dwi Pada Viparita Dandasana full pose on elbows, or drop overs where you would be jerking the spine)
Focus on poses lifting the weight of the body on a safe angle (i.e., planks, half full arm balance)
Focus on engaging the muscles to the bones in any pose and staying at least 30 seconds
On October 22, 2023, I will be teaching a Free-to-Members Zoom workshop for IYASE with much more information and will do a specific practice to help build stronger bones.
I must say that thanks to Yoga and my teachers, I was able to bounce back from the fracture that I suffered, and currently I don’t have any back pain. I feel stronger than ever because I focus on my body weight lifting and truly engaging the muscles. Most importantly, I have a more informed practice. The yoga philosophy we study has contributed a great deal to build resilience and turn the experience into significant personal growth. Now more than ever, I understand that “the study of asana is not about mastering posture. It is about using posture to understand and transform yourself.” Ref. BKS Iyengar.
In love and health,Marisó de ColsaCIYT Level 2Certified in Yoga for Osteoporosis by YogaUonline (based on Iyengar principles and Dr. Fishman’s material)IYASE Membership and Continuing Education chair