If you have been diagnosed with osteoporosis, please consult your doctor first. It is useful to have a bone scan to determine what potential dangers there are.
If you are in a class, let your yoga teacher know about any injuries or conditions you have been diagnosed with, but always follow what feels OK for your body and the advice of a trained health professional who has assessed you individually. Don’t assume that your teacher will know a lot about your condition unless they have a specific interest and training in it and can also give you one to one attention in class. Be patient with your practice and it will be with you for life.
What is Osteoporosis? A bone-thinning disease that will cause approximately half of women age 50 and older to break a bone. (Men get osteoporosis too, but 80 percent of sufferers are female, likely because women typically have smaller, thinner bones and because production of estrogen drops off sharply at menopause.) The hard truth is that by the time you hit the age when your skeleton becomes more brittle, it’s much more challenging (though not impossible) to build protective bone mass.
New research shows that yoga is surprisingly protective when it comes to staving off fractures and helping to prevent osteoporosis in the first place. There are however some precautions you should take if you are planning in complementing what your health professional has prescribed you with a yoga practice.
If you practice yoga, you’re already protecting your frame in a few major ways. Each time you do a pose, you’re potentially building new bone. When you hold a pose or a twist, you’re opposing one group of muscles against another, like the quadriceps against the hamstrings or the gluteal muscles against the shoulder muscles, respectively. That opposition creates a force that physically stimulates osteoblasts, bone-making cells that initially live on the outside of the bone and turn into osteocytes, which are cells that become embedded within your bone. You’re actually laying down new bone. Yoga also plays a vital role in preventing fractures by helping you cultivate your sense of physical balance and stability as well as mental balance which in terms lowers the levels of the stress hormone cortisol, another factor which reduces bone density
N.B. IMPORTANT! If you are diagnosed with osteopenia or osteoporosis the likelihood of spinal bone fractures is increased. One family of postures contraindicated for those with osteopenia and osteoporosis are forward bends – for fear of fractures on the anterior (front) portion of the vertebral bodies (irregular bones of the spine).
When practicing yoga with osteoporosis, or when teaching students with osteoporosis, emphasize the following poses and actions.
- Do…practice neutral-spine postures.
Students with osteoporosis should make neutral-spine poses like mountain/ Tadasana the crux of their practice and should work on aligning the spine optimally in these 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.
What about those with rounded upper backs who are unable to create a neutral spine? Come as near neutral as possible.
For example: Mountain, reclining hand to big toe pose (using a strap), low lunge, the warrior poses, tabletop, and plank are all neutral-spine poses.
- Do…focus on lengthening.
Having arranged your spine in its neutral or near-neutral shape, work to elongate it. With osteoporosis, the weakened vertebrae sometimes collapse to the point of fracture. Lengthening the spine creates space between the vertebrae, preventing or correcting that collapse.
For example: Think of a marionette string pulling up from your head no matter what position you’re in. Alternatively, imagine lifting up into an object—like a book or jug of water—balanced on the crown of your head.
- Do…include poses that encourage the hands to bear weight.
Bring your hands to the mat. As noted, one of the advantages of yoga over other exercises is that bearing weight on the hands allows us to build bone density in the arms as well as the legs.
For example: Tabletop, plank, forearm plank, chaturanga, reverse tabletop, and downward facing dog.
(Please note: It is not safe to bear much weight on the hands if the upper back is rounded. In tabletop, work to indent the space between the shoulder blades, and only proceed to poses like chaturanga, plank, and downward facing dog once this is possible. Avoid arm balances like crow that call for a rounding of the back.)
- Do…include gentle backbends.
Because osteoporosis is so often accompanied by thoracic kyphosis, it’s especially important to work on gentle backbends, which move the thoracic spine in and lift the chest, improving thoracic spine extension.
Even mild forward folds are not recommended for those with osteoporosis, but some mild backbending is fine. The extension movement is much less risky than flexion because of the strength of cortical bone in vertebrae.
For example: Bridge, sphinx, baby cobra, camel pose (with hands on your lower back), lying down over a foam roller or rolled-up blanket (placed horizontally under the thoracic spine), and restorative backbends. This practice for kyphosis is safe for many of those with osteoporosis.
- Do…include mild sidebends and twists.
Varied spinal movement is important for preserving the health and strength of the vertebral bones, although any pose that rounds the back should be avoided.
These varied movements include mild sidebends and twists, which will allow you to maintain the greatest flexibility of your spine without causing the fractures associated with osteoporosis.
But how far should you go? The less the torso approaches end range [of motion] the less the strain. Encourage yoga students with osteoporosis to go only as far as they can without sacrificing spinal length.
When sidebending, go only as far as you can without collapsing the waist on the side to which you are bending. When twisting, go only as far as you can while maintaining a gentle inward curve in the lower back.
For example: Bend to the side by just a few degrees while standing or lunging, as well as in reverse warrior, gate pose, or while reclining in bananasana. Enjoy gentle reclining twists like “windshield-wipering” the legs from side to side. And when doing more vigorous twists, keep a neutral spine (i.e., do not round the back), twisting by only a few degrees.
- Do…move from pose to pose slowly.
To decrease the risk of falling, it’s important that students with osteoporosis move from pose to pose slowly.
For example: Come up slowly from positions like half forward fold (bending the knees and bringing the elbows to the knees for a modified chair pose before rising to mountain pose) to decrease the risk of a head rush and a fall. Before stepping a foot back for a pose like warrior I or Crescent Moon, always make sure the front foot is well-grounded.
- Do…challenge balance without sacrificing stability.
Because a fall could mean a fracture for students with osteoporosis, it’s vital to work on balance in yoga class. But, to avoid a fall, you should initially challenge your balance while making the most of the support available to you. For instance, in standing balance poses, bring a hand to the wall to steady yourself, or keep the toes of the foot you’re about to lift on the mat until you feel stable. You will still improve balance and coordination even if you are not in the ‘full’ pose.
- Do… add some weights.
Rather than increasing the challenge with more extreme poses, keep the pose straightforward and use light hand and/or ankle weights.
If a student with osteoporosis is comfortable in a pose like bird dog, it can be tempting for him/her to turn that pose into a big backbend (by bending his/her back knee and bringing his/her lifted hand up behind him/her to encircle his/her lifted ankle).
Instead, we recommend lifting a weight with the front hand and strapping an ankle weight around the back ankle. The weight should be an amount that you can lift 10 to 12 repetitions without strain, perhaps one to two pound dumbbells or ankle weights.
For example: Hold hand weights with the arms overhead, alongside you in chair pose, or out to the sides in warrior II. And strap an ankle weight around the ankle of the lifted foot in single-leg balance poses like warrior III.
It is essential for yoga students with osteoporosis to avoid extremes in range of movement. The poses and practices below are those we recommend avoiding.
- Don’t….do crunches or sit-ups.
While core strength is important to support the lower back, these poses require loaded lumbar flexion, placing a high demand on the lower back as you work to lift the weight of the upper body, leading to fractures in the thoracic or lumbar vertebrae.
Instead: Work on core stability in all neutral-spine poses by drawing the belly in and up on the exhale. From a lying down position, work the core by lifting and lowering the legs rather than the upper body, keeping the spine in its neutral position.
- In fact, avoid all poses that require spinal flexion (rounded-back poses). Students with osteoporosis should avoid not only sit-ups and crunches, but all poses that require spinal flexion (rounded-back poses) because of the stress that puts on the lower back. This means steering clear of forward folds, even mild ones, and also avoiding hugging the knees in as you lie on your back—as you would for wind relieving pose or happy baby.
Certainly, rolling up to stand, a challenging movement to do well for even the strongest of yoga students, is one that students with osteoporosis should always avoid.
Instead: Skip uttanasana (standing forward fold) in favor of ardha uttanasana (half standing forward fold). In this “flat-back pose,” you might bring the hands to blocks, the seat of a chair, or to a wall, in order to maintain your optimal spinal shape.
Choose upright seated poses like staff over forward folds like stretch of the west (leaning back if necessary to curve the lower back in toward the belly and lift the chest).
To stretch the hamstrings, instead of going deeper into a forward fold, practice lying down hand to big toe with a strap around the foot of the lifted leg. In all of these poses, focus both on keeping the spine in its neutral position and on lengthening.
- Don’t…practice big backbends.
While some gentle backbending, as mentioned above, is fine for students with osteoporosis, big backbends like upward facing dog, wheel, bow, and camel pose with hands on the heels, can be dangerously compressive. The thoracic spine is the area of the spine at greatest risk for those with advanced osteoporosis: This is where the majority of stress is placed in any rounding of the spine, but also in extreme spinal extension (backbending).
Instead: Stick with the milder backbends recommended on the Do’s list above.
- Don’t…practice extreme twists and sidebends.
Trunk rotations cause torsional stress on the spine. The discs and vertebral bones are stressed most when in a rounded position combined with a big twist. Think of the motion involved with shovelling dirt or snow: That’s when many spines are injured.
That means that moving into a deep chair pose twist or a Marichi’s pose with your elbow to the outside of your thigh is off limits. Big sidebends (for instance, bringing your hand to your shin in gate pose or reverse warrior), often have an element of twisting to them and can be compressive too.
Instead: Stick with the milder twists and sidebends listed in the Do’s above.
- Don’t…start an inversion practice.
Those diagnosed with low bone density who have practiced inversions regularly throughout their lives and are able to keep their neutral-spinal alignment in these poses may be able to safely practice inversions such as headstand, shoulderstand, and handstand, though they would be wise to consult with their doctors first. If given permission to practice inversions, students with osteoporosis should practice them at the wall in order to minimize the risk of falling.
For those who haven’t already been practicing poses like these regularly, if you’ve been diagnosed with osteoporosis, this is not the time to start. The weakened, low-density vertebrae will not tolerate the compression [of these inversions], especially if there is a loss of cervical curve.
Instead: For many of the circulatory and energetic benefits of inversions, practice milder inversions like downward facing dog, bridge, and legs up the wall.
- Don’t…take fast-paced, competitive classes.
What’s the rush? Some vinyasa flow or power yoga classes transition quickly from pose to pose, and stability is of the essence for students with osteoporosis. Steer clear of those classes and the teachers that encourage you to move so fast you risk your balance.
Instead: Take hatha, Iyengar, gentle, restorative, yin yoga, or any alignment-focused practice.
Often students with small losses in bone density—mild osteopenia—can safely practice the majority of yoga poses. Students whose bone loss is more advanced—whose spines have already rounded into a “C” shape or who have already suffered fractures—will need to be more cautious. But the only way to know what range of motion and activities your bones can handle is to consult with your doctor.
12-Minute Yoga Sequence to Boost Bone Health
Breathe slowly as you hold each pose for about 30 seconds per side.
Vrksasana, Tree Pose. Stand in Tadasana. Bend your right knee and rotate your right thigh outward without turning your pelvis. Lift your right foot and place it above the ankle or knee of your left leg (but not against the knee itself). Bring palms in front of your chest. (N.B. Foot can be against calf instead of thigh).
UtthitaTrikonasana, Extended Triangle Pose. From a wide stance, rotate your left leg so your foot and knee turn out 90 degrees. Lengthen your torso over your left leg. Place your left hand on your left shin, the floor, or a block. Stretch your right arm up. (N.B. Back foot turned in 45 degrees, front heel aligned to back heel or arch)
Virabhadrasana II, Warrior II: From a wide stance, rotate your left leg so that your foot and knee turn out 90 degrees, front heel aligned to back heel or arch. Bend your left knee over your left heel (right angle). Reach your arms actively out to your sides at shoulder height. Push down through front heel and lift under front thigh. Keep back foot strongly planted on the floor as your anchor.
Utthita Parsvakonasana, Extended Side Angle Pose. From Warrior II, lengthen your torso and lower your left forearm onto your left thigh. Reach your right arm up and over your right ear. Stretch from your right outer heel through your fingertips. Keep pressing down with your front heel to activate buttock muscles.
Salabhasana, Locust Pose. Lie face-down on your mat with your arms alongside your torso. Lengthne one leg at a time and then place all 10 toes on the floor and lift your knee caps. Lift your chest forward and up as you raise your legs and stretch them out behind you. Lift your upper body and legs without straining, streaming your arms along your torso.
Setu Bandha Sarvangasana, Bridge Pose. Lie on your back with knees bent, heels in line with your knees. Press into your feet as you lift your hips and torso. With your arms extended, interlace your fingers and come on to your outer shoulders. Keep throat open.
Supta Padangusthasana/ Reclining Hand-to-Big-Toe Pose: Lie on your back. Hook a strap around the ball of your left foot; hold an end of the strap in each hand. Straighten your left leg, drawing it up toward the ceiling without lifting your left sitting bone.
Then hold both ends of the strap in your right hand. Keep the left side of your body grounded as you extend your right leg out to the right side and lower it toward the floor.
Savasana / Corpse Pose: Lie on your back with legs hip-distance apart, heels under your knees. Press your shoulder blades into the floor. Rest your hands on your lower belly. Stretch each leg out in front and let each foot fall open. Open each arm, palms turned up.
When it is time for you to rise, ease yourself up into a seated pose like hero’s pose or
any pose in which it is possible for you to elongate your spine.
Bring your palms together in front of your heart and notice the effects of this
lengthening and strengthening practice in which you worked to align your spine and
shoulders and channel weight through your limbs. Perhaps you feel lifted from within
and a new sense of sturdiness seems to permeate your bones.
Practice safely – Namaste
Based on articles appeared on Yoga Journal amd Yoga International