To Bend or not to bend
With Osteoporosis this is a common question especially if you practice yoga.
The Bone Health & Osteoporosis Foundation recommendations regarding osteoporosis include: avoid bending and twisting at the same time, don’t fall (of course) and include upper back strengthening and balance training in your workouts. A common way we bend and twist is when we lift groceries or a laundry basket and there are poses in yoga that my combine these motions if we are not intentional with our spine lengthening as we practice.
So what if yoga is your go to for exercise, stress management, strength and flexibility training? As a fellow yogini, Physical Therapist, and yoga teacher I feel conflicted. So what do we know?
We know that
🙂 Forward bends settle our nervous system
🙂 Forward bends feel good
😞 Life stressors and lifestyle may create a rounding in the upper back putting more unwanted pressure on the bones of the spine (vertebrae).
😞 Many of us initiate bending through the spine more often than bending through the hips and knees when doing daily tasks.
For people with osteoporosis, the research surrounding yoga and forward bending offers both insights and cautions.
Let’s review what we know about yoga
Research supports that there are mental and emotional benefits to forward bends in yoga, that we want to be cautious when there is increased rounding in the upper back (kyphosis) and that there are movements and poses that can support good spinal alignment in movement both on and off the mat.
Forward bending poses help stretch the back side of the body, including the back, hamstrings, and calves and they can feel familiar and comforting. Flexibility is important with osteoporosis especially in areas that often become tight due to prolonged sitting and slumping. Releasing these areas can be especially beneficial for our balance and preventing falls and for the alignment of the spine and lower back that feels good too. Yet it is important to note that many of these areas can be released without bending the spine. Many forward folds activate the fascia that extends from the head to the toes down the back side of the body and support posture by encouraging length and mobility throughout the spine and legs. Lengthening this myofascial chain has been shown to improve flexibility and provide a calming, introspective experience that helps soothe the nervous system. (Ekhart Yoga)
From a therapeutic perspective, forward bends can also stimulate the parasympathetic nervous system (aka rest and digest), helping to reduce stress and promote relaxation. The gentle compression in forward bends has benefits for the digestive organs and can increase circulation to the abdominal area. Moreover, when forward bends are practiced with slight engagement of the abdominal muscles to maintain spinal length, they may create support for and space between the vertebra and may relieve tension in the lower back. (Arhante Yoga Ashrams)
Did you know that Body in Tune offers individualized care to assess the alignment and offer modifications to your practice to keep you safe while you practice.
Why we are cautious
As a physical therapist and yoga teacher, I often approach forward bends (flexion) with great caution when working with individuals who have kyphosis and osteoporosis. Both of these conditions present unique challenges, and it’s essential to understand the biomechanics and risks involved in forward bending to protect the spine and overall health of my clients.
With osteoporosis we often see an increased rounding in the upper back usually starting just below the level of the shoulder blades upward to the base of the neck. This is called kyphosis. It can become a habit due to lifestyle and poor posture, muscular imbalances, or age-related changes like vertebral compression fractures, a fracture that changes the shape of the vertebrae. With osteoporosis, the internal portion of the bone, the honeycomb-like dense bone becomes less dense and more prone to fractures, especially in areas like the spine. Forward bending, if done incorrectly or too aggressively, can place excessive load on the anterior portion of the vertebrae, where bone loss is often most pronounced. The Bone Health and Osteoporosis Foundation discusses concern that over time our spine may develop micro stress fractures, gradually changing the shape of the bone and increasing the risk of falls and fractures.
When we move into a forward bend, the forces through the spine increase significantly as we reach forward, even more so if we round the upper back. Hence, if individuals are practicing with a kyphosis when their spine is already in a compromised forward curve, adding further flexion can exacerbate this curvature, and over time lead to postural changes that can be difficult to reverse and may increase pain or discomfort in the long term.
Good news! Body in Tune would love to collaborate with you to help you build a personalized yoga practice and to support your ongoing practice so you can enjoy your life off the mat with confidence.
recommendations when bending
In yoga, safe modifications are key to keeping our bones safe while reaping all the benefits yoga has to offer. Instead of deep forward folds, I recommend intentionally
lengthening the spine creating space between the vertebrae
engaging the core to support the spine and back muscles
hinging from the hips, tipping the pelvis first to minimize rounding the back
This may help preserve the integrity of the spine and lower the risk of fractures.
Following the guidelines from the Bone Health and Osteoporosis Foundation, I also emphasize strength-building exercises to improve upper back strength, postural support and balance, as these can be highly beneficial in reducing kyphosis, slowing it’s progression and preventing falls. I also emphasize back bending postures to help reverse the curvature in the upper back. More strength leads to better support with bending and better posture.
Knowledge about your body’s unique issues and body awareness are critical. It is important listen to your body and avoid pushing into a stretch that feels uncomfortable or overly intense. Gentle, intentional movements and awareness of body and spinal alignment are more effective in the long term. By prioritizing safety and focusing on modifications, we can enjoy the benefits of yoga without compromising spinal health.
Overall, the benefits of yoga for osteoporosis can include improved bone density, strength, and balance, but it’s crucial to adapt practices with caution, avoiding deep forward bends. For those with osteoporosis, it’s best to seek classes that are gentle and ideally led by instructors trained in osteoporosis-safe practices. This approach allows one to enjoy the bone and balance benefits of yoga while minimizing risk.
Body in Tune, LLC was born from a belief that quality of life matters; both life and physical balance matters.
I would welcome the opportunity to be part of your support team with regards to your muscles, joints, bones and osteoporosis. The goal is, after all, to help you feel confident in your body so you can play with your grand children, take that long-dreamed of vacation and get outside and enjoy a walk with friends.
