Yoga for Osteoporosis: Prevention, Rehabilitation, Tips for Teachers Q+A with Dr. Loren Fishman and Ellen Saltonstall

Can yoga prevent or even reverse the thinning bones of osteopenia and osteoporosis? In this interview, Dr. Loren Fishman and Ellen Saltonstall, co-authors of Yoga for Osteoporosis, discuss these questions and talk about some of the important precautions yoga teachers should be aware of when teaching yoga to people with osteopenia or osteoporosis.

*Dr. Fishman and Ellen Saltonstall will be teaching a 6-part online course on Yoga for Osteporosis – Teaching and Practice on November 10 – 28. Enter code YOGADORK at checkout for 20% discount if you register before November 20th. Details here.

By Eva Norlyk Smith, Ph.D., CYT-500

Eva Norlyk Smith: You have written a book on Yoga for Osteoporosis and are in the process of conducting a large study on the bone-building benefits of yoga. What made you interested in this subject in the first place?

Dr. Loren Fishman: Well, osteoporosis is one of the most widespread chronic conditions in the Western hemisphere. It’s hard to exaggerate its health effects. It affects 44 million Americans, more than half of everyone over the age of 50. It is 50 percent of all women over 50 and 25 percent of all men.

We worry so much about breast cancer in women, but in actuality, the risk of a hip fracture is equal to the combined risk of breast, uterine and ovarian cancer! And it’s not just women who are at risk. Men over 50 are actually more likely to have a hip fracture than prostate cancer. Fully 25 percent of the people that have hip fractures die within a year. Another 25 percent enter a nursing home never to leave. So half of people who contract a hip fracture have a very significant life change. So this is big time.

Ellen Saltonstall: We also see that more and more people in the middle to older age range are wanting to try yoga. They need to know how to practice safely and effectively, and teachers need to know how to teach safely to this age group. Yoga can help people with many different health issues, and it’s particularly satisfying to empower people who are beginning to feel fragile as they age. So when Loren proposed that we do the book together, it was a natural step to take. I teach Anusara Yoga, which is well suited to therapeutic applications.

ENS: Traditionally, people are referred to weight-training exercise to strengthen bones. Do you have any indications that yoga actually helps grow stronger bones?

Dr. Loren Fishman: We have a large study going on right now that we’re still waiting for the results from. However, we did a preliminary study on a smaller sample over a two-year period. We looked at the before and after bone density measurements of people who practiced yoga regularly versus a group who did not (the control group). We found that the control group lost about .1 of a unit on the T-scale for bone density. The yoga group, on the other hand, gained .75 of a point in bone density for their spine, and more than .9 of a point for their hips. So the study really did suggest that yoga is a strong stimulus for building bone.

We’re now running a larger study to see if the results bear out. I will be talking more about this study in our online course on Yogatherapyweb.com, where we also talk more specifically about how to use yoga to counter osteoporosis, and what yoga teachers need to know to teach yoga to people with osteoporosis.

ENS: Are you still taking people for the study?

Loren Fishman: Yes, we are indeed. Many more are joining now because I got some attention in the New York Times and the lay press and a lot more people found out about the study. But we’ll probably close it within about 6 months or a year.

ENS: What are the mechanics of how yoga might impact bone growth?

Ellen Saltonstall: It is commonly believed that weight-bearing stress increases bone strength. This is compressive stress on the bones. Yet, we find that different types of pressure, not just weight-bearing, also stimulates the bones. When the bones are stimulated by the pull of working muscles, they extrude more protein and strengthen to adapt to the demand. This is tensile stress.

What yoga does is provide a wide range of options for both compressive and tensile stress, in positions that are far more varied than daily life. Many yoga poses put significant healthy stress on the hips and lower back, which are areas that are measured for bone density. Yoga practice includes both the dynamic tension used to go in and out of poses, plus the sustained resistance of holding poses, often with two parts of the body working in opposition to each other. Both types of healthy stress improve bone strength.

ENS: Which are some of the other benefits yoga might have for people with osteoporosis, other than improving bone strength?

Loren Fishman: Oh, there are so many. The big thing about osteoporosis is that most people focus on bone mass, but it’s really fracture risk you have to worry about.  And when it comes to fracture prevention, yoga is extremely beneficial in so many ways. Yoga improves your sense of balance, it improves your range of motion, it improves your general dexterity and grace of movement. All of these things reduce the likelihood of you falling and incurring a fracture.

ENS: What is the best advice you can give to young people, say in their 20’s and 30’s, who want to avoid osteoporosis in the first place?

Loren Fishman: The earlier you start preventing osteoporosis, the better. The best time for building strong bones is really when you are in your 30s. Most people reach peak bone mass somewhere between 30 and 40. So you want to get enough deposits in your bone bank, so that as you age and begin to lose bone mass, you start from a place of maximum strength. You don’t want to be in the position of having a balance due, which is what happens if you don’t put anything in and start taking stuff out.

So, get yourself a regular exercise regimen that you like, which may not be the same every day. Get that working and let it evolve with you over the years. Then when your bone mass does begin to decline, it will decline much more slowly with the yoga than without it.
ENS: What should yoga teachers keep in mind when teaching yoga to an aging population, many of whom might have osteoporosis?

Ellen Saltonstall: It’s important to pace the class to avoid fear or carelessness, but at the same time to empower students with confidence and stimulate them to greater activity levels than they would do by themselves.
In addition, there are several precautions teachers should be aware of. Avoid spinal flexion poses (traditional forward bends, with the spine rounded), and teach healthy alternatives. Back bending poses, if paced appropriately, will increase stimulus to the vertebral spine and improve posture. Since falling is the greatest danger with osteoporosis, balancing poses that facilitate steadiness and good coordination are important skills to work on.

Lastly, in our approach to teaching yoga for osteoporosis, we use specific actions in the poses to help build muscular strength overall, and also build the habit of using that strength in daily life. There are many other things, of course, but these are the main ones.

Loren Fishman: If you have osteoporosis, or some other health condition, you better tell your yoga teacher. And, if you are a yoga teacher teaching older students, you better ask your students if they have low bone mass, and you better educate yourself on how to work with people with that specific condition. That’s really important.

Over the centuries, yoga was always taught one on one. And there’s a reason for that – because poses have to be adapted quite frequently. It doesn’t work that way in the way yoga is being taught in the U.S. right now, but it’s important for yoga teachers to know how to adapt poses for people with low bone mass.

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For more tips on teaching yoga for osteoporosis, download Loren and Ellen’s free report here: The 12 Do’s and Don’ts of Yoga for Osteoporosis
Sign up for the 6-part online course led by Dr. Fishman and Ellen Saltonstall on Yoga for Osteporosis – Teaching and Practice. (don’t forget the YOGADORK code for 20% off!)

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Earlier…

• Yoga Therapy Helps Prevent Orthopedic Problems, Bone Loss, Reports New York Times
• Practicing Radical Presence: The Art of Teaching Yoga – An Interview with Judith Hanson Lasater – Part 1
• Yoga? Breakdancing? Pure Awesomeness – Incredible Video
• Yoga Alliance Approved, My Ass
• Yoga Class: Where’s YOUR Head At? (funny video)