Nathalie Fairbanks is an Iyengar Yoga instructor who loves to see the fruits of an intelligent yoga practice in her students. A member of the International Association of Yoga Therapists, she is certified at Level 2 in the Iyengar system and teaches Yoga and Yoga for Osteoporosis in person and online.
Osteoporosis, or loss of bone density, affects 500 million people worldwide. About 6% of men and 21% of women over age 50 are affected, resulting in roughly 70 fractures per minute. The most common fracture sites are the hipbone, spine, and wrists. After a hip fracture, about half of the patients become dependent on care, and 24% pass away within a short time.
These are grim statistics, yet there are lifestyle choices we can make to reduce the likelihood of this trajectory.
Proper nutrition, regular aerobic exercise, and good posture are a given. But what about yoga? This article will cover the dos, don'ts, and whys of how an Iyengar Yoga practice can help strengthen your bones.
What is osteoporosis?
Osteoporosis results from the gradual demineralization of bones, making them less dense. This occurs as we age, leaving our bones weak and brittle. If left uncountered, this aging process will continue. The condition is diagnosed using a DEXA scan, a simple test you can request from your doctor.
Who is at risk of osteoporosis?
Our bone density begins decreasing in our thirties. After age 30, bone production decreases while bone resorption increases. This affects women more than men due to hormonal changes during menopause. 21.2% of women and 6.3% of men aged 50 and older are affected by the disease.
While age is the main factor, certain lifestyle choices and medical conditions can negatively affect bone mineral density:
Excessive alcohol consumption
Smoking
Poor nutrition, especially low dietary calcium intake
Vitamin D deficiency
Eating disorders
Sedentary lifestyle
Visual impairments
Balance issues
Muscular dysfunction
Some studies suggest that a plant-based diet may have a beneficial effect on bone mineral density.
Why is osteoporosis such a problem?
Most people would never know their bone density is suboptimal without a DEXA scan. You can't feel it; you can't see it, and it doesn't affect you until you fall and break a bone or one of the vertebrae in your spine collapses. (Yes, this can really happen!)
One way to help prevent falls is to work on your balance. In yoga, practicing any of the standing poses, but more specifically those that require standing on one leg (Tree Pose, Half Moon Pose, Hand to Big Toe Pose, etc.), will improve your balance and increase your chances of mitigating a fall.
A rather discouraging statistic is that once you have broken a brittle bone, you are at double the risk of breaking another bone within a year. For women, the risk is fivefold. All the more reason to strengthen those bones!
A few things to know about bone creation
Just like other cells in the body, our bone cells undergo a continuous process of creation and destruction. Osteoporosis arises when more bone cells die than are created in any given period. This tipping point usually occurs in our thirties.
We create and build bone in the following ways:
Bone cells are created with impact. Walking, running, jumping, and dancing are all fun ways to keep bones strong. However, once osteoporosis has set in, avoid jumping and running to prevent brittle bones from fracturing.
Bone cells are created under pressure. Wolff's Law states that bone will be created in the line of force applied to it. When considering forces applied to bones in everyday life, gravity is the first that comes to mind. Standing and walking help keep bones strong. While essential, these activities are not enough to prevent the steady decline in bone density that comes with age.
The creation of bone cells doesn't begin until continuous pressure has been applied for 12 seconds, says Dr. Fishman in his training, Yoga vs. Osteoporosis. There's a window of about a minute, between 12 and 72 seconds, during which the process occurs while the force is applied. After 72 seconds, bone cells tire and need a rest. In Iyengar Yoga, we are challenged to build stamina by holding poses, which differs from Flow or Vinyasa-style yoga, which encourages constant movement.
Relaxation also facilitates bone creation. When we release tension, the hormone relaxin is released, favoring remineralization of bone tissue. A restorative practice, using props to lengthen the time spent in poses, will benefit your nervous system while promoting bone creation.
How does yoga optimize the forces applied to your bones?
Yoga postures require you to distribute body weight at varying angles. Because bone is created where force is applied, assuming a pose increases and changes the forces affecting the bones. A Warrior Pose, where one knee bends at a 90-degree angle, puts tremendous pressure on leg bones at angles that walking does not. Inversions (like Downward-Facing Dog and Shoulder Stand) use gravity on your arms and neck in ways no everyday activity can match.
Yoga postures stretch and contract all body parts: legs, arms, torso (front and back), neck, and feet. With extension and contraction, tendons (attaching muscle to bone) and ligaments (attaching bone to bone) pull and push on the bones, creating forces needed for bone cell creation.
Is yoga safe when you have osteoporosis?
Loren Fishman, M.D., an assistant clinical professor at Columbia University College of Physicians and Surgeons and co-author of Yoga for Osteoporosis, has extensively researched this question. His yoga experience led him to devise a series of 12 yoga poses safe for building strength, flexibility, and bone density. He had students practice this series for 12 minutes daily, comparing DEXA scans before and after two years. He found that in 80% of participants, bone mineral density increased. Given the experiment's success and the absence of fractures during hundreds of thousands of combined practice hours, it was an exciting start.
What poses can you practice when you have osteoporosis?
A balanced yoga practice includes different pose families:
Standing poses
These are very effective for increasing bone density. To avoid falls while learning balance, practice with your back to a wall and a chair or table nearby for support.
Forward bends
Pressure on the anterior part of the vertebrae risks spinal fracture; therefore, learn to bend forward with a straight or concave upper back. This takes time, especially if you already have a rounded upper back. The forward bend originates in the hip and depends largely on hamstring length.
Backbends
Similar to forward bends, backbends put pressure on the backs of the vertebrae. A correct backbend begins by lengthening the spine to create space between vertebrae. Backward tilting starts only after this separation. Precise instruction and a methodical approach are essential for safe practice.
Twists
As with forward and backbends, lengthen the spine before twisting. Twists strengthen vertebrae because many ligaments and tendons attach to them. In twists, they are pulled in different directions at varying angles, ideal for bone cell creation. Correct instruction is essential for safe twisting.
Inversions
Shoulders and headstands are integral to yoga practice due to their physical and emotional benefits. However, find a skilled teacher who uses props (blankets, chairs, blocks, straps) and intermediary steps to ensure safety. Neck vertebrae will gradually bear more weight; however, with osteoporosis, you'll likely spend time in preparatory poses strengthening your back, shoulders, and arms.
A well-trained teacher will provide safe progression instructions for all poses, regardless of your starting point. You may be advised to avoid certain poses. The goal isn't to perform complex poses, but to learn actions ensuring proper alignment and balanced poses.
In his book, Yoga for Osteoporosis, Loren Fishman, M.D., recommends different pose versions depending on whether the student has osteoporosis or osteopenia.
Iyengar yoga is an antidote to osteoporosis
An osteoporosis diagnosis, while initially discouraging, can be the start of a new adventure practicing Iyengar Yoga! As Dr. Fishman likes to point out, it will not only strengthen your bones but increase your strength and flexibility, better your balance, empower you, give you hope, and create community. Did I mention it is a lot of fun? Find a teacher wherever you are in the world or online!
Read more from Nathalie Fairbanks
Nathalie Fairbanks, Iyengar Yoga Instructor & Yoga Therapist
Nathalie Fairbanks is an Iyengar yoga instructor who loves to witness her students' breakthroughs: physically, mentally, emotionally. Her students have better balance, stronger bones, reduced pain, faster recoveries and more joy as practice becomes a regular part of their lives. She makes yoga accessible to any body at any age and will inspire you to accomplish things you never thought possible, step by step. She teaches Iyengar Yoga and Yoga for Osteoporosis at Yoga for You.
