Guest Post from Sara M. Meeks: Yoga and Osteoporosis

While I study anatomy and physiology when I have the chance, I do not consider myself proficient enough, or expert in any way. I wonder sometimes about being a yoga teacher and asking people to do things with their bodies that I do not full well know the repercussions of. 

Here's someone that does. 

Sara M. Meeks is a faculty member at Kripalu who often contributes to discussions on a yoga listserve that I sometimes mention in this space. Recently she wrote an email addressing one issue about A + P that I had been thinking about in particular. I emailed her back, asking if I could share it. As a yoga teacher, I think it is every teachers responsibility and in every students (heck, every bodies) best interest to read her article, or seek out this information in detail in general. 

So, without further introduction, Sara's article on yoga, osteoporosis, and spinal flexion.

Comments on limiting spinal flexion in yoga classes.
1.    The literature is very clear that flexion exercises are contraindicated in persons with known osteoporosis.  However, osteoporosis is also called the "silent disease" in that many persons are not aware they have it until a fracture occurs.  By then, the condition may be well advanced.  Over 55% of persons, male and female, over the age of 50 already have bone loss--osteopenia or osteoporosis.  This means that more people have it than don't.  Erring on the side of caution would, it seems to me, be the way to go with exercise….Yoga or others.
2.    Side-bending and rotation are also either contraindicated or to be done with considerable caution.  Yoga postures often combine all 3 movements at once and so the risk is tripled.  Also, little attention is paid to the posture of the back during complicated (and simple) postures.
3.    Up to 70-80% of fractures are silent.  This means that what "feels good" actually may be causing fractures in some individuals.  Then what can happen is this.  People go along with "feel good" Yoga and exercise, sustaining silent fractures and then one day they get up out of bed and experience the Vertebral Fracture Cascade, sustaining several fractures and losing inches of body height in the process.  Not much feel good there!  And, this happens more often than you might imagine.  Besides that, silent fractures result in loss of body height, internal organ compression and other side effects, causing decreased quality of life, heart and lung problems etc. 
4.  Another point is that, unless guided to move with consciousness and with an elongated spine, people tend to move in their areas of greatest flexibility.  That it, when bending, twisting etc, they will tend to move in the same segments.  Usually, these segments are somewhere around T9 vertebra, which is a pivot point of the spine and around which most fractures occur.  Not only are fractures a problem but also disc compression, facet joint instability etc.  These are called repetitive use injuries (similar to carpal tunnel except occurring in the spine and frequently silently......although they do affect function.)  Moving with spinal elongation creates an opportunity to spread the forces more evenly along the spine and, thus, build in more safety—plus stronger movement.

5.  As long as I have an opportunity to talk about some of these things to people who might listen, I’d like to add another movement pattern that is problematic to me.  That is, students are often told to “tuck the tailbone” and then “lengthen the spine.”  First of all, the tailbone (coccyx) is already “tucked” when the spine is in neutral; secondly, when you tuck the tailbone, usually you perform a posterior pelvic tilt which tends to round the lumbar spine.  It is then impossible to lengthen the spine and the spine is out of neutral alignment.  In neutral alignment, the tailbone curves under, the sacrum is rounded, the lumbar spine is arched, the thoracic spine is rounded in kyphosis, and the cervical spine is arched.  Rounding the lumbar spine only creates more problems further “up the chain.”

I teach SAFE Yoga for Skeletal Health and also BONE CAMP at Kripalu.  BONE CAMP is for yoga teachers, exercise and health professionals and will take place at Kripalu in November 2010.  You might want to check out either my website or Kripalu's for details.  I teach movement with an elongated spine, moving from least to most compression and concentrate on the movement and postures we need for a stable and strong spine and hips (among other areas.)

With osteoporosis occurring in all populations regardless of age, gender, lifestyle, ethnicity or any other factor, much, much more education is needed on bone health.

It might help if someone other than myself contacted Kripalu with questions on this.  There is strength in numbers.  A large number of people go through Kripalu and they would benefit with teaching that takes spinal integrity and bone health into consideration.

Thank you for this opportunity to share.

Jai Bhagwan,
Sara Meeks, PT, MS, GCS

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