Are there any special considerations for a movement practice for someone who may be at risk of osteopenia or osteoporosis, or perhaps is already diagnosed with a condition of impaired bone density?
Absolutely! One size does not fit all when it comes to movement, especially when it comes to protecting the integrity of our bones. At the Wellness Station with our Feldenkrais-inspired approach, it is our job to address osteoporosis and osteopenia with individually-crafted lessons that are unique for every individual. Factors that are important to consider throughout therapy are how to maintain and increase bone density, improve muscular strength and responsiveness, body awareness, and help prevent the risk of a fall or compression fracture.
Here are some key considerations when engaging in yoga or any movement if you are aware that you have decreased bone mineral density:
1. Communicate effectively with your body:
When we move, we are engaging in a dialogue with our body. We initiate the movement, and it is our job to listen to how our body responds, and modulate our movement based on that response! In other words, what are the subtle signs that we can pick up when we are putting our body through strain? Do we notice when we are doing a forward fold that we feel uncomfortable pressure in our abdomen? Do we notice that the way we pick up a heavy object from the floor causes us to hold our breath and feel a sense of distress? If so, we have to change the way we are moving.
2. Modify movements that put excessive load on the front of the spine or neck of femur:
The most common osteoporotic fractures are of the front vertebral bones in the low or mid back. Notice in this image the location of the compression fracture is in the front of the spinal bone towards the middle of the back. There are many types of movements that increase load on these bones, such as bending forward at the waist, as well as twisting and turning the body when bent at the waist. When engaging in movement that involves compression of the front spine, consider the load that is going through these bones, and be careful not to push or strain if any discomfort is felt.
Consider a forward fold. Especially if the hamstrings are tight, the spine may become very rounded in this pose, which can put extra load through the front vertebral bodies, especially if we are straining to try to get the hands to the ground.
When modifying your movement practice, consider the intention of the movement, and modify to match the intention but in a safer and more effective way.
The intention of a forward fold is to experience lengthening and relaxation throughout the back of the body, including the hamstrings, gluteals, and muscles of the low back, and the fascia (connective tissue) that runs down the back of our body.
Notice that in this movement sequence, these same intentions are met, but the spine is fully supported by the ground and we are able to move dynamically without increasing the load on the vertebral bodies.
The neck of the femur just below the hip joint is also a common fracture area. Be cautious about poses such as pigeon, as this position subjects that bone to a high amount of load. Many people practice pigeon in a very passive way, which is not helpful for strengthening the bones and the surrounding hip musculature.
Consider these hands and knees variations of pigeon pose. Notice that by performing this “wagging the tail” movement, we are bringing suppleness into the whole spine, and also challenging the weight-bearing leg (the leg that is down on the ground). Notice that “sitting back” into the weight-bearing leg is very similar to the “pigeon” position, but it is a dynamic rather than a passive movement. This challenge can stimulate bone density as well as improve strength and responsiveness of the supportive hip muscles including the gluteals and piriformis.
After you get the hang of wagging your tail, try to make circles! Notice the engagement of the entire body with this dynamic movement pattern.
3. Prioritize extension postures rather than flexion postures
Flexion-based movements such as forward folds are when the spine is bending forward, which puts more compression on the front of the vertebrae. Extension-based movements do the opposite. Also known as backbends in yoga, extension-based postures are very safe for those with bone density loss. Spinal extension helps to reverse the compression on the front of the body, and helps to strengthen the muscles that promote healthy posturing.
Notice these extension-based movements performed while lying on the belly. This is an excellent way to build strength and awareness of the back side of the body. Notice the balance and stability that is created by performing these diagonal movement patterns in which the right upper body moves with the left lower body, and vice versa.
4. Challenge your balance with ease and support
Yoga can be an excellent tool for improving balance, but it is important to be able to maintain stability and ease throughout your standing practice. There is no point in practicing feeling unbalanced, so modify your practice to meet yourself where you are. If you are feeling too challenged and at risk of falling, then this is not doing you any favors. Maintain stability and ease by modifying and using props. My favorite props for balancing poses are the wall, chairs, and even the kitchen counter. By gently contacting one of these props with a hand, we can maintain groundedness, and correct ourselves more easily if we begin to lose our balance.
Notice the use of the wall as a prop to perform this standing side bending and circular movements. This sequence is the same as what we did on hands and knees, but now in a standing position. As balance is a dynamic process, adding movement is more helpful for improving balance compared to holding a static position such as tree pose. Additionally, the weight-bearing leg is being stimulated in a way that will help improve bone density and strength. This is also a great way to warm up the body before further activity such as going on a jog.
At The Wellness Station, we will help you become aware of habitual movement patterns, yoga poses, and lifestyle factors that may be affecting your bone density and risk of fractures. We will help you develop or modify your movement practice with considerations of your individual needs, medical history, and goals. Every day is an opportunity to get to know your body on a deeper level in order to stay active, healthy, and strong, even with osteoporosis.