"Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected."
- National Osteoporosis Foundation
Forty four million Americans are known to have low bone mass. That amounts to 55% of everyone over 50.
Osteoporosis is responsible for more than 1.5 million fractures annually.
We have been using yoga poses to treat osteoporosis. It is a progressive illness endangering 200,000,000 people world wide, many of whom have no means nor access to the medicines that might be used to treat it.
The medicines themselves have side-effects. The most common side-effects are gastrointestinal, and patients are advised to stay clear of food for at least an hour after taking the medication. Acid reflux, abdominal pain, nausea and irregular bowels are the main things to worry about, and they are not uncommon. Other side effects, such as osteonecrosis, essentially disintegration of the jawbone or auditory canal, have made the press quite often in the past few years, but are estimated to be quite unusual, and related to the duration of treatment.
Since osteoporosis is a physiologic process that is enhanced by nearly inevitable hormonal changes, one can artificially (and with some risk) reverse these changes, or one can initiate an antagonistic process that is stronger than the one that causes osteoporosis. created a strategy using Yoga to accomplish just this.
Many studies confirm that weight-bearing exercise is helpful in osteoporosis. ‘Way back in the Renaissance Leonardo Da Vinci reasoned that since a bone’s strength is related to its cross-sectional area (pi R2), and an animal’s weight is related to its volume (4/3 pi R3), and since healthy bone has a given, fairly constant strength, and we are composed chiefly of water, with a given specific gravity, that the ratio of any healthy animal’s bone length to width would be a specific constant value. And, strange to tell, in every animal ever evaluated, Leonardo has been wrong. (1,2)
The reason he erred is that the strongest force on bones is not gravity. We can and do overcome gravity in almost everything we do, from lifting our little finger to pole vaulting. We do not always oppose gravity. Consider health club devices, wrestling, and swimming under water, which present their own types of resistances. In each of these, as with gravity, movement is only possible because our muscles are stronger than whatever forces oppose them. If one adds in the mechanical disadvantage that many of our anatomical leverages and angles produce, we are often generating forces in the high hundreds to thousands of pounds per square inch.
The point is that muscular action, while opposing gravity and other resistances, puts more stress on the bones than gravity alone!
Why do the forces matter at all? In the 1850’s an engineer wandered into a natural history museum in the city of Cologne and was amazed to find that the reinforcement of a vulture’s wing bone was nearly exactly what he had in mind for the head of the crane he was designing. Julius Wollf, an anatomist and surgeon soon came out with what has come to be known as Wollf’s law. (3) It states that the architectonic of a bone follows the lines of force to which the bone is subjected. This makes physiological sense since it means the bone will develop resistance exactly where it needs it.
Since that time many biochemical and genetic studies have confirmed the mechanotransduction that gives step-by step backup of the means by which stress increases the mass of a bone exactly where it needs it the most – how DNA and RNA are mobilized in sequence to produce proteins that are then extruded from the cell to thicken and strengthen bone just where the stress is greatest. (4, 5, 6).
Yoga, by opposing one muscle group to another over relatively long periods of time, is an excellent stimulus of this type of bone reinforcement. Since it is self-administered, it can be carefully controlled to produce forces that are great enough to stimulate bone strengthening, but not to damage the very bones one is trying to reinforce! And it is available to all people, without the need of any payment to anyone.
Footnotes
1. Schmidt-Nielsen, Knut. Scaling: Why is Animal Size so Important? Cambridge University Press, New York, 1984.
2. Forey P, Janvier P. “Evolution of the Early Vertebrates.” American Scientist.vol.82 (1994):554-65.
3. Wollf J. The Law of Bone Transformation. Berlin, A. Hirschwald, 1892.
4. Pead, MJ, Suswillo, R, Skerry, TM et al: “Increased 3H uridine levels in osteocytes following a single short period of dynamic bone loading in vivo.” Calcif Tisue Int 1988;43:93-97.
5. Rubin, CT, Lanyon, LE: “Regulation of bone formation by applied dynamic loads.” J Bone Joint Surg 1984;66A:397-402.
6. Masuko-Hongo K, Sato T, Nishioka K. “Chemokines differentially induce matrix metalloproteinase-3 and prostaglandin E2 in human articular chondrocytes.”Clin Exp Rheumatol. 2005 Jan-Feb;23(1):57-62.
Manhattan PMR invites participants in a study linking yoga to prevention and cure of osteoporosis and scoliosis in women and men of all ages. Individuals interested in joining the study are asked to call (212) 472-0077, and ask for Nimmi, or email Dr. Fishman at Loren@sciatica.org.
The poses pictured and described below may be too difficult for some of the people that would benefit from doing them. We have a good deal of experience teaching individuals appropriate modifications from a large variety of less demanding postures.
After consulting with us, we will ask you to obtain a few simple tests from an outside lab of your choice to estimate your current bone density and to rule out hormonal and hereditary causes of osteoporosis. If you have scoliosis, you will only need a simple spinal X-ray.
Then we will teach you poses that are at your level, poses that you can do on your own at home.
We will then call you up or e-mail you every few months to make sure things are going well, and possibly to advance your daily practice.
After one year, and again after two years you will have another DEXA-scan or spinal X-ray.
That is the entire study.
So far we have entered nearly 50 people into the study and treated 9 people with osteoporosis/osteopenia for more than one year. All nine of them have improved their bone density. Three were taking anti-resorption medication (alendronate, Fosomax and risedronate, Actonel). Each improved beyond the curve of expected bone-strengthening for their medicine.
The physicians that manage this study have appointments at Columbia College of Physicians and Surgeons and Cornell Medical School.
Here are the poses. Often there are several versions presented. Please begin with the “easiest,” which is usually recognizable from the picture alone. If any are painful, seem dangerous to you, or cause unexpected side-effects, please refrain from doing that pose, and either get in touch with us or with a local physician, yoga therapist or experienced yoga teacher.
Do once daily, on an empty stomach.
Yoga for Osteoporosis and Osteoarthritis
1. Trikonasana
• Stand in Tadasana (erect, feet together and parallel, arms at your sides).
• Spring legs to 3 - 3 ½ feet apart, raise arms to horizontal, palms down.
• Turn left foot out 90 degrees, right foot inward 30 degrees.
• Exhale and descend toward the left, reaching the outside of the left foot with the left palm.
• Remain in this position for 15-30 seconds.
• Repeat on the right side.
2. Urdvha Mukha Svanasana (upward facing dog)
• Lie in the prone position arms stretched out before you, toes pointed and feet one foot apart.
• Bend your elbows and place your palms noon the floor beneath the shoulders, fingers pointing toward your head.
• Inhale slowly while raising up first the head, then the throat, the chest, abdomen, pelvis and legs.
• Bring the chest as far back as possible.
• Leave only the palms and dorsal feet on the floor, toes pointed back. Straighten the legs maximally.
• Arch the entire body including the buttocks and all sections of the spine: lumbar, thoracic and cervical, as far as comfort allows.
• Do not over-do it, but thoroughly round the entire torso.
• Breathe deeply and slowly for 10-20 seconds.
3. Adho Mukha Svanasana (downward facing dog)
• From a prone position and go on all fours, hands and knees.
• Breathe quietly for 20 seconds.
• Press forward on the floor with the palms of both hands.
• Partially straighten the elbows, wrists and knees.
• Raise the hips and chest further and further above the floor.
• Be careful not to over-extend the neck.
• Keep the toes parallel and straighten the backs of the legs. The toes should now point in the same direction as the fingers.
The picture above is the absolute maximum.
• Press the heels down to the floor, extend your knees and thoracic spine amd flex your shoulders.
• The top of your head may rest on the floor.
• Breathe deeply and slowly for about a minute.
• Carefully lift your head and chest, then lower head and chest and abdomen to return to the prone position on the floor.
4. Setu Bandhasana or Urdhva Dhanurasana (back bends)
This is Setu Bandhasana:
• For Urdhva Dhanurasana, you should be a more advanced student, or have a teacher. Lie Flat on your back. Lift your hands overhead and place your palms on the floor above your shoulders, fingers pointing toward them. Your forearms and upper arms should be about as far apart as your shoulders, and parallel to each other. Flexyour knees until your feet are about half-way toward your waist and flat on the floor. Feet should be parallel. The feet, legs, thighs, shoulders, arms and hands should be in one plane for each side of the body.
• Press down with your hands to lift your head and shoulders off of the floor. Place the top of your head on the floor, taking some of your weight off of your hands and feet.
• It may be difficult to extend your neck sufficiently. In that case use your hands more than your head here and move quickly on to straightening your elbows, lifting the head and shoulders away from the floor.
• Balance your weight evenly between your hands. Straighten your elbows completely, raising your head and trunk as far as possible.
• Straighten your knees.Raiseg the abdomen and groin regions as high as possible. Move the shoulders behind you and together. Stretch the armpits front-to-back.
• Breathe quietly for 10 - 20 seconds.
• To leave the posture, flex the elbows carefully until your head touches the floor. Increase the weight on your head just a little, and then slide your head away from your heels until your shoulder blades rest on the surface.
Janusirsasana (one straight-legged forward bend)
• Sit on the floor with both legs extended in front of you.
• Bend your right knee off to the side, the outside of the thigh and calf in contact with the floor. Place the right heel high on the inner left thigh. The right shin and left thigh are now at right angles.
• Pull in your stomach open your chest and keep your back straight. Bend at the hips, coming forward (not down) toward your left foot.
• Use a belt or towel wrapped around the mid foot to increase the bend and reduce the angle between the left thigh and your abdomen. Do this judiciously.
• Breathe quietly for 10-20 seconds.
• Gradually, over 2-3 months, increase to 1 minute on each side.
6. Paschimottanasana (two straight-legged forward bend)
• Sit on the floor with legs extended straight in front of you and in contact with each other. Ankle bones should also be in contact, feet vertical. Place palms on the floor.
• Breathequietly for a minute.
• Exhale and fold your torso forward. Bend at the lowest waist, at the thigh joints. Keep your back straight, and pull your chest forward toward the tops of your feet.
• You can adjust this pose infinitely. You can begin with your hands on your thighs, and gradually advance your hands (over weeks or months until you can grasp your ankles. Then, going further, you will reach the outsides of your feet, then you will be able to put your palms on the soles of your feet, and interdigitate your fingers behind the feet. Eventually you will have one hand holding the opposite wrist. That is the point at which Mr. Iyengar suggests that you can rest your chin on your shins.
7. Navasana (The Boat)
• Lie in Savasana, the corpse pose.
• Bend your knees 45 degrees.
• As you straighten your knees, so your entire legs are at the 45 degree angle, raise your torso 45 degrees as well.
• Retain your head in line with your spine as you elongate it.
• Puff out your chest and retract your shoulders, even as you raise your arms to horizontal, palms facing each other.
• Breathe quietly and hold the pose for 20-30 seconds at first, building up slowly to one minute.
• Bend your knees as you lower your legs and trunk and return to Savasana.
A starter version of Navasana
8. Marichyasana, Matsyendrasana or Jathara Parivartanasana (twists)
• Sitting on a flat surface, extend the right leg and flex the left thigh until the heel is at the buttock. Use a blanket if your shin is longer than your thigh. The left ankle should press against the inside of the right thigh. Take a breath in. This is Marichyasana:
• Upon exhalation, revolve the torso 90 degrees to the left, the right arm sliding past the outside of the left thigh, forearm and hand vertical, palm facing left. The back of the right armpit rests against the outside of the left knee and thigh.
• Walk behind (towards the right) with the left hand. Bring the right palm to the outside of the right calf.
• Rotate the left shoulder counterclockwise by “walking” your left hand behind you; press the right chest forward and to the left by pulling the right shoulder blade back toward the spine, and downward toward the pelvis. From this position near the spine the right shoulder blade impels the right chest forward beyond the right shoulder. Gaze at the right foot, which should be firmly vertical, but not stiff. Grasp the left wrist with the right hand.
• Breathe calmly for 10 - 20 seconds. Then repeat the entire pose and breathing on the other side. Gradually extend the time to 1 minute on each side.
• Now for Matsyendrasana, essentially the same idea with lower knee bent, and leg folded over the lower leg’s thigh:
Jathara Parivartanasana
• Lie supine.
• Abduct the arms 90 degrees, keeping palms down.Point your toes, straighten knees retaining contact between anklnoes, and raise both legs together to vertical. Take a calm breath.
• When trying this at first, both knees can be bent when raising the legs.
• Straighten knees straight out when the thighs are vertical.
• Swing the buttocks slightly to the left, and then lower both legs to the right as you exhale. Keep the legs in contact both with each other and the floor, feet parallel to the right arm, or even closer.
• Press downward with the right hand. This will maintain contact between the left shoulder and the floor.
• Retain as much of the thoracic and upper lumbar spine as possible in contact with the floor.
• Breathe calmly for up to 1 minute.
• After that time, press the right hand and forearm against the floor to raise the legs back to vertical. Take a breath.
• After swinging the buttocks slightly to the right, perform the same lowering on the left as you exhale, using left hand pressure to keep floor contact for the right shoulder and lumbar spine.
• When the legs are on the floor and parallel or closer to the left hand, breathe quietly for 1 minute, adjusting your ribs so that there is equal pressure on each side with inhalation.
• Then raise the legs back to vertical again, bend the knees, return the arms to your sides, and rest in Savasana (below).
10. Savasana
• Rest in Savasana
Dr. Fishman is a Clinical Assistant Professor at Columbia University College of Physicians and Surgeons. His M.D. is from Rush Presbyterian St. Lukes in Chicago, his B.Phil. from Christ Church, Oxford. He has written more than 60 articles, chapters and books, focusing chiefly on functional matters, electrodiagnosis and on yoga, frequently combining these areas. He is also in private practice in Manhattan where he lives with his wife and youngest child.