The Ultimate Guide to Yoga for Osteoporosis

Exercise / August 25, 2016

Yoga Can Help You Build Better Bones in Just 12 Minutes A Day

Lara Pizzorno, MDiv, MA, LMT and Taffy Frost, Owner, Director, The Yoga Tree

How Yoga Can Help You Build Bone | The 6 Principles of Practice  | Dr. Fishman’s 12 Yoga Poses For Osteoporosis | Yoga Exercises That Safely Strengthen Abdominal Muscles

For many years, Dr. Loren M. Fishman, a physiatrist* at Columbia University, has been studying the effects of yoga for osteoporosis and bone health, hoping to demonstrate that yoga can be an effective therapy for osteoporosis. (*A physiatrist is doctor who specializes in Physical Medicine and Rehabilitation.  Physiatrists treat both acute and chronic pain, utilizing a wide variety of nonsurgical treatments for the musculoskeletal system.)

In 2005, Dr. Fishman initiated a small pilot study involving 11 subjects with either osteopenia or osteoporosis, who were given a series of 12 yoga poses to do daily, and 7 controls, who did not practice yoga. In 2009, he reported that 2 years of consistent yoga practice had increased bone mineral density in study participants’ spine and hips compared to controls, who lost bone.(1) 

Encouraged by the results of this small study, Fishman decided to invest his own money to conduct a much larger study. He enlisted three collaborators — Yi-Hsueh Lu of The Rockefeller University, Bernard Rosner of Brigham and Women’s Hospital, and Dr. Gregory Chang of New York University — and solicited volunteers worldwide via the Internet for a follow-up of the initial pilot study.

Seven hundred-forty-one volunteers responded. Participants were asked to complete a health history questionnaire and to send in the results of a DXA scan run no more than 6 months prior. Those whose DXA showed osteopenia or osteoporosis were also asked to have standard labs run to evaluate:

  • Overall metabolic health
  • SED rate (the rate at which red blood cells sediment, which if elevated may indicate a number of conditions in addition to increased inflammation, e.g., anemia, autoimmune disorders, infections, some kidney diseases and some cancers.
  • Vitamin D, parathyroid hormone and thyroid hormone levels
  • NTX level (a biomarker excreted in urine that indicates the rate of bone turnover)

All volunteers were sent a 10-minute DVD of the 12 poses that had been found to improve BMD in the pilot study along with verbal descriptions of each pose. 

Of the 741 people who joined Fishman’s experiment between 2005 and 2015, 227 (202 of whom were women) actually followed through and did the 12 yoga poses daily or at least every other day. The average age of these 227 participants when joining the study was 68; 83% of them were either osteopenic or had osteoporosis.

Before entering the study, participants had been consistently losing bone: their pre-study DXA scans showed an average monthly loss in BMD of -0.036 g/cm2 in the spine, -0.017 g/cm2 in the hips, and -0.03g/cm2 in the femur, prior to starting yoga practice.

After 2 years, the participants who stuck with the program and did the series of 12 yoga poses at least every other day were consistently building bone: + 0.048 g/cm2 in the spine, + 0.088 in the hip, + 0.003 in the femur.

Before the study, the participants had experienced 109 fractures, reported by them or found on X-rays, but none suffered a further fracture due to yoga practice. To date, with more than 90,000 hours of yoga practiced largely by people with osteopenia or osteoporosis, no reported or X-ray detected fractures or serious injuries of any kind related to the practice of yoga have occurred in any of the study participants.

In contrast to the side effects associated with the drugs commonly used to manage osteoporosis—which include atypical femur fractures, osteonecrosis of the jaw, esophageal cancer, atrial fibrillation, and gastrointestinal upset—Fishman notes that yoga’s side effects “include better posture, improved balance, enhanced coordination, greater range of motion, higher strength, reduced levels of anxiety and better gait.”

The 12 poses, briefly described and pictured below, were:

  • Vrksasana (Tree)
  • Trikonasana (Triangle)
  • Virabhadrasana II (Warrior II)
  • Parsvakonasana (Side-angle pose)
  • Parivrtta Trikonasana (Twisted Triangle)
  • Salabhasana (Locust)
  • Setu Bandhasana (Bridge)
  • Supta Padangusthasana I (Supine hand-to-foot I)
  • Supta Padangusthasana II (Supine hand-to-foot II)
  • Marichyasana II (Straight-legged twist)
  • Matsyendrasana (Bent-knee twist)
  • Savasana (Corpse pose)

Each pose was held for 30 seconds. Once learned, the full daily regimen took just 12 minutes.(2) 

Having reviewed this inspiring research, I (Lara) will be practicing these 12 yoga poses daily, using Yoga for Osteoporosis, Dr. Fishman’s book, which he co-authored with Ellen Saltonstall, (Fishman & Saltonstall, Yoga for Osteoporosis, W.W. Norton & Company: New York, 2010) and the DVD from Manhattan Physical Medicine.

I’ve provided pictures of the poses here in this article to give you an idea of the routine, along with a few other Pilates-based exercises that are safe and very helpful. However, to fully understand and get the most bone-building benefit from your yoga practice, I urge you to order the DVD and/or Yoga for Osteoporosis for the very detailed explanations they provide. In addition, beginning your practice with the help of a skilled yoga instructor who can help ensure your alignment is correct is highly recommended.

Yoga for osteoporosis

How Yoga Can Help You Build Bone

Fishman believes yoga is “the answer for older people who want to stay strong, flexible and pain-free.”  In Yoga for Osteoporosis, he and Saltonstall explain why.

We aging humans face a supposedly impossible dilemma. We’re told we must do weight-bearing impact exercises, such as jogging, to stimulate bone renewal and stave off osteoporosis, but after age 50, frequent impact exercise is likely to promote osteoarthritis.  And by the time we’re 60 or older, 10% of men and 13% of women have symptomatic knee osteoarthritis, for which impact exercise is definitely not in order.(3)  So, it seems we have to choose between strong bones or healthy joints. Fortunately, by practicing yoga, we can have both. Here’s Fishman’s take on why:

“In yoga, the joints are moved to an ever-expanding range, circulating their fluid and stimulating renewal of cartilage, tendons and ligaments. Simultaneously, the bones are isometrically subjected to forces many times those of gravity, exactly the same forces involved in impact exercise. But in yoga, the forces are applied without any impact—[thus] yoga provides an excellent solution to the twin perils of osteoarthritis and osteoporosis.”

The application of force is key for healthy bones. Force applied to bones stimulates them to grow stronger at the point where they are stressed – this is a well-known principle of physical medicine called Wollf’s law.  Developed by the German anatomist and surgeon Julius Wolff (1836–1902), Wolff’s law states that bone in a healthy person or animal will adapt to the loads under which it is placed by remodeling itself over time to become stronger to resist that sort of loading.  And the process begins almost immediately: within bone, levels of different enzymes and biochemical markers of bone synthesis increase within 10 seconds of subjecting bone to stress. 

Yoga positions stress bone with isometric contractions at practically every angle. By opposing one group of muscles against another and stimulating muscle-to-bone attachments, the practice of yoga sends signals to mechanosensor cells within our bones called osteocytes, which then recruit osteoblasts, the cells that build new bone, telling them it’s time to get to work.(4)(5) 

Yoga is also beneficial as it can improve balance, muscle strength, range of motion and general coordination. The whole package contributes to your ability to stay upright and not fall. Obviously, if you don’t fall, you greatly reduce your risk of a serious fracture.

And last, but definitely not least, aside from its directly physical effects, yoga soothes the nervous system, which reduces stress and anxiety, often leaving its practitioners with a sense of peace and well-being.

Interested? You’ll get much more from your yoga practice if you begin with an awareness of the following principles:

The 6 Principles of Yoga for Osteoporosis

Your “approach” and “how” you practice yoga is key to its beneficial effects on your bones. Taffy Frost recommends practicing yoga using the following guidelines and principles, which she learned from Dona Holleman.

These principles will help you develop awareness, which in turn will lead to “working with the intelligence” in your body. Your body is continually giving you feedback, but until you develop an awareness, you won’t be able to hear it.

#1 Relax First and Connect to Your Breath

We want to get rid of as much tension in the body as possible before we practice. We do this so we can reach the deeper layers of the muscles (closer to the bones themselves). 

Starting in a comfortable position, follow and feel a full cycle of breath. And then another. The mind will wander. When you notice it has wandered, simply bring your focus back to the breath. No judgment, just a gentle re-focus back to the breath.

Scan the body with your “internal eye” and where there is tension – relax.

This first step helps the body become stable and still as well as helping quiet and “empty” the mind. Think of your yoga time as time for you to renew and care for your body – let the cares of the day melt away (they will be there later, and you’ll be in better shape to deal with them). Working with a quiet mind will intensify your practice in a good way. We un-do first, then do.

#2 Intent

See and feel your intention for your practice. See and feel your objective. As the mind directs itself, the body begins to center itself for the practice, and this lends itself to a fuller, more focused and beneficial result.

 #3 Rooting

Whatever part of the body is in connection with the earth, allow this connection to press down or sink into the earth. Rest into the grounding, supportive power of this downward movement. Think of how the roots of a tree deepen and widen into the earth, providing grounding and stability. From stability, comes a lightness and freedom for the branches to expand and move into the sky. As you feel your own downwardness, start to connect with how this base of support also facilitates a sense of lightness and length in your body.

#4 Connecting

In each yoga pose (asana), always be aware of the two opposing directions that are connected to each other. In every asana, the furthest part of the body from the ground remains deeply supported by the other part of the body that is rooting into the ground. Because of this connection, all parts of the body remain in balance and work together in harmony.

#5 Breathing

Be aware of your inhale. Be aware of your exhale.

While inhaling, the body elongates and widens; while exhaling, it steadies itself in rooting and connecting. The nature of the breath will change from sweet and soft to deep and long, and anywhere in between. The duration of inhale and exhale will also change, sometimes one being longer or shorter than the other. Sometimes the breath will be in the background, other times it is the source of action, but the breath flows through and energizes all. The above principles all work together, and you want to apply all of them continuously throughout your yoga practice. How do you do this? You deepen your understanding of each principle by choosing one or two of them and work with them over time. Become curious! As you practice, they will penetrate your being and become second nature.

#6 Alignment

We spend far too much time sitting, both at work and at home. Our largely sedentary life encourages a forward curvature in the spine – longer and rounded in back, shortened and compressed in front (think of it as training for the so-called Dowager’s hump, the stoop forward posture of osteoporosis). Eventually, if we don’t actively counteract it, this posture gets locked in – greatly increasing our risk for vertebral fracture. And it’s not pretty! You want to move through life erect and graceful, not hunched over.

Fishman’s 12 Yoga Poses are specifically modified to encourage proper spinal alignment. Note that when bending forward, especially, you want to be moving your entire back forward from as low down your spine as possible. In other words, you want to tilt your pelvis forward from the hips, so you will be maintaining a long spine. When you bend forward, you want to create a crease at the top of your thighs, not at your waist! Always keep your spine long; do not bend forward from the waist. At first, this may be challenging because one of the side-effects of our sedentary forward rounding posture is tight hamstrings (the muscles on the back of your thighs), but as you lift and elongate, your body will breathe a huge sigh of relief. It will quickly become easier, and then habitual.(6)(7) 

Chair - Hip Hinge

Taffy demonstrating how to hinge forward from the hips, maintaining a long spine, photographed by Christian Cabanero

Dr. Fishman’s 12 Yoga Poses for Osteopenia/Osteoporosis

— plus a few more safe, helpful poses from Taffy and Lara.

Tadasana (Mountain pose)

Taffy suggests always beginning with Tadasana to center yourself and establish core awareness. Tadasana is your primary posture, whether practicing yoga or going through your daily activities with ease and grace. When moving from pose to pose, transition through Tadasana.

Root whatever part of the body is on the floor into the earth. If your feet, feel your weight distribute evenly across your feet. Press all your toes into the floor, the full balls of your feet and your heels, not just the inner or outer edges.

If supine, let the floor beneath you ground your entire body: relax the back of your head, let your shoulders open wide and rest into the floor along with your rib cage. You should feel a small egg-sized pocket of air between your waist and the floor (this is the natural curvature of a healthy spine), but your hips, legs and feet should feel deeply relaxed and grounded.

Whether standing or supine, connect with your breath. Let the flow of your breathing fill you. You will naturally lift, elongating your spine, and the crown of your head will lift away from your shoulders, lengthening your neck. Think – long spine. Do not arch your back, pushing out your rib cage. Instead, energize your pelvic floor (think mild Kegel exercises), pull your navel into your spine to awaken your core strength, and you will feel yourself lift and elongate. Let your shoulders open and your shoulder blades drop flat down your back. Lift from your tailbone up through the crown of your head.

Yoga for Osteoporosis - Tadasana

Taffy in Tadasana, photographed by Christian Cabanero

Vrksasana (Tree)

Benefits: strengthens the legs and hips, improves balance, posture and focus.

Osteoporosis modification: Place a sturdy chair near the wall, and use the back of chair and, if needed, the wall to help you balance. Push your left foot into the inside of your right upper thigh. Stretch the opposite arm up (your right arm, in this case).  Then intensely stretch out from the core of your pelvis both up to the ceiling and down to the floor. Hold for several full breaths. Switch legs.

Vrksasana pose

Alex Suri in Vrksasana, photographer Dr. Joe Pizzorno

Osteopenia modification: stand next to the chair, in case you need it for support. Place your left foot on your upper inner right thigh and extend your arms out to the side.

Yoga for Osteoporosis - Triangle 2

Lara in Virsasana, photographer Dr. Joe Pizzorno

Trikonasana (Triangle)

Benefits: stresses the greater trochanters, anterior lumbar and posterior thoracic vertebrae, and pubic bones, builds stamina, focus and balance.

Osteoporosis modification: stand in front of wall next to chair in warrior, right toes under chair, left foot rotated out, align right heel with arch of left foot, arms outstretched, rest right hand on the chair without letting hips and upper torso come forward. Curve tailbone down, lift abs up, lengthen out through the spine. Extend torso out, bending at hips not waist. Stretch occurs in back of right leg and on left side of pelvis. Repeat on opposite side.

Yoga for Osteoporosis - Triangle pose

Lara in Trikonasana, photographer, Dr. Joe Pizzorno

Osteopenia modification:  Same pose placing your hand on a yoga block behind your right foot instead of the chair. Repeat on opposite side.

Trikonasana 2 pose

Lara in Trikonasana, photographer, Dr. Joe Pizzorno

Virabhadrasana II (Warrior II)

Benefits: stimulates the femur and pelvic bones, improves hip mobility, balance, leg strength.

Sit across a sturdy chair or, if standing, use the wall, a handrail or a chair that won’t fall over for support. Root down into all four corners of your feet.  Drop your tail bone down while you elongate the crown of the head towards the sky. Relax your shoulders and let them drop away from your ears. Draw your shoulder blades toward each other. Extend your arms, fingers spread, muscles engaged, and gaze over the middle finger of the front arm. Keep your hip bones level and even. Your front knee should be directly over your ankle. If this is not yet possible, keep your front knee slightly behind your ankle as you gain mastery of the Warrior pose.

Osteoporosis modification:

Warrior with Chair 1 Pose

Taffy in Warrior II, photographed by Christian Cabanero

Osteopenia modification: Same pose, standing, no chair.

 Warrior 1 Pose

Taffy in Warrior II, photographed by Christian Cabanero 

Parsvakonasana (Side-angle pose)

Benefits: produces stimulating torque to the entire central and peripheral skeleton.

Osteoporosis modification: Sit on a chair, legs spread apart, and lean to the right, moving from the hip, not the waist.  Rest your right forearm on your right thigh.  Extend your left leg straight, firm your abdominal muscles, place your left hand on your left hip and roll your left shoulder back until your entire upper body faces outward. Turn your torso enough to the left to grasp the back of the chair with your left hand and look up, being careful not to hyperextend your neck. Think L-O-N-G spine. Repeat on opposite side.

Parsvakonasana 1 Pose

Alex Suri in Parsvakonasana, photographer Dr. Joe Pizzorno

Osteopenia modification:

Begin in Warrior II with your arms outstretched, then extend to the right side, resting your right elbow on your right knee and reaching your left arm up and back. Look up at your left arm. Be sure to keep your torso facing forward and your spine long. Repeat on opposite side.

Parsvakonasana 2 pose

Alex Suri in Parsvakonasana, photographer Dr. Joe Pizzorno

Parivrtta Trikonasana (Twisted Triangle)

Benefits: strengthens thigh, hip, and back muscles, improves balance and stability

Osteoporosis modification: Place a yoga block at the top of your mat. Stand about a foot back from the block at the top of your mat in Tadasana. Step your right foot back 2-3 feet, slightly angling it toward the outer edge of your mat. Square your hips, raise your arms up overhead, inhale and hinge forward from the hips, keeping your spine L-O-N-G. Once your fingers have reached the block, leave your right hand on the block, raise your left arm up toward the ceiling and open your torso to the right. Inhale, then exhale and roll your right shoulder back as you extend your left hand straight up to the ceiling.  Turn your head to gaze up at your left thumb. Hold the pose for 30 seconds to 1 minute. Gently release the twist, press firmly through your left heel, lift your torso and lower your arms.  Repeat on the opposite side.

Twisted Triangle aka Parivrtta Trikonasana pose

Alex Suri in Parivrtta Trikonasana, photographer Dr. Joe Pizzorno

Osteopenia modification: the same pose as above, but you can rest your bottom hand on the shin of your front leg or, if flexibility allows, near the inside of the front foot instead of on the block.

Parivrtta Trikonasana PoseLara in Parivrtta Trikonasana, photographer Dr. Joe Pizzorno

Salabasana (Locust pose)

Benefits: strengthens the muscles of the back (including the erector spinae, which support the vertebrae), buttocks, and backs of the arms and legs; stretches the shoulders, chest, belly, and thighs; improves posture; stimulates abdominal organs; helps relieve stress.

Osteoporosis modification:

Lay on your belly, legs side by side. Activate your pelvic floor muscles and lengthen your tailbone toward your heels. Rotate your thighs inwardly by rolling your outer thighs toward the floor. This helps broaden and lengthen your lower back and sacrum (the downward-facing triangular bone at the back of your pelvis) to protect it.

Extend your arms alongside your torso, palms down and reaching actively towards your feet – think of trying to touch the wall behind you. Use your exhale of your breath to activate your core and elongate your spinal column. Lift your chest off the floor 2-3 inches, which will activate your erector spinae, the muscles that support your spine.

Bring awareness to your lower belly, the area just below the navel. Lightly activate your pubic floor (the muscles that contract when you do a Kegel exercise or stop the flow of urine) and transversus abdominus (a muscle that wraps all the way around your hips like a supportive corset), drawing your belly up away from the floor and into your lower back. This very subtle belly lift supports your lumbar spine, protecting your lower back and awakening the erector spinae in your lower and upper back.

Hold the pose for several full breaths, then as you exhale, slowly lower your torso and release your belly.  You can let your forehead rest on a rolled towel on the floor. Lie quietly, broadening your back with each inhale, releasing any tension with each exhale.

Locust 1 PoseTaffy in Locust pose, photographed by Christian Cabanero (www.christiancabanero.com)

Then, lie on your belly with your arms along the sides of your torso, palms up, forehead resting on a rolled towel or the floor. You might want to pad the floor below your pelvis and ribs with a folded blanket. Inwardly rotate your thighs by turning your big toes in towards one another, gently firm your buttocks, pressing your tailbone toward your pubis.

Inhale, activate your core. Exhale and lift your legs away from the floor, firming your buttocks. Reach strongly through your heels, lengthening back of your legs. Then think of elongating your knees and shins away from your hips, lengthening the front of your legs.

Be careful to maintain a long, neutral spine. Don’t jut your chin forward and crunch the back of your neck. Keep extending through the crown of your head, elongating your neck. 

 Locust 2 PoseTaffy in Locust pose, photographed by Christian Cabanero (www.christiancabanero.com)

Osteopenia modification:

Combine the two movements. On the inhale, lift your feet, legs, hands, arms, chest and head off the mat. Roll your shoulders on to your back and firmly engage your back muscles. Be careful not to jut your chin forward and overextend your neck. Again, you want a L-O-N-G spine.

Locust Pose
Lara in Locust, photographer Dr. Joe Pizzorno

Setu Bandhasana (Bridge)

Benefits: The Bridge pose will strengthen your core, gluteus maximus (buttocks) and hamstrings, and also the deep inner muscles that act as hip stabilizers (your gluteus medius and minimus, piriformis, quadratus, vastus lateralis, the adductors, and more).  This pose also helps combat khyphosis, the rounding of the thoracic spine (upper back and rib cage) that so often develops in osteopenia and osteoporosis.  The thoracic spine tends to compress and drop forward as the vertebrae weaken, but khyphosis develops in part because the muscles on the front of the body shorten and become tight. These muscles include the pectorals, rectus abdominus, internal and external obliques and the intercostals (the muscles between the ribs). The intercostals help with exhalation, so if they have become short as a result of not breathing deeply or prolonged slumping, this also contributes to developing khyphosis. The gentle, supported extension provided by the modified Bridge pose will begin to open the front ribs and thoracic spine. 

Ribs and Thoracic Spine Diagram

Ribs and Thoracic Spine.(8)

Lateral and Anterior Spine View

Lateral and Anterior View.(9)

In all supine poses, if you have developed kyphosis (rounding of the upper back, a.k.a. dowager’s hump), use a pillow to support your head and enable you to maintain your spine in neutral alignment.

 Bridge 1 Pose

Taffy in Bridge, photographed by Christian Cabanero

Osteoporosis modification:

Lie supine on your mat, feet hip-width apart and firmly rooted. Reach your arms long and out to your sides, palms down. You can also help stretch the pectoral muscles and open your chest by rotating your shoulders externally. Turn your palms forward and your shoulders will naturally roll open, back and down, pressing your shoulder blades into the back ribs.

Move from neutral into flat spine (see Yoga exercises that safely strengthen the abdominal muscles: Neutral to Flat Spine contractions below), engaging your pelvic floor, rectus abdominus and transverse abdominus muscles (see images of muscles above). Engage your gluteus and hamstring muscles. Lift your hips 1-inch off the floor and hold. As your pelvis and back rib cage lift off the floor, and your arms press down into the floor, let your shoulders relax and open. You’ll be gently stretching the upper portion of your pectoralis major and the front of your deltoid (the muscle that forms the cap covering the shoulder joint (see image above). This will help you reverse the rounding in your shoulders and elongate your thoracic spine.

Bring awareness to your neck. You should be looking directly up to the ceiling, not back, which will hyperextend your neck, and not forward, causing your chin to move toward your chest as this will flatten the natural healthy curve in your neck. If your tendency is to hyperextend, check that you are looking straight up, not back. To check that you are not tucking your chin, touch the underside of your neck. If your neck is flat against the floor, gently tilt your head slightly back, just enough to create a little space between the vertebrae in your neck and the floor.

For support, you can place a folded blanket (2×3 feet), or two folded blankets, under your arms and shoulders, with your neck curving over the edge of the blanket(s) and your head resting on the floor or if you are lying on a mat, the mat. This will reduce the flattening and remove any strain on your neck. Over time, the extensors on the back of your neck,  will stretch and lengthen. Breathe and relax into the stretch for a couple of minutes.

Bridge 2 Pose

Taffy in Bridge, photographed by Christian Cabanero 

Osteopenia modification:

As you become more flexible, you can remove the supporting blankets and will become able to gradually lift your hips higher, more fully extending your thoracic spine.

Bridge

Lara in Bridge, photographed by Dr. Joe Pizzorno

Supta Padangusthasana I (Supine hand-to-foot I)

Gently and safely stretches the hamstrings and increases flexibility in the hips, allowing the heads of the femur (thigh) bones to settle into the back of the hip socket and move easily forward and back, as well as toward and away from the mid-line of the body

Lie on mat, wrap belt or strap around arch of one foot and raise that leg up for stretch while extending the other leg long on the mat.  Only raise your leg as high as you can keep your tailbone fully on the floor. To do so, inhale and then on your exhale, activate the muscles of your pelvic floor, your rectus abdominus and your transversus abdominus and drive your belly button back towards your spine. Keep breathing, but maintain a light contraction of these pelvic muscles.  Keep your back flat, tailbone long, shoulders wide and open. If your neck feels strained, place a blanket, thin pillow or towel under your head to support your neck.

 Supine hand to foot 1 Pose

Lara, Supine Hand to Foot I, photographed by Dr. Joe Pizzorno

Supta Padangusthasana II (Supine hand-to-foot II)

Lie on mat, wrap belt or strap around arch of one foot and raise that leg up for a stretch while extending the other leg long on the mat.  Externally rotate the leg you are stretching and release it to the side. Extend your opposing arm. Feel yourself widening and opening. As in Supta Padangusthasana I, do not let your tailbone curl up off the floor and keep both hips fully on the floor. Activate your pelvic muscles to stabilize you and give you the support you need to do so.

Osteoporosis modification:

Place a pillow alongside the leg you are extending to the side, so you can rest your thigh on it for more support (as shown in the Supine version of the Bent-leg Twist below). This will help you fully relax and open the hips. As in Supta Padangusthasana I, do not let your tailbone curl up off the floor and keep both hips fully on the floor. Activate your pelvic muscles to stabilize you and give you the support you need to do so.

Supine hand to foot 2 pose

Lara, Supine Hand to Foot II, photographed by Dr. Joe Pizzorno

Matsyendrasana (Bent-knee twist)

Benefits: stretches the back muscles, encourages movement and mobility in the spine and vertebrae.

Since you are in the supine position where your spine is least loaded, the twisting pose, can be safely done. However, it must be performed in a slow, controlled manner and not taken to end-range.

Lie on your back with your arms extended out 90 degrees at your sides, keeping palms up. Breathe! Flex your feet bringing your ankles and legs together. Bend your knees keeping your ankles together. then twist your hips no more than 10 or 15 degrees to the right, using pressure on the floor with the back of your right arm and hand to keep your torso in line.

If your left shoulder comes off the floor, and pressure on the floor with your right arm doesn’t help, you’ve gone too far. Rest your knees upon pillows or a bolster on either side at first rather than let the weight of the knee pull the twist to end-range of motion. Over time, as strength and flexibility develop, gradually increase the twist of your hips, keeping the knees bent and relatively in line with each other.

Bent-Knee Twist Pose

Taffy in Bent-Knee Twist, photographed by Christian Cabanero 

Marichyasana III Spinal Twist

Benefits: Stresses lumbar and thoracic vertebrae, shoulder joint, and the femurs.

Osteoporosis modification: Stand facing the seat of a chair, feet parallel and hip width apart. Place your right foot on the chair seat with knee and foot aligned in front of your hip. Firm your leg and spinal muscles. Move the left top thigh back, lengthen the tailbone down, lift your lower abdomen, place your right hand on your waist and left hand on your thigh. Inhale and root down through your left leg. Exhale and turn your spine above your waist to the right. Pull with your left hand on your right knee to help yourself twist. Actively wrap your left lower ribs around toward the right. Resist the tendency to move forward and open your right should back to the right. Keep your shoulders, head and hips level. Spinal Twist pose

Lara, Marichyasana, photographer Dr. Joe Pizzorno

Yoga Exercises That Safely Strengthen the Abdominal Muscles

A strong abdomen supports your spine and promotes good posture, both of which are especially important for anyone with osteopenia/osteoporosis. Key exercises that safely strengthen the abdominal muscles include:

Neutral to Flat Spine Contractions 

Lie flat on your back, knees bent, feet flat on the mat. Inhale and let your ribs expand fully. This will slightly increase the egg-sized pocket of air between your waist and the mat. Then exhale and contract the muscles of your pelvic floor and your abdominal muscles (rectus abdominus, transverse abdominus and obliques) to shorten the distance between your ribs and hip bones, and flatten your back to the floor.

Check that you are doing this correctly by placing your thumbs on your lower ribs and your index fingers on your hip bones. When you engage your abdominal muscles, your index fingers will move close to your thumbs as your back flattens into the mat.  Check that you are not using your gluteus muscles (buttocks) to move your hips towards your ribs. Touch your buttocks, they should be soft, not contracted. If they are tight, relax them and start over using only the muscles that lift your pelvic floor and flatten your abdomen.

Neutral Spine

Taffy, Neutral Spine, photographed by Christian Cabanero

Flat Spine

Taffy, Flat Spine, photographed by Christian Cabanero

The need for this practice never goes away, no matter how advanced your exercise routine becomes.

As your strength develops, you can slowly lift one knee at a time from the floor while being sure not to lose your flat back and tummy. You can place your hands on your abdomen to feel if you are maintaining the contraction. If your hip bones tilt forward, you’ve lost it.

Planks

Planks strengthen all your muscles. If you have osteoporosis, start out with the Wall Plank. As you build strength, you can try the Bent Arm Plank, remembering that you can always lower your knees to the mat. If you have osteopenia, you may find you can quickly move from the Wall Plank through the Bent Arm Plank to the Full Plank. Again, remember that you can always lower your knees in the Bent Arm or Full Plank.

Wall Plank

Begin in Tadasana, 2-3 feet away from the wall. Inhale and maintaining your long spine, raise your arms to shoulder level and tilt your posture so that your hands brace against the wall.  Root all your toes deeply into the floor. Engage your hamstrings and gluteus muscles. Activate your inner thigh muscles, so that you lift into one long fully engaged column. Lengthen through the back of your legs. Check that your pelvic floor and abdominal muscles are engaged. Exhale and drive your belly button towards your back to support your spine. Breathe in and elongate your neck, reaching the crown of your head away from your shoulders. If your shoulders start to creep up toward your ears, gently lower them, letting your shoulder blades drop and flatten into your back.  Open wide through your collarbones. Lift your chin so that you are looking straight ahead. Breathe and keep scanning from your toes to the crown of your head. With every breath, grow taller.

  Wall Plank PoseLara, Wall Plank, photographer, Dr. Joe Pizzorno

Bent Arm Plank

Begin in Tadasana. Hinging at the hips, bend forward keeping a flat spine, and bending your knees until your hands can firmly touch the floor. Bend down fully bringing your knees to the floor. If balance is an issue, use a sturdy chair or railing for support.

You can use your transition from standing to the floor to practice another helpful exercise on the way. The following picture shows the yoga pose, Downward Facing Dog, modified for osteoporosis. Hinge forward at the hips, keeping your back flat and long, and knees gently bent. Rest your extended arms on the chair seat and then use the chair to support you as you continue to bend your knees and lower yourself to the floor. 

Downward Facing Dog

Taffy in Downward Facing Dog, modified for osteoporosis, photographed by Christian Cabanero 

Once on the floor, move onto your hands and knees, keeping your spine level and elongating from your tailbone out through the crown of your head. Maintaining your flat, long spine, lower your elbows to the floor. When fully braced into your elbows, lift first one knee and then the other knee away from the floor. Lengthen your legs and root your toes deeply into the floor. Engage your core, lifting your midsection away from the floor. Engage your hamstrings and gluteus muscles, which will help you lift. Pull your belly button up and in towards your spine. Keep breathing! Activate your quadriceps (the muscles on the front of your thighs), pulling your knees up to support your legs. Activate your inner thigh muscles, as if you were pulling your legs closer together (don’t, but activate these adductor muscles to fully engage your legs). Become one long, fully engaged, powerful column. Lengthen through the back of your legs. Breathe. Check that your pelvic floor and abdominal muscles are engaged and supporting your spine. Your spine should remain in neutral alignment, neither drooping down nor hunching up. Both sides of your hips should be level with one another. Breathe in fully and elongate your neck, reaching the crown of your head away from your shoulders. If your shoulders start to creep up toward your ears, gently press them down, letting your shoulder blades drop and flatten into your back.  Open wide through your collarbones. Look straight down at the floor; don’t look ahead as this will over-extend your neck. Lengthen the back of your neck and grow taller. Keep breathing!  And keep scanning your engagement and alignment from your toes to the crown of your head. With every breath, grow longer and stronger.

Bent Arm Plank Pose

Lara, Bent Arm Plank, photographer, Dr. Joe Pizzorno

Full Plank

Begin in Tadasana. Move onto your hands and knees as outlined above. When fully braced into your palms and all ten fingers with your hands directly below your shoulders, lift first one knee and then the other knee away from the floor. Root your hands and toes deeply into the floor, evenly distributing your weight between each of your shoulders and each of your feet.  Lengthen your legs. Engage your core, lifting your midsection away from the floor. Pull your belly button up and in towards your spine. Keep breathing! Activate your quadriceps (the muscles on the front of your thighs), pulling your knees up to support your legs. Activate your inner thigh muscles, as if you were pulling your legs closer together (don’t, but activate these adductor muscles to fully engage your legs). Become one long fully engaged powerful column. Lengthen through the back of your legs. Breathe. Check that your pelvic floor and abdominal muscles are engaged and supporting your spine. Your spine should remain in neutral, neither drooping down nor hunching up. Your pelvis should be level. Breathe in fully and elongate your neck, reaching the crown of your head away from your shoulders. If your shoulders start to creep up toward your ears, press them down, letting your shoulder blades drop and flatten into your back.  Open wide through your collarbones. Look straight down at the floor; don’t look ahead as this will over-extend your neck. Lengthen the back of your neck and grow longer. Keep breathing!  And keep scanning your engagement and alignment from your toes to the crown of your head. With every breath, grow longer and stronger.

Full plank pose

Lara, Full Plank, photographer, Dr. Joe Pizzorno

Remember, you can always lower your knees. The key point here is to keep your spine l-o-n-g.

 Modified plank pose

Lara, Plank Modified to Hands and Knees, photographer, Christian Cabanero

Savasana (Corpse)

Always take a moment to end with Savasana. Its purpose is to let you fully and completely relax, and to let the energy released work deeper, helping your muscles and bones assimilate the improved postural alignment you have practiced. If your neck and shoulders are rounded forward (kyphosis), you may want to rest your head and neck on a folded blanket, and also place a folded blanket or pillow under your knees to further support your back. Make sure that the blanket supporting your head and neck does not prevent your shoulders from opening and relaxing flat on the floor.

Once again, think L-E-N-G-T-H. Lengthen your legs out fully away from your hips. Let them relax and fall open. Elongate your spine from your tailbone out through the crown of your head. Let your shoulders relax into the mat and open fully, so your collarbones are wide. Inhale deeply, but try not to let your ribs pop up. Exhale fully and let your belly button sink deeply into your abdomen. Keep breathing deeply and RELAX, enjoying your improved posture and strengthened muscles. Feel your bones renewing themselves!

Corpse Pose

Taffy in Corpse Pose, photographed by Christian Cabanero 

We hope you enjoyed this post as much as we enjoyed putting it together for you. Yoga is not only great for your physical fitness and balance, but amazing for your mental wellbeing! And you can do it in the comfort of your own home, at your own pace.

Also, I wanted to quickly share a story that brought a smile to my face.

Im sure many of you have heard about Anna Pesce, and 85 year old from Orangeburg, NY, who managed to beat the scoliosis in her back. After completing yoga therapy with certified yoga instructor Rachel Jesien. Prior to the therapy, Anna needed a wheelchair to get around and has a sever hunch in her back. Today, she can stand up straight!

I just love success stories like Anna’s, and I hope yoga can help you in some way too! You can read more about Anna’s story here.

Please let us know in the comments if our ultimate yoga post has helped you to find balance and strength. Be sure to share this post with your friends too 🙂


Sources:

  1. Fishman LM. Yoga for osteoporosis—a pilot study. Topics Geriatr Rehabil. 2009;25(3):244-250
  2. http://manhattanphysicalmedicine.com/dev/?page_id=70
  3. Zhang Y, Jordan JM. Epidemiology of Osteoarthritis. Clinics in geriatric medicine. 2010;26(3):355-369. doi:10.1016/j.cger.2010.03.001.
  4. Motorwala ZS, Kolke S, Panchal PY, et al. Effects of Yogasanas on osteoporosis in postmenopausal women.Int J Yoga. 2016 Jan-Jun;9(1):44-8. doi: 10.4103/0973-6131.171717. PMID: 26865770
  5. Kim S, Bemben MG, Knehans AW, et al. Effects of an 8-Month Ashtanga-Based Yoga Intervention on Bone Metabolism in Middle-Aged Premenopausal Women: A Randomized Controlled Study. J Sports Sci Med. 2015 Nov 24;14(4):756-68. eCollection 2015. PMID: 26664272
  6. McArthur C, Laprade J, Giangregorio LM. Suggestions for Adapting Yoga to the Needs of Older Adults with Osteoporosis. J Altern Complement Med. 2016 Mar;22(3):223-6. doi: 10.1089/acm.2014.0397. Epub 2016 Feb 19. PMID: 26894869
  7. Kristen Shea, Yoga Poses to Avoid with Osteoporosis, http://www.livestrong.com/article/360964-yoga-poses-to-avoid-with-osteoporosis/
  8. Ribs and Thoracic Spine Diagram: http://image.slidesharecdn.com/labquizstudypracticeabdominalmuscles-121211104036-phpapp01/95/a-p-ch-6-muscular-system-lab-quiz-study-practice-abdominal-muscles-1-638.jpg?cb=1355223004
  9. Lateral and Anterior View of Ribs Diagram: https://shiangyingdotcom.files.wordpress.com/2014/03/intercostals1332103303714.png
Lara Pizzorno

5 thoughts on “The Ultimate Guide to Yoga for Osteoporosis

Irma

Thank you for posting these exercises, I will start working on them this weekend.

Sally C Kane

Thank you for this information. I’ve practiced yoga for over 40 years and this is the first researched based article I’ve read on how yoga benefits osteoporosis and osteopenia. I’m forwarding the article to all my yogi friends.

Monica

Hi Sally,

Thank you so much for your feedback and sharing with your friends! We are super excited about this article and the research behind it. Glad you agree 🙂

– Monica from AlgaeCal

Shahnaz

Hi Monica. I am a big fan of AlgaeCal and have been using it for 3 years now. It has improved my back and hip bone density. I have recommended this to my friends too. I love your yoga poses,will try them too. Love them all. Thanks for sharing them here.

Monica

Hi Shahnaz,

Thank you for taking the time to comment! So glad to hear you’re enjoying the information (especially the yoga posts!) on the site. We’ll keep them coming 🙂

– Monica from AlgaeCal

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