Friday Q&A: Dangerous Poses for Osteopenia

Q: Could you please post an article discussing dangerous yoga positions for women with osteopenia in the spine? I am a 57 yr old woman with a -1.7 T score (?) for my spine on my last DEXA scan. I am doing the yoga poses for strengthening bones in Loren Fishman's “Yoga for Osteoporosis.” I can easily do most of the versions of the poses for osteopenia, but worry about doing the classical poses, especially the twists and those involving forward flexion. I would love to hear your views on this.


A: I’ll start by addressing why it may be dangerous for people with osteoporosis to do spinal flexion (forward bending of the spine). When we round the spine into a flexed position, such as in a seated forward bend, the front of the vertebral bodies will have more weight than the back of the vertebral bodies, and this uneven weight bearing is the potential culprit for causing vertebral body fractures.

Additionally, in osteoporosis there are often changes in the spinal curves, and an increase in thoracic kyphosis occurs with a decrease in lumbar lordosis. This is commonly due to loss of vertebral disc height and to poor posture with postural adaption due to decreased back extensor strength. The changes in the spinal curves will cause a “wedging.” The change in the vertebral body shape cannot sustain the biomechanical loads generated in forward bends when the spine flexes. The postural changes may also be associated with shortening of the trunk flexors (the abdominal and hip flexor muscles), so when we bend forward and our spine rounds, the muscle contraction of the front trunk muscles puts more pressure on the front of the vertebral bodies and this also increases fracture risk.

Dr. Loren Fishman cites that decreased back extensor strength predisposes individuals with osteoporosis to a three times higher fracture risk than individuals with strong back extensors who do not have osteoporosis. Some yoga teachers are absolute in preventing students who have had prior vertebral fractures from doing ANY poses that cause spinal flexion. That would include either single or double Knee to Chest, Reclined Leg Stretch series (Supta Padangusthasana), and Child’s pose (Balasana). However, I am a proponent of learning to move from your hip joints and keeping your spine in neutral (not rounded) when working in forward bending positions. In my mind, rolling in bed, getting out of a car, or getting up from a low couch may present more fracture risk than a mindful, slow yoga practice!

Now, what about twisting? How you twist and how you move into a twist are the crucial elements for osteoporosis safety. Twists involve compression, bending, torsion and bone shear, which is stimulating to bone growth. However, if you use your arms and force yourself into a twisted position, you are running a risk of fracture and more. Body parts do not like to be forced into any positions! On the other hand, if you use your breath, awareness and move SLOWLY into a twist position without using your arms to leverage the twist, your fracture risk is much reduced. Paying careful attention to maintaining your neutral spinal curves prior to the twist is also important.

I hope this helps you with your practice!

—Shari