Friday Q&A: Is Loren Fishman's Osteoporosis Sequence Safe?

Q: You say that people should not do the same poses all the time. What about programs like Dr. Fishman's osteoporosis study, which has participants doing the same sequence of poses every single day?

A: Thanks for this question. Indeed, if a person does the same sequence day in and day out, you could run the risk of a repetitive strain injury. The fact that Dr. Fishman's sequence is only supposed to take 10 minutes a day to do means that the practitioners are not holding the poses terribly long, which would reduce this risk considerably. However, a review of the poses taught (see here) reveals several poses that I feel could be potentially injurious to the wrists, neck and lower back, these being Upward Bow pose and the deep seated forward bends. I would consider other poses if I were to design such a practice, but Dr. Fishman does mention tailoring the sequence to students individual needs. I would suspect that this had to be done quite a bit.

Recall that the number of patients that started the study was much larger than those that completed the study. (117 vs 11). Interestingly, there is no discussion as to what caused so many to drop out  and why they were unable to do a 10 minute practice everyday. One factor could have been boredom, which is why I often suggest that students alternate practices from day to day to help maintain better focus and follow through. And it is possible that some found the sequence too advanced, despite the individual adjustments offered. The bottom line, in real life, when you can vary your practice, I highly recommend you do so.

—Baxter

A: With Baxter's blessing I'm going to tell you why I wouldn't want to do this sequence on a daily basis. I'll start by telling you that the three yoga injuries I've sustained have all been repetitive strain injuries. I was a pretty enthusiastic practitioner for a number of years, and did a lot of standing poses and sun salutations. And the injuries I had were: sacroiliac joint injury (common among dancers and yoga practitioners, but not the general public), tennis elbow (possibly from sun salutations), and housemaid's knee (from kneeling too much on the bare floor).

Now let's look at the sequence:

1. Triangle Pose (Trikonasana)
2. Downward-Facing Dog Pose (Adho Mukha Svanasana)
3. Upward-Facing Dog Pose (Urdva Mukha Svanasana)
4. Bridge Pose (Setu Bandhasana)
5. Upward Bow Pose/Rainbow Pose (Urdva Dhanurasana), without or with a chair
6. One-Legged Forward Bend (Janu Sirsasana)
7. Two-Legged Forward Bend (Paschimottansana)
8. Boat Pose (Navasana)
9. Reclined Leg Stretch (Supta Padangusthasana)
10. Marichyasana 1 twist
11. Lord of Fishes twist (Matsyendrasana)
12. Reclined Twist (Jathara Parivarthasana)

After I got over the shock of trying to imagine doing all those poses in 10 minutes, without any warm-ups, I examined the poses in detail. First, two of the poses in the sequence are known for causing sacroiliac joint injuries, Triangle pose (Trikonasana) and One-Legged Forward Bend (Janu Sirsasana), with One-Legged Forward Bend a particularly guilty party. For me, personally, I've concluded it's just not good to do either of those poses every single day. Then, as Baxter mentioned, there is a very deep backbend in the sequence, Upward Bow, and doing this every day could put a lot of strain on the wrists and elbows, but of just as much concern to me is that it is followed immediately by a deep forward bend, taking the lower back into such extreme movements with no rest between. In particular, the Two-Legged Forward Bend is known for causing lower back strain. The combination of the deep backbend followed by the deep forward bend could cause a lot of back strain (personally, I would have moved the forward bends to the end of the sequence). The sequence ends with three twists, asymmetrical poses that are also hard on the sacroiliac joint, with no symmetrical counter pose to finish the sequence. (On the bright side, no danger of housemaid's knee here.)

I understand some of the thinking behind this sequence, which tries to engage all the different muscles of the body to strengthen as many bones as possible, within a short sequence, and uses the twists to "release" the back after the strain of the backbends and forward bends. However, if I were to design an osteoporosis practice, for safety's sake, I would develop five or more different sequences that the practitioner could alternate between on different days, rather than trying to cram everything into one single practice. There are so many wonderful poses in the yoga tradition, why would you limit yourself to just 12?

—Nina

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Accepting Reclined Leg Stretch

by Nina

An excellent time to combine acceptance with active engagement (as Baxter discussed in his post yesterday) is when you are doing yoga poses. By far, the healthiest and most effective way to do yoga poses is to cultivate an awareness of your body’s current state while at the same time actively working toward making changes to it, such as stretching or strengthening. This is one of the best ways to protect yourself from injury. And it also helps you reap the most benefits from your poses.

When I was trying to think of a pose that epitomized this need for both acceptance and active engagement, Reclined Leg Stretch pose (Supta Padangusthasana) sprang to mind. To be honest, that’s because every time I've taught the pose, I’ve seen people “cheat” (yes, I’m talking about you with the bent leg over there), a sure sign that the “acceptance” side of the equation is lacking.

Reclined Leg Stretch (Supta Padangusthasana) is a very beneficial pose because it revitalizes your legs while it eases tension in your lower back. It stretches your hamstring muscles and your hip joints, which is important for maintaining physical health if you sit at a desk or walk a lot. It is also helpful for lower back pain and maintaining a healthy back. And it’s a great way to begin a yoga practice or even to do as a “single pose practice.” Plus, you get to do it lying down! 

Baxter prescribes it for: 

• leg fatigue or weakness 
• lower back conditions 
• arthritis 
• knee pain 
• swelling of feet and ankles 
• maintaining flexibility of the legs and hip joints as you age

However, most people are too tight in their hamstrings to do the pose like their teachers or the pictures they’ve seen, so some (not naming any names here) cheat by bending the knee of their top leg or by lifting their pelvis off the floor in order to bring their toe closer to their head.

Can you do it like this? (From "Moving Toward Balance," Rodney Yee with Nina Zolotow)

But while cheating may make you feel more flexible, bending your top knee means that you won’t be getting the full hamstring stretch that’s so beneficial. So the next time you do this pose (and it’s a great one to practice at home), use a strap or belt around the arch your foot and hold the right side of the strap in your right hand, the left in your left hand. Now be honest with yourself. Is your upper leg truly straight? And is your pelvis resting evenly on the ground? If not, let your leg go until your knee is straight, your pelvis is even, and your leg reaches its natural angle (90 degrees or less, even much less).

Using a strap. (From "Moving Toward Balance," Rodney Yee with Nina Zolotow)

That’s the acceptance part. The active engagement part is to stay in the pose for 45 to 90 seconds and to practice regularly. Although we can’t promise it, there’s a very good chance that over time this pose will increase your flexibility, making many other poses more comfortable and enhancing your physical health.

Some helpful variations:

• If your head and shoulders aren’t resting comfortably on the floor, use a folded blanket under your head. 
• If you are so tight that it’s hard to hold your leg with a strap, do the pose with the bottom leg extending through a doorway and your top foot resting on the wall next to the doorway. 
• If you want to strengthen your bottom leg as your stretch the top one, you can practice with your bottom foot pressing against a wall.

Cautions: If you have lower back issues, you may need to keep your bottom leg bent. If you have wrist issues, you may need to change the way you hold the strap.

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