Ankylosing Spondylitis and Yoga (Not Yoga for Ankylosing Spondylitis)

by Shelly Prosko, PT, PYT, CPI

Sunflower in Bouquet

I recently had a physical therapist colleague ask me for some advice for some yoga poses that might help her client who has ankylosing spondylitis (AS). I explained that there are certainly some poses I would share with her that could potentially address some of the general commonalities of the symptoms of AS and how people with AS may present in similar ways, but I also explained I thought it was important for her and her client to understand that: 

1. Therapeutic yoga is so much more than prescribing poses for a particular dysfunction or special population.
2. The phrase "yoga for ankylosing spondylitis" (or any diagnosis) tends to suggest, in my opinion, that we are using a reductionist approach and falling into the trap of treating/addressing a diagnosis instead of a person who is a living, breathing, moving, thinking, feeling and reacting being, who is connected to and affected by the surrounding environment. Every being consists of complex systems and layers, each one influencing the other, including the nervous system, digestive system, musculoskeletal system, hormonal system, immune system, integumentary system, and emotional, social and spiritual layers, just to name a few.

That being said, there are certainly some common physiotherapy exercises and yoga methods that can be used for people looking to optimize spinal and rib mobility and alignment, maximize breath patterns, improve pain management, and/or calm the nervous system. But I suppose that would be a really long title for this article.  

I can appreciate how it's easier to simply say "Yoga For ( diagnosis )"; and I would assume we all understand that we're making generalizations that aren't to be used as prescriptions or individual therapies, but simply outlining some potentially valuable guidelines in order to help people. So, for the record, this article is not meant to be interpreted as “Yoga for Ankylosing Spondylitis.” I want to be clear that I strongly believe in “Yoga For the Individual Person” and his or her unique physical, mental, emotional, energetic, and spiritual states, which are constantly changing and responding.

Keeping this in mind, I'd like to share the response to my colleague's request. One of my yoga students, who happens to also have AS, was willing to demonstrate some physio and yoga techniques that I chose for this case. A short interview with him is also included at the end of the video about how yoga has helped him manage his AS symptoms. I hope you find the video valuable and perhaps even worth sharing with someone who you think may benefit from it: 

About Ankylosing Spondylitis

AS is a chronic inflammation of the joints of the spine and is considered to be an autoimmune disease. For reasons we do not know (although, there is speculation and theories presented) the body receives a trigger that tells it to “attack” itself. The body can potentially then go into repair mode, causing excess bone formation, which explains the fusion of joints that is sometimes seen in advanced AS.

Some of the symptoms and complications of AS are:

• pain experienced in the areas of SI joint, spine, hips, shoulders, knees, ankles 
• stiffness/reduced mobility of spine
• reduced chest/rib mobility or expansion, resulting in decreased efficient breathing patterns
• fatigue
• osteopenia/osteoporosis
• digestion problems (IBS)

Some of the intentions of PhysioYoga therapy in this case are to:

• reduce the chances or severity of secondary complications as above
• help improve management of symptoms as above
• maintain and optimize joint mobility and alignment
• optimize muscle health and function
• maximize efficient breathing patterns (which can help improve movement)
• improve self management of pain
• increase self-efficacy
• optimize feelings of joy, pleasure, and gratitude
• maximize functional capacity and quality of life

Certain yoga poses, movements and breathing methods can help address posture, alignment, mobility, and stability as well as potentially address the energetic layer (combat fatigue, improve sleep) or produce a calming effect on the nervous system, which can help with such problems as pain management. Mindfulness or meditation practices, such as awareness, visualization or other methods of focus, can also potentially help with pain management, change the pain experience, and perhaps even reduce the chance that the genes associated with inflammation are expressed. Ram's previous posts "Chronic Inflammation and Yoga" and "Meditation: Effects on Gene Expression" shed further light on these topics.

There is currently no formal test to actually diagnose AS. The Arthritis Society states that although most people who have AS carry the HLA-B27 gene, most people with the HLA-B27 gene do not get AS. So, just because you have the gene, it doesn't mean you will get AS. The Arthritis Society states, "in fact, only a very small number of people with this gene will ever develop AS."

If your physician suspects you have AS, it is a good idea to get a referral to a rheumatologist to help guide and manage your care. PhysioYoga can be used as a valuable and beneficial complementary therapy to your current medical treatment. I highly recommend following and continuing with your medical treatment plan, in addition to finding a physical therapist or health care professional in your area who is trained in integrating yoga therapy and nutritional therapy into his or her treatment sessions (online directories of practitioners across North America are here and here). Or perhaps a yoga therapist or teacher in your community can work together with your physical therapist and health care team for optimal success and safety.

With education, supportive treatment as needed, and guidance, people with AS can have active, meaningful, happy lives and relationships filled with vitality and longevity. 

Disclaimer: This article and video is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities.

Shelly Prosko is a Physical Therapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physical Therapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina and her Pilates certification through Professional Health and Fitness Institute in Maryland. 

Since 1998, Shelly has been integrating yoga principles and methods into her physical therapy treatments. She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory  conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States.


Currently, Shelly resides in Sylvan Lake, AB and travels across Canada and the United States offering specialty Physio-Yoga Therapy workshops, classes, private sessions, lecturing at University and College programs as adjunct faculty of Professional Yoga Therapy Studies, teaching at YTT’s and actively promoting the integration of medical therapeutic yoga into our current healthcare system. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Her treatments are individually based and are a unique blend of both approaches. Please visit www.physioyoga.ca for more information about Shelly’s mission and services, and to read a variety of testimonials of how PYT has profoundly influenced many people’s lives.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Friday Q&A: Moving Your Spine in Twists

Q: You have written superbly about the spine but I can't find any comments on maintaining an upright spine for seated twists. Please, could you explain the anatomical need for this sometime?

A: The first thing to ask is: is it actually important to maintain an upright spine when doing seated twists? To this, I would say “yes,” for both immediate success in having the greatest rotating range of motion in your twist and, secondarily, for the long-term health of your spine. 

You might try a little experiment right now. Sitting in your chair or on the floor in simple Crossed-Legs pose (Sukasana), allow your spine to slump forward into a “C” shape. Try to twist to your right and notice how far your twist gets. Then come back to center, maintain your slouchy position, and repeat to the left, noting again how far you are able to twist. Next, coming back to center, lengthen up from your sitting bones to the crown of your head, establishing what I like to call the “inner lift” of your spine. I also call it the “prime directive” (for all you Trekkies, this is a bit different than the guiding principle Jean Luc Piccard was constantly invoking!), as I feel it keeps your spine ready and safer to move into any yoga pose direction. Now repeat your twist experiment and notice your range of motion: 99% of you will find you can twist a little or a lot further with a lifted spine. 

Sukasana Twist

I just tried the same experiment with my spine lifted into a bit of a back bend, and, for my body, the back bend arch also limited my twisting ability compared to the neutral lifted posture. So, there is practical value in sitting upright for seated twists; you can increase your range of motion, which could come in handy in daily life, like turning to check on this kids or grandkids who are sitting in the back seat of the car!

Yes, you can twist while forward bending (we do this in some asymmetrical forward bends, such as Janu Sirsasana and Parsvottanasana), and you can twist while back bending (we do this a bit in certain asymmetrical backbends, such as Natarajasana). But the spine rotates maximally from its neutral alignment. Creating your inner lift, or what Leslie Kaminoff refers to as Axial Extension, allows you to start any seated twist with the most overall length in the spine. 

If we could look at the cushiony discs between each vertebrae of the spine while we twist, we could see that the disc compresses down a bit and loses some height in the twist, and then after the twist, usually springs back up to full thickness. And if you add up all the discs in an entire spine (23, as the top two spaces don’t have a disc proper), the cumulative result of going into a deep seated twist is the loss of some overall height, until you come out of the twist. The squeezing and pumping action on the discs though all directions of movement, if fairly evenly done (meaning not overdoing just one movement, for example, forward bending) will tend to keep the discs healthy over time. Inevitably, over time, the discs and bones of the spine will gradually change by losing water content, becoming a bit less resilient, and experiencing wear and tear. That’s right, more of that aging process! But maintaining good posture, especially in seated twists, as well as any twists, distributes the forces in the discs in a more even and, hopefully, healthier way than, say, always being in a bit of forward bend (like a couple of my students who are professional gardeners) or a bit a backbend (like my contractor who painted the ceilings in my house one time). These folks may be at risk of spinal problems down the road. But their yoga practice could act as an antidote to some of those repetitive directions of movement their jobs require!

It might also be helpful to think about where you are turning from when you twist. It turns out the spinal areas have different abilities to twist easily. For instance, the lumbar spine can only allow about 5 degrees of rotation, which is not very much. In fact, the lumbar spine tends to go where the sacrum turns because of that. If you keep your sacrum facing forward in Sukasana and turn everything above, the spine itself does not start rotating naturally into the twist until you get to the area of L1, T12 and T11. If, however, you try to force the lower lumbar area to turn independently of the pelvis and sacrum, you run the risk of overstretching the supportive ligaments that run from the lower lumbar bones to the pelvis bones, which is destabilizing for the spine, and can possibly cause the sacro-iliac joint on one side to overstretch, which is destabilizing for the SI joint. So, some prominent teachers encourage you to allow your sacrum and pelvis to rotate in the direction of the twist, while others suggest you focus on the twist coming from the L1, T12, T11 interchange. I usually fall in the later camp, recommending that my students start twisting from the navel area, but understand that the twist will “look” like a bigger twist if you start with the pelvic area. 

I suggest you play around with the easier seated twists, such as Sukasana, Marichyasana 3, and Upavista Konasana twists.

Marichyasana 3

First try turning from your pelvis. Then try turning from around the area of the navel line (an imaginary line I envision around the equator of my belly at the navel that corresponds to L1, T12, T11). See what you discover about the degree of satisfaction you get from each one!

What about the other areas of the spine? What is their capacity to rotate? The thoracic spine is capable of 35 degrees of rotation, and the cervical spine has the most ability to rotate, allowing up to 50 degrees of rotation. Due to the greater twisting ability of the neck area, practitioners often tend to lead with this area in twists. I like to have you start from the navel area to get a better sense of what the middle spine can do before adding in the ease of the neck turn. (I don’t always start from down low, but do a good 95% of the time!)

—Baxter

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Friday Q&A: Safe Neck Movements

Self portrait at the age of eighty three by Hokusai

Q: was wondering if you could do a post about the safety of neck movements in older yoga practitioners (maybe 60 and up?). I teach a beginner yoga class for seniors in the Downtown Oakland Senior Center. I do like to incorporate some neck movements into our practice but just recently I got to read Swami Satynanda Saraswati’s book (Asana, Pranayama, Mudra, Bandha) and he mentions that elderly people should not do the neck movements he suggests in his Pawanmuktasana Part 1 series (chin to chest, head turning to side, ear to shoulder, head rolls (I don’t do that one with the seniors). He also suggests that cervical spondylosis patients should strictly avoid forward bending of the neck. What I mostly heard before is to be careful about back bending the neck. Would you advise patients with arthritis in the cervical spine not to do any neck movements? Or just perhaps do only 50% of their range of motion?

A: Thanks for this important question! Here at YFHA, we have written quite a bit about neck pain, neck arthritis, and normal movements of the spine, including the neck area, and other aspects of the neck (please see the end of this post for a list of recommended posts from our archives).

Before writing my answer to you, I did an online search for clear guidelines on range of motion exercises for the neck for older adults, without much luck. One study Effect of an upper-body flexibility intervention on neck range of motion in older women tried to determine if having older women practice a set of neck and upper body range of motion exercises twice a week could improve their neck range of motion. The study noted that as adults age, they often experience a decrease in mobility that can make driving a car or even safely crossing a street while checking for traffic to their right and left difficult, resulting in decreased ability to safely move about their community. They were hoping to determine a way to help turn this around. Sadly, the study did not show any significant change in neck mobility, but suggested that doing the exercises more than twice a week might change that outcome.

Before I go any further, let me clarify a few definitions for those readers new to the topic of neck problems in general:

Cervical Spondylosis: According to the Mayo Clinic Cervical Spondylosis is “a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, bone spurs and other signs of osteoarthritis develop. More than 90 percent of people older than age 65 have evidence of Cervical Spondylosis and osteoarthritis that can be seen on neck X-rays. Most of these people experience no symptoms from these problems.”

Facet Joint Arthritis: This is a form of arthritis that affects the facet joints of the neck located behind the area of the discs, and can occur alone or in conjunction to the disc changes described above.

As for the cautions that Swami Satynanda Saraswati gives in his book, I cannot directly comment on them, as I don’t have a copy of the book and I can’t check to see if he references any sources for these recommendations. However, I have some general guidelines I use when suggesting range of motion exercises to my older students.

Disc Changes

For those with significant disc changes, including Degenerative Disc Disease with symptoms or disc herniation causing symptoms, I recommend limiting forward bending of the neck, especially if any force is being applied to the neck. Examples of poses that might overload the neck for these students include Bridge pose, Rabbit pose, and even Child’s pose if the chin is tucked and the head is resting on the floor. As to whether non-weight bearing flexion of the neck is okay, such as standing in Mountain Pose and nodding the chin to the chest, careful experimentation could be tried and if there are no worsening of any neck symptoms, some practitioners might benefit from maintaining range of motion in that direction.

Facet Joint Arthritis

For those with Facet Joint arthritis that is symptomatic, extension of the neck and head (tipping the head back) can be aggravating. Therefore, caution is recommended in taking the head and neck back into extension (backbend) or extension combined with rotation. Camel Pose is an example of a neck position that I recommend be avoided by practitioners with this kind of neck arthritis. However, gentle head lifts, such as in Locust pose and Low Cobra pose, could possibly help maintain some extension range of motion in the neck while also helping to strengthen the muscles at the back of the neck. And gentle chin lifts combined with chin tucks could also be tried cautiously. Empower your students to notice the effects of the movements and make appropriate adjustments as they go along.

Basic Range of Motion Movements

It is reasonable to share some basic range of motion movements with older adults and let them monitor whether the stretching sensations that arise are acceptable or not, and allow them to limit the movements to a degree that allows the movements to be done pain free. I usually suggest simple seated or standing positions to begin. Then I have my students try simple rotation of the head and neck to the right and left, moving with the breath, which I call Owl Turns. Inhale as you turn your head to the right, exhale as you turn back to center, inhale as you turn your head to the left, and exhale as you turn back center, and repeat for perhaps 2 to 3 rounds. I usually follow that with simple side-bending movements, which I fondly refer to as Curious Dog Tips, where you inhale as you bring your right ear towards your right shoulder without letting your head rotate, and exhale as you return your head to center, and then repeat on the left side. Two to three rounds of Curious Dog Tips is a good test of how a practitioner might handle that motion.

Like our reader, I tend to avoid the head circles or head “rolls” that are sometimes taught in modern yoga classes, as these seem to have the potential to aggravate a lot of necks, young and old (see Thursday Q&A: Head Rolls).

I hope these suggestions will both give older readers of YFHA some ideas to work with and yoga teachers out them some options to share with their students.

Previous posts that can give our readers a good background understanding of the neck region of the spine include:

1. For a basic understanding of the spine as a whole and how it moves: All About Spine Anatomy and Movements 
2. For a look at pain in the neck generally: A Literal Pain in the Neck 
3. For a study on Degenerative Disc Disease, which can affect the cervical spine: Degenerative Disk Disease and Yoga 
4. A general discussion of arthritis in the spine: Arthritis of the Spine 
5. My recommendations for working with neck spasms and strains: Neck Muscle Strain and Spasm, Part 2 

—Baxter

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Spinal Movements: How to Keep Your Spine Safe

by Shari

We recently received this query from a reader about contraindications for spinal movements:

When are extension and flexion of the spine contraindicated. I have a patient who has issues with L5 and L6. I guess extension (backbends) would be contraindicated, correct? Also what about folks who have issues with inter vertebral discs? And what about people who have a hump in the cervical-thoracic region?

These are actually very complex questions but I will try to stay on track here. My previous post All about the Spine  gave some background on how the spine changes shape in various movements, including forward bending, back bending, twists, and side bending. Now I like to think about the spine as a train where the head on the neck is the “engine, the subsequent vertebra are the train, and the coccyx is the “caboose.”

All these separate vertebrae are connected to each other by numerous ligamentous attachments. Anterior is a long ligament that runs down the front of the vertebrae from C1-S1 and posterior is long ligament that runs down the back portion of the vertebrae. This sandwiches the vertebrae so they don’t slide forward or backward in relation to the individual top- and bottom-connecting vertebra. There are also many other types of connecting ligaments between different portions of the spine. Again, the function of all the ligaments is to keep the spine stable, and to allow coordination of movement but not too much movement at specific vertebral levels!

Anterior and Posterior Long Ligaments of the Spine

Now the interesting thing about ligaments is that they don’t have much stretch to them. In fact they don’t really stretch at all because they are stabilizing structures. What that means is that they limit movement in the spine. This is a good thing since the spine houses the spinal cord.We really don’t want to tug or pinch our spinal cord because it is the main power house that connects our brain literally to our bones and muscles and allows us to move when and how we want to.

Between each vertebra sits a cartilaginous structure called an intervertebral disc that is connected to both the top and bottom vertebra. The discs are the shock absorbers of the spine and they absorb the motion at each vertebral level.

Lumbar Vertebrae (L1-L5)

Now lets talk about what happens when there is a problem at a specific vertebral level. We can have “cranky” backs and sometimes it doesn’t take a whole lot to have your back “go out” (actually I dislike this expression because the back isn’t going anywhere so it can’t really go “out”). However, there can be areas of the spine that are more sensitive to movement. The question asks about L5 and L6 specifically. Now there aren’t a whole lot of people who actually do have an L6. Typically we only have 5 lumbar vertebrae (L1-L5), and L5 is often injured or fragile in a lot of people from different causes.

When there is a specific vertebral level that is injured, it is important to understand what the actual injury is because then you can understand how to take care of it.

There are specific spinal conditions where forward and backward bends should specifically avoided, including recent spinal surgeries, recent or acute disc injuries, or any acute injury where pain is a true warning sign not to proceed. For spinal instabilities like spondylolisthesis  back bends should be avoided, and if you have facet arthritis of the spine in lower back or neck, backbends may aggregate this kind of arthritis pain. Also, with rheumatoid arthritis and other conditions where ligaments are adversely affected, all yoga postures will need modifications to avoid over stressing ligamentous attachments.

But specific level vertebral injuries can be challenging because you can’t just stop that area from moving Movement allows the intervertebral discs to get nutrition and hydration. When the spine is prevented from moving whether from medical intervention (like surgery) or wearing a rigid brace to prevent movement, sometimes the injured area heals but due to immobility a lot of other areas of the body aren’t very happy. When there is a disc injury, allowing some flexion and extension is encouraged but the issue is the degree of motion. So what you can do is to learn how to move without causing further injury.

When I say it is important to learn how to move, what I mean is that often when people do forward- or back-bending asanas, the movement isn’t well distributed along the spine and certain areas take more of the movement in an unhealthy way. When vertebrae are stiff or there is a particular loss of motion in one area, another corresponding adjacent area will move more to correct the motion loss. This isn’t a conscious action but the body learns how to make due with what happens. So if the L5 doesn’t move well then the vertebra above it, L4, will begin to move more to compensate for the loss of movement at L5, and S1 (the top of the sacrum) will also move more than it should to also compensate. This motion loss can occur anywhere along the spine, though certain areas are more predisposed to motion changes and this is how problems develop.

But in situation described by the reader (issues with L5 and L6), should the student practice forward and back bends? Well, there isn’t really a simple answer. Remember, the spine needs to move. So, the answer is yes, but with careful attention to form and detail. I like to think about making the movement long and soft, not short and tight. There is always a quality of “work” in every active asana, but the key is how much work is safe? There should never be sharp point of specific pain and there should never be asymmetrical pain.

Now the last part of the question, about the hump in the cervical/thoracic region, In a previous post Kyphosis (Dowager's Hump), Baxter described several causes for this rounding of the upper back. While it is sometimes caused by a structural issue like scoliosis or osteoporosis, other times rounding of the upper back is due to long-standing postural habits and a long life of sitting at a desk working with the head in a down position. At a certain point the individual may no longer be able to correct the curvature by standing up straight. In these instances, where there is no actual medical contraindication, then gentle passive backbends are a wonderful approach to the upper back rounding.

A passive backbend over a bolster or blanket roll (lying on your back with your knees bent using a bolster or a blanket roll perpendicular to the torso) to help change the upper back curve is beneficial as long as the neck and lower back are protected so they don’t arch too aggressively. Also, learning to relax as well as stretch the diaphragm  are also helpful, which you can do with a gentle Cobra pose or  supported Upward Bow (Urdhva Dhanurasana) with a chair. Another very accessible backbend for the upper back is Supported Bridge pose (setu Bandha Sarvangasana on low blankets (one for torso and one for legs, with or without a belt tied around the legs).

Ultimately, to keep healthy, your spine needs to move daily through a full range of motion. Our daily lives limit our motion dramatically, so this is where your yoga practice plays a powerful role in spinal health. With attention to your breath, intention of non aggression in your practice, and a healthy dose of common sense we can encourage our spines to move safely in our practice. Then the key is to take these skills back into our daily lives to encourage more healthy motion.

Subscribe to YOGA FOR HEALTHY AGING by Email ° Follow Yoga for Healthy Aging on Facebook

Read More

Friday Q&A: Kyphosis (Dowager's Hump)

Q: I teach chair yoga for older people. Several of my students have pretty bad kyphosis, a rounded curve in the upper back. They are not yet into a dowager's hump but they are on the way. When we do down dog with a chair, their upper backs are very humped. If I have them try to do cat/cow stretches with hands on the chair seat, their upper backs barely move. I have suggested that they try to lie on their backs with a small blanket roll under the bottom tips of the shoulder blades. Do you have any suggestions for how they might try to reverse this curve or at least stop it from getting worse?

A: This is an interesting question: what to do with the student who has kyphosis of the thoracic spine, the part of the spine in the area of the rib cage? What can we do as yoga practitioners to prevent the progression of the spinal changes we are seeing, and is it possible to reverse the excessive posterior curve in the upper back?  And should we be more attentive to this area when we are younger and possibly avoid this kind of change in the upper back (yes!)?

As we have discussed in the past, the normal anatomy of the spine involves a gentle, undulating set of curves from head to tail. From the backward curve of the back of the skull, as we move into the cervical (neck) spine, the spine curves forward toward the front of the body.  As we travel down into the thoracic (rib cage area) spine, there can be a natural backward curve, although in indigenous peoples and from ancient sculpture there is evidence that minimal curve in this area might be a healthier variation (see the work of Esther Gohkale). As we proceed further south and enter the lumbar (lower back) spine, the spine curves toward the front of the body once again. Finally, the sacrum curves backwards to complete the serpentine trail of the spine.

According to the Mayo Clinic website (I love these folks!):

“Kyphosis is a forward rounding of your upper back. Some rounding is normal, but the term "kyphosis" usually refers to an exaggerated rounding — sometimes called round back or hunchback. While kyphosis can occur at any age, it's most common in older women where the deformity is known as a dowager's hump.” 

Today, I am interested in kyphosis that occurs in older adults. In my experience, I have encountered this pronounced curve in both older men and women. The Mayo clinic notes that it occurs more often in women, likely due to the earlier onset of osteoporosis (OP) in women. What’s the OP connection?

The most common site of fracture in people with osteoporosis is the spine, and more specifically the thoracic spine. The typical fracture in the area is called a wedge fracture, in which the body of the vertebrae, that kidney bean-shaped biggest part becomes so thin that the front part collapses, and when seen from the side, it looks like a wedge. If you get several of the vertebrae in a row doing that, then the whole upper spine begins to bow forward like the Kokopelli image.

In some instances this will result in stiffness and difficulty maintaining an upright posture, and for some pain will also arise. Along with pain, in more severe cases of kyphosis, the change in spinal curve can affect your lungs, nerves, and other tissues and organs. So we need to do at least one important thing before we start moving these students of our reader around a lot: have them see their family doctor for an X-ray of the thoracic spine to see if fractures have already happened and get a DEXA scan to rule out OP if this has not been done. Once you know their OP status, you can make better decisions around yoga poses and practices.

Two other important factors that can contribute to kyphosis in older adults are disc degeneration (we have written about this, too) and cancer and cancer treatments (which can weaken the vertebrae and contribute to fractures as well).

Your western doctor may recommend certain treatments:

• If there is OP present, medications to treat osteoporosis might be prescribed.
• If pain is present, pain relieving meds could be recommended. 
• If the person’s condition is compressing a nerve or causing some other significant problem, surgery to fuse bones could be suggested, but the risk of complications is high and tends to minimize this option.
• Physical therapy exercises are prescribed to improve flexibility in the spine, as well as ones to strengthen the abdominal muscles to help support better posture.

Obviously, this last area, improving flexibility of the spine and strengthening abdominal muscles, is where yoga practice could be helpful.

If you don’t yet have a copy of Loren Fishman’s book Yoga for Osteoporosis and you are working with older adults, perhaps today’s the day to order it! It is a good resource of suggested poses and ways of doing them that you will likely find invaluable. A valuable piece of advice from the book regarding patience with these students is:

“Although yoga can be slow, requiring months or even years to achieve major effects, the trip is pleasant…”

So, with patience in mind, in regards to the reader’s observations, I’d suggest that for Downward-Facing Dog with the chair, if they are putting the hands on the seat of the chair, bring them up to the back rung, and if already on the back rung, do a higher version of Half Dog Pose at the Wall.

Half Dog Pose at the Wall

Let them bend their knees a bit and focus on lengthening their spines to whatever degree they can pain free. Even if not much seems to be happening in Cat/Cow pose, keep doing it anyway. I like the effect of dynamic movements like that for loosening tightness up gently. Along those lines, have them stand in Mountain pose with their backs to the wall, perhaps with the kyphosis lightly touching the wall. Then have them inhale one arm forward and up overhead and exhale it back down. Repeat with the other arm. Do several sets of these. The mere act of taking the arm overhead will begin the encourage extension of the upper back, exactly what you are looking for here, and strengthen the upper back muscles that assist in this goal. You could obviously do this sitting as well. 

If they can easily get down to the floor for Savasana, I find that no lift is needed under the thoracic spine, but a lift is definitely needed under the head so it stays level with the chest. Over-extending the neck has its own set of worries you don’t want to cause! In that reclining position, you can again have them work the arms as we did in Mountain pose.

To strengthen the abdominals, you could create a variation of Boat pose (Navasana) done sitting at the front edge of a chair, lifting one bent leg up a few inches and holding it in position for a few breaths, then lowering that foot to floor and repeating with the second leg. Again, if they can get to the floor and you can teach them Locust pose (Salabasana) or even one-legged Locust (which takes the spine into extension), you can have them do that at home or even in bed if they have a firm mattress.

One-Legged Locust Pose

I’ve already gone on a bit too long today, but I do believe that by intervening now and getting these people to practice at home as well as in class, you have a good chance of stopping the progression of the kyphosis and in some cases, where no wedge fractures have altered the anatomy, maybe even helping to reverse it! Please let us know how things go.

Subscribe to YOGA FOR HEALTHY AGING by Email ° Follow Yoga for Healthy Aging on Facebook

Read More

Arthritis of the Spine

by Baxter

Whale Bone by Michele Macartney-Filgate

Be it lower back, middle back, upper back or neck pain, not a day goes by when at least one student offers up his or her particular version of back pain. Due to the effects of time, age and stress on the spine, one of the underlying causes of back pain is arthritis of the spine. To be more specific, we usually refer to it as “osteoarthritis of the spine” to differentiate it from other types of arthritis that may be due to autoimmune conditions.  Sounds specific, maybe even helpful to have a label to attach to one’s problem, but what does “arthritis” refer to? Well, it is an “itis,” so there’s a clue. "Itis" usually implies some inflammatory process, you know, like tendonitis, where the tendon is inflamed.

In arthritis, it is the boney structures and their coverings, usually cartilage, that are involved. In a healthy joint, anywhere in the body, the ends of two bones that make up a joint are covered with a protective coating of connective tissue known as cartilage, which acts as both a cushion between the two bones, and as a smooth, slippery surface that can slide and glide as the bones move over one another during motion. Here’s where time, age, stress and other factors ruin a perfectly good system.  Over time, with the aging process (which can dry out and thin the cartilage independent of the other factors), and with certain movement patterns (especially unusual, misaligned ones) and repetitive use, especially with additional stress from gravity or carrying loads, the cartilage can fray and thin and outright wear away. This exposes bare bone, which is not that smooth and slippery, and leads to the “itis” or inflammatory process we feel as “arthritis” via the symptoms of stiffness, immobility and pain.

When talking about the spine specifically, the places where two spinal bones, or vertebrae, meet include the donut-like intervertebral discs (which I will refer to as discs from now on), which sit between two adjacent “bodies” of the vertebral bones, in vertical relationship, and the two posterior facet joints, right and left, whose smaller surfaces are covered by a thin coating of cartilage. The most common area for arthritis in the spine is in the lowest part of the lower back, or lumbar region, due to extra effects from gravity of holding up the belly, torso, head and arms. The next most common area is the neck area or cervical spine, likely due to its incredible mobility and relatively short intervertebral discs. The thoracic area or rib cage region of the spine is often affected when two other complicating factors are present: scoliosis, or curvature of the spine, and osteoporosis, or thinning of the bones. I’m sure there will be more on those topics at another time.

Coming back to the discs for a minute, all the cumulative factors mentioned above can cause these guys to lose their normal integrity, resulting in the discs losing water and drying out, which increases the risk of them breaking open or rupturing their tougher outer ring known as the annulus fibrosis (even sounds tough!) and extruding or pushing out their inner contents, which is the gel-like inner part, the nucleus pulposa, often compared to the jelly in a jelly-filled donut. The discs also lose some of their height, which normally helps to keep a healthy distance between two vertebrae. This can then result in the facets rubbing more closely together, the opening for nerves narrowing enough to start pinching on nerves, and other such difficulties! When that nucleus pulposus material is released into the spinal canal, which sits just back of the discs and where your spinal cord descends down from the brain to the tail bone, it causes a local flare of inflammation that can last a while. When the disc is losing height but does not rupture, we call that degenerative disc disease (a bit of a misnomer, as it may not be a disease per se, but more like a natural aging process of the disc). This alone can result in pain for some, and it can be found in adults starting in their thirties!

How’s yoga supposed to improve this arthritis situation of the spine? Well, those of you who have been in class with me lately have heard me use the phrase “the prime directive.”  Sounds a bit Star Trek-y doesn’t it?  But in this setting, it refers to the inner action of creating an even lift from the base of the body, either the tailbone or the sitting bones, up through the whole length of the spine to the crown of the head. This is technically known as axial extension, and, according to Leslie Kaminoff, it does create a longer spine, even as it slightly diminishes the amount of natural arch in each region of the spine. That is, it straightens the spine a bit, but not entirely.  And it requires some muscular effort, especially if you have not been practicing it. You can do this anywhere, anytime, and if you are doing it and paying attention to how it feels as well as, perhaps, how it affects your breath, and you remain connected to the action for a bit, you have a mini yoga practice under way. 

And then from there, you can take the spine through some gentle range of motions, via some easy, basic yoga poses, such as Cat/Cow pose, Child’s pose to low Cobra pose, Standing Side Bend (sometimes called New Moon pose), and gentle reclining or seated twists. As you do this, you are always assessing the effect on the area of your spine that is sensitive, modifying the intensity, range of motion or number of repetitions or length of holding to make it appropriate for you situation. I believe that a while back Shari mentioned that movement actually hydrates, nourishes and revitalizes the discs of the spine, so inactivity is not a great option, is it? (See Yoga for Osteoarthritis for an interview with Shari about arthritis.).  So let’s get moving, yogis!  Great to be back from spring break. More good stuff tomorrow! See Arthritis of the Spine, Part 2 for more poses you can do to find relief from back pain and to lengthen your spine.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More