Friday Q&A: Forward Bends and Osteoporosis

Standing Forward Bend (Uttanasana)

One of our readers left the following comment on our post Featured Sequence: Mini Sun Salutation:

I am surprised you are including a deep forward bend. Research supports avoiding forward bends in osteoporosis and osteopenia and considering there are over 54 million people with osteoporosis and many don't know they are osteoporotic it seems safer not to teach forward bends for healthy aging. I think we have a higher percentage of yoga practitioners who fit the risk profile....slight, female, white, especially if they had a restricted diet in their younger years. 

This reader is concerned about practitioners who may have osteoporosis doing deep forward bends as we showed in our Mini Sun Salutation. And, indeed, for those with OP or even undiagnosed OP (they have it but don’t know it yet) forward folds hold the potential of increasing the risk of the most common fracture in those with OP: a wedge fracture of the thoracic spine. So, if you fall into this camp, I’d recommend modifying your standing forward bends by allowing your knees to bend as much as you need to help release your pelvis over the thigh bones as you bend, and maintain a more neutral alignment of your spine as you go down. That means avoiding rounding your upper back in the area of your thoracic spine.

I have a student in one of my class in her late 60s with recently diagnosed OP, and we discussed her modifying her forward bends in just this way for poses such as Standing Forward Bend (Uttanasana) and Widespread Standing Forward Bend (Prasarita Padottansana), and she has been diligent about doing so.

Having said all that, I’d like you to keep in mind that our blog is not just for older adults who might have or be at risk for OP—or any condition for that matter. So, the Mini Sun Salutation post was really just an opportunity for us to share with you a basic common modern yoga practice that you can refer to as needed. We will try to add in a few more cautions to these sequences in the future, but you should always read our posts on yoga poses and sequences through the lens of your own personal situation, and take good care of yourself by making any modifications to the poses to better serve your needs. And if you are uncertain as to the safety or appropriateness of any YFHA recommendations, check things out with your local teachers. 

—Baxter

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Featured Sequence: Mini Sun Salutation

by Baxter and Nina

The Mini Sun Salutation a simple, accessible version of the classic Sun Salutation, which skips the Plank or Pushup pose and the Upward-Facing Dog or Cobra pose that is usually included after the Downward-Facing Dog pose. This modified Sun Salutation is a great way to warm up for a full Sun Salutation, and provides a simple alternative for people who are just starting to learn this sequence.

Because you move quickly from one pose to another in this sequence, the mini Sun Salutation cultivates agility (Cultivating Agility with Yoga), one of our four essential physical skills for healthy aging. The sequence also benefits your cardiovascular system (see Yoga for Heart Health), both strengthening and stretching the muscles and connective tissue that your body’s blood vessels pass through, thus exercising your heart and encouraging more efficient flow through the piping of your system.

This sequence is also quite invigorating, and can uplift you if you’re feeling depressed or stimulate you if you’re feeling lethargic. If you’re feeling anxious, you can use a Sun Salutation to work off some of your excess energy before you move onto more relaxing poses (see 10 Ways to Soothe Anxiety with Yoga).

Mini Sun Salutation

1. Start by standing in Mountain pose (Tadasana) at the front of your mat, with your hands in Namaste position in front of your heart. Take a moment to check in with your body and your mind. For your first round, start out at a reasonable pace and let yourself warm up gradually. 

2. On an inhalation, take your arms overhead into Arms Overhead pose (Urdhva Hastasana).

3. On your exhalation, bend forward into Standing Forward Bend (Uttanasana) with your fingertips on the floor if possible. If you can’t reach the floor with straight legs, either place your hands on your shins or bend your knees slightly.

4. On your next inhalation, bend your left knee and step your right foot back onto a High Lunge pose. Keep your fingertips on the floor on either side of your front foot. If it is not possible for you to touch the floor, support both hands with blocks. 

5. As you exhale, step your left foot back in line with the right foot and come into Downward-Facing Dog. Consider staying for 3-5 breaths. Since Downward Dog is a partial inversion, you are assisting in the return of blood from the veins of the body back to the heart, as side benefit of most inversions for heart health!

6. On your next inhalation, swing your hips forward as you step your right foot to the front of your mat, coming into High Lunge once again. (Sorry, no photo yet of left foot forward in the lunge.)

7. On your exhalation, step your left foot forward to meet your right foot and come back to Standing Forward Bend (Uttanasana). 

8. On your next inhalation, bend both knees and sweep your arms and torso up into Powerful pose (Utkatasana). 

9. Stay in Powerful Pose for a breath. Then, on your next inhalation, straighten your legs and body back to Arms Overhead pose.

10. On your exhalation, release your arms and bring your hands into Namaste position if front of your heart. Take a moment in Mountain pose to check in with your body and your mind before continuing onto the next side.

Repeat the sequence again, this time leading with your left foot. Since this part of the practice will likely get the heart rate up a bit, feel free to do several rounds—anywhere from two to six.

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Balance and Strength

Today we’re pleased to present a second interview with Shari Ser, a practicing physical therapist and yoga teacher. This time we asked her about strength and balance, as a follow-up to our original conversation about balance in general (see here). 

Nina: Why is strength an important factor in our ability to balance?

Shari: Balance and strength need to go hand in hand like cookies and milk! Muscle strength has to be present in sufficient amounts for us to resist gravity and move our bodies through space, allowing us to sit, to stand, and to walk efficiently. When we are weak, we can’t move efficiently and smoothly, and our effort is often more than the effects we can produce. Strength also has to be reproduce-able and renewable. But muscle strength is very concrete, and it is something that can be improved. Just the act of standing up from a chair 10 times will build your strength. Learning to use your legs instead of your arms to stand from a chair builds strength.

Repetition of effort with your current range of motion builds strength. From coming up from a chair with no arms, you can progress to Powerful pose (Utkatasana) to build back strength as well as arm and leg strength (see here). Using a wall to pike forward over bent knees to come down into Powerful pose is easier than fighting gravity to come up into the pose. But how you use gravity will work differently on your strength. Powerful Pose trains muscles differently depending on how you do it.

For good balance, your muscles have to be both strong enough and coordinated enough to fire on demand, not with a lag time till “everything is set up just right.” So isolated strength training doesn’t translate to improvement in balance. Smoothly transitioning between positions with repetitions will build strength better. Think sun salutations, with countless modifications.

Nina: Are there particular muscles we need to keep strong?

Shari: In order for us to maintain our balance, all our postural muscles need to be kept strong. But gastroc-soleus (one of the calf muscles) is a really big deal in balance, as are hamstring and quadriceps (the backs and fronts of our thighs), quadratus lumborum (a lower back muscle), and the hip abductors, and hip adductors (the inner and outer thighs). And we need the strong back extensors to keep us upright (which is especially important if there is a pendulous abdomen pulling us forward). 

Nina: Can you list some of the key yoga poses for building strength, and explain why you've chosen those particular poses?

Shari: I have touched on Powerful pose already and mentioned Tree pose in a previous post (see here). Warrior 1 and Warrior 2 (see here) are also favorites because any standing pose that puts you into an isometric hold position with a bent knee is going to build strength in the legs. And any pose where a limb is raised up is going to build strength in that limb, and both Warrior poses have raised arms. Warrior 1 is also a backbend, which helps strengthen back extensors.

Nina: This is one of the many reasons why yoga is so wonderful. A well-rounded yoga practice, with an assortment of standing poses, backbends, and twists, helps strengthen the postural muscles you need to maintain good balance as you age. Add to this moving smoothly between poses in some form of sun salutation or moving with your breath between two poses (viniyoga style), and you’re all set!

Shari Ser has over 25 years of orthopedic experience as a physical therapist and has been teaching yoga for a wide range of medical conditions since 1999. She graduated from The Yoga Room Advanced Studies Program in 1999, and was certified as a “Relax and Renew” teacher by Judith Hanson Lasater. She currently  teaches ongoing beginner level and back safe yoga classes, and co-teaches Yoga for Chronic Health Issues at The Yoga Room in Berkeley, California. For information see here.

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