Advice on Practicing Yoga in Middle Age, Part 2

Here is part one of his responses. A third and final set will appear on Booming next week. More than 100 readers submitted questions about aging and yoga; because of the volume, not all could be answered. Some questions have been edited for length, and new questions are no longer being accepted.

FIRST, A THANK YOU

To everyone who asked me questions, thank you. Many people start doing yoga when they are young. There is also a large group who begin doing yoga after 50, who become enthusiasts and continue for the rest of their lives. I think yoga is a perfect match for us as we grow older, because it’s no-impact, good for flexibility, balance, coordination, strength and attitude. Answering your diverse, intelligent questions has given me new ideas for research into the fascinating topic of yoga for those over 50.

OSTEOPOROSIS

Q. What about yoga for osteoporosis. I’m 65, have been doing yoga for 20-plus years, and continue to do forward bends, plow, shoulderstand and twists, all presumably not O.K. for osteoporosis. I’m just at the line at 2.5 dexa. I don’t want to give up these postures if I don’t have to. What’s the risk? — Cat, NYC

Q. Hi, Loren. Please share your thoughts on the almost universal advice given to older people with bone density issues that they should avoid any kind of spinal flexion altogether. Clearly, there is a difference between spinal flexion as a normal range of motion that is necessary to do daily movements like tying your shoes, and a “loaded” lumbar flexion that occurs in a pose like halasana, or even a standing forward bending movement with the arms extended from the body. I have seen many people who have been trained to fear fracturing their spines in normal ranges of motion, and they impose tension and restrictions on their movement and breathing that actually worsens their condition.— Leslie Kaminoff, New York City

Q. I used to practice yoga but I found out from a Dexa scan that I have osteoporosis of the spine and although I have not had any fragility fractures I’m concerned about any forward bending or twisting just in the course of every day activities. It’s affecting the quality of my life because I’m thinking about osteoporosis every time I move. It would be wonderful to have some practical guidelines. Thank you. — Maracache, California

A. On Sciatica.org I discuss 12 poses that can be used to prevent and treat osteoporosis and osteopenia.

Many readers wrote in with questions about osteoporosis. Cat in NYC and Mellieone in New Zealand have osteoporosis, and have been doing all the poses that they’ve been told not to: Cat does forward bends, the plow, shoulderstand and twists. Mellieone’s regimen is similar, and neither of them have any pain. Diane in West Hartford and Nancy B from Maryland find that even gentle yoga gives their osteoporotic backs considerable pain. Maracache in California and Leslie Kaminoff in New York want clarification: surely we all have to bend forward, so what are people with osteoporosis supposed to do?

Mehrsheed Sinaki from the Mayo Clinic showed long ago that forward bending does produce more osteoporotic spinal fractures. Once you have one fracture, your spine is inclined even more forward, and the risk of a second fracture is even higher. These fractures are not life threatening, but they are usually quite painful. And a second fracture raises the likelihood of a third.

So forward bends should be done only with a straight back, or, if you’re not confident you can do that, stick with Supta Padangusthasana: lying on your back and raising your straight legs as far as possible. Your back will stay straight, thanks to gravity and the good carpenter that made the floor, but you’ll get all the benefits of a forward bend, and some of the good that comes with inversion.

Twists are a different matter, in fact, just the opposite. Many yoga practitioners, including excellent ones like Sara Meeks and Carole Krucoff, caution against doing twists if you have osteoporosis, but the only research papers addressing this in the literature that I have found actually say the opposite: that they are safer than forward bends.

I recommend going along with the literature. But there is another reason not to avoid twisting:

If you think about it, there are very few other ways to strengthen the vertebral bodies. In a clinical trial I am conducting to examine the possible benefits of yoga for osteoporosis, more than 500 people have used my 12-minute DVD with what I consider safe and helpful yoga poses for osteoporosis. This amounts to over 60,000 hours of people, mainly with osteoporosis or osteopenia, doing three twists, without even one report of a fracture. I repeat, there are no reports of fractures. Many of these people have before-and-after X-rays of the spine that have, at least so far, revealed no new fractures either. This is important because in spite of their often painful nature, some vertebral fractures are “silent.” So twists appear to be safe, provided you keep your back straight. Of course, until the trial is over no definitive conclusions can be stated, but the data so far are promising.

Yoga does not necessarily prevent bone loss altogether. Irene of the Connecticut Valley, who wrote in, is also in our study, and although 80 percent of the people reporting so far have gained bone after two years, she has lost a little in the spine, and held her own (without medicines) in the hip. My criterion for success in the study is no fractures of any kind. A person’s bone mineral density (usually measured through a DEXA scan, which is something like an X-ray) is well correlated with fractures, but is not the same thing: fractures are also reduced by better balance, improved strength, greater range of motion, enhanced coordination and lower anxiety, all of which are produced by yoga, not medicine. No medicine can do that. There are medicines that lower anxiety, but they impair balance. For more information about my study, go to sciatica.org.

SHOULDER PAIN

Q. Four months ago I also hurt my shoulders doing the plank pose into downward dog. Even if I kneel into the plank position first, then go to DD, I reinjure my shoulders. Warrior poses are not as painful. Should I avoid planks/downward dog poses in the sun salutation sequence? — BeauJoe Lais, California

A. Several readers (including Janine K from Seattle and Crone from Oregon) asked about shoulder pain. Downward Dog can be particularly dangerous to shoulders. That’s true even if you have a good teacher. So avoid doing it if you have a shoulder injury. Also avoid plank pose, and the crocodile, Chattaranga.

The triangular forearm support, the headstand and variations, however, can be used to end shoulder pain for people with rotator cuff tears by training the subscapularis muscle to take over for the supraspinatus. This relatively simple solution has helped many of my patients avoid a costly, painful and unnecessary surgery.

REGAINING RANGE OF MOTION

Q. At 5 feet 10 inches tall, 165 pounds and 57 years old, all of my previous exercise regimens (tackle football as a youth and through high school, long-distance bicycling and running), before becoming a professional desk jockey, have formed me into a hunched-over hulk with a variety of injuries resulting from the imbalances imputed by those practices. Currently, muscle and joint tightness keeps me from the level of yoga I desire (I’d like to be able to do a decent forward fold and cobra). . . . All of my back bend-related asanas (cobra, sphinx, up dog, bridge, etc.) are extremely shallow. Enduring discomfort as a part of a method to increase the range of motion limits of these asanas would not be a problem for me, nor would specific strength training exercises, if they were recommended, but I have not been successful in finding a resource I can trust. With professionally modified yoga practice, can one expect to reverse the effects of a lifetime of debilitating physicality and regain significant loss in vertebral column range of motion? — Roe Bear Toe, Cedar Rapids, Iowa

A. Roe Bear Toe in Iowa, as you get older, your intervertebral discs gradually convert some of their water content, into fat, which limits their flexibility some. Otherwise tight ligaments, shortened tendons, stiff muscles and slumpy posture will all yield to gentle pervasive yoga poses and related maneuvers. One other caveat: men injure themselves more than women, largely, I believe, because they pit their greater strength against their lesser flexibility and end up hurting themselves. So reserve the might of the high school tackle for other things, and do the yoga to gain self-control, not to lose it.

OVERWEIGHT BUT INTERESTED

Q. I am extremely overweight, age 56, 270 pounds, 5 feet 6 inches tall. How should I start practicing yoga? Other than the weight I am well. I have done yoga in the past. I practiced along with a TV show (Lilias) when I was much younger and I was the proper weight, 135 pounds. I enjoyed it. I worry about the weight because everywhere I look the people doing yoga are very thin and seem to already be in shape! In the Times photo with this article everyone is tiny! I guess what I am really asking is, are there special instructions/programs for the obese starting out in yoga? — Rational Reformer, Oklahoma

A. There is no special instruction for overweight beginners, apart from being careful not to injure your ankles, knees and hips and the upper extremities. As your weight increases, the area of your feet and the joints of your lower extremities do not. So there are more pounds-per-square-inch in all these places. The joints of the upper extremities have no menisci, no extra padding of the kind you find in the knees. This may be because of their not usually being weight-bearing in human beings. In yoga, though, there are many poses in which the hands, wrists, elbows and shoulders do bear weight. This makes things easier on the legs and feet, but these are reasons to be especially careful of the more delicate joints above.

As William J. Broad points out in his book, “The Science of Yoga,” yoga lowers metabolism, which does not bode well for weight-watchers. But yoga can promote weight loss by stretching the organ, the stomach, that sends “satiety” signals to the appetite centers in the brain. Parsvakonasana (side angle pose), paschimottanasana (extreme forward bend) and matsyendrasana (a twist) all do this, each in a different plane.

MISCELLANY

Q. Great article but you left one name out: Larry Payne’s Prime of Life Yoga of http://www.samata.com. Larry has been promoting this style of yoga for the past 10 years. He is currently teaching at Loyola Marymount in California and is well respected around the world. — Lisa, Austin, Tex.

A. Larry Payne should not be neglected, Lisa. He has helped many people and has been a potent influence in bringing yoga therapy to where it is today, and where it is headed tomorrow.

Q. I am a 50-year-old former professional dancer and current fitness instructor (water, stretch, dance). I am interested in going through a yoga teacher training program, but don’t know how to go about deciding between different programs. I feel my interests lie primarily in teaching older students with more of an emphasis on health, fitness and therapeutic value. Any insights for me? — SH, Chicago

A. Again, I recommend B.K.S. Iyengar’s methods. Many former dancers gravitate to Iyengar yoga because it is rigorous, classical, and precise, with an emphasis on alignment. Also the former Anusa program is good, as is Integral Yoga.

Next week, Dr. Fishman will respond to questions about headstands and glaucoma risk, poses to improve balance and other questions.

Previous Ask an Expert columns can be found here.