osteoporosis - sally champa

8/12/2019 Osteoporosis - Sally Champa

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OSTEOPOROSIS

Structural Yoga Therapy Research Paper

Sally Champa

[email protected]

May 6, 2005


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1. Case Study - Initial intake, review of symptoms, subjective pain level

Marilyn

Marilyn is 57 years old and is married. Her husband just recently retired so he is home

most of the time which is stressful for Marilyn. Marilyn loves to garden and read. She

likes to travel and every year her and her husband go to Europe for 3 months. She is a

very busy person she always has to be doing something. She has a hard time sittingdown to relax. She says There are too many things that need to be done and I feel like I

am wasting time if I sit down. Her parents passed away 8 years ago and she still carriesa great deal of grief from this. She started *perimenopause at 49 years old. She has

been a vegetarian for 14 years. She likes her black tea which is caffeinated and drinks 4-

6 cups a day.

She was told in October 2003 she had Osteoporosis in the spine. She could not

remember where in the spine it had started to affect her. She was complaining of acute

pain in her right hip accompanied by low back pain, joints are very stiff, pain inside leftelbow, pain in left knee, acute pain in neck on the left side. She has continual flair-ups of

pneumonia. In the year 2000 she had pneumonia 7 times. And she has asthma.

On my initial intake I observed a high right shoulder with the head tilted toward the right.

She had a small thoracic curve of 4 degrees (with the scoliometer) to the right with the

Apex around T8. Her sacroiliac joint does not move on the right and the left. In standingand using the scoliometer her left leg was longer.

Yoga Sutra of Patanjali by Mukunda Stiles chapter 1 sutra 30-31 (p. 9 & 10) says Lack

of concentration leads to suffering, frustration, restlessness and disturbed inhalation and

exhalation. I observed Marilyn with these qualities due to her lack of concentration.

*Definitions:Premenopause are women with signs of menopause about to begin.

Perimopause are women who are having irregular periods which happens in their late40s to early 50s.

. In April 2005 she decided to go to Europe for 3 months herself to heal.


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1b. Examination Records

Dates 8/23/04 10/24/04

Range of Motion Left Right Left Right

Supine PositionHips

Leg length longer 1/8 longer

Internal Rotators Felt tight both sides Felt more movement

External Rotators Tighter on left Felt more equal

Internal Rotation 30 30 35 34

External Rotation 40 35 45 40

Hip Flexion 125 135 129 135

IT Band check Tight Tight Dropped further both

sides

Neck

Neck Lateral Flexion Very limited due to pain 35 30

Neck Rotation Very limited due to

pain

60 52

Prone Position

Hips

Internal Rotators 30 30 35 35

External Rotators 43 40 45 42

Muscle Testing

Supine position

Hips

Hip flexion 3 3 4 4

Psoas 2.5 2.5 3.75 3

Sartorius 4.5 2 4.75 3

Prone Position

Hips

Internal Rotators 3.5 3.5 4 4

External Rotators 3 3 4 4

Hip Extension 4.5 3 4.5 3.75Gluteus Maximus 2.5 2.5 4 4

Knee Flexion 3 3 4 4

Shoulders

Shoulder Extension 3 3 4.5 4.5

Lower Spinal Erectors 4 4 5 5

Upper Spinal Erectors 3.75 3.75 4.5 4.5

Middle Trapezius 3 3 3.75 3.75

With Marilyns neck pain I evaluated her ROM and muscle testing on her shoulders. She

had normal ROM.


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1c. SUMMARY OF FINDINGS

Muscles to be Released (V) Stretched (P) Strengthened (K)

Left/Right hip internal rotators-TFL Left hamstrings Left/Right Psoas

Left/Right external Left/Right internal -

Rotators rotators more on right

Left/Right external rotators

Left/Right hip flexors psoasLeft/Right gluteus maximus

Left/Right tricepsLeft/Right hamstrings &

Left/Right gracilis

Middle and Lower trapezius

1d. RECOMMENDATIONS

Marilyn was in a lot of pain in the neck and hips. She is an extremely uptight person with tremendous amount

of anxiety. I found she has been a chest breather for a long time. I first taught her the wave breath to help hercalm down and to teach her how to breath correctly. I then gave her the SI Joint Exercises to stabilize thesacroiliac joint. I had her do 12 times on each side. The poses to strengthen the gluteus maximus and the deep

6 external rotators were lifting one leg at a time straight leg and then with bent knee 6 times on each side. I told

her to work up to 12 repetitions each. Then camel with little pulses while squeezing the external rotators 6times each. I recommended the Joint Freeing Series to help with the stiffness in her joints and also to work on

calming her down. I had her do 6 times on each pose incorporating the wave breath. When she came to theneck exercises I told her to do them slowly and to focus on breath and movements. I did not want to overwhelm

her at first because she is a very stressed person.

The painful neck could be a pinched nerve so I recommended her to a massage therapist to start to release the

pain in the neck.

On our next session she felt that the SI exercises were freeing up her hips a little bit. She was continuing withthe wave breath but her mind was all over the place. I had her continue with the above exercises and I added

Cat Bows (6 times) to strengthen her triceps and middle/lower trapezius, Stick with the leg lifted and then out to

the side (6 times) to strengthen her psoas and Rolling Bridge (3 times) to continue to strengthen her externalrotators, her whole back side and front abdominals. I had her lie in Savasana for as long as she could after the

asanas. Then I taught her Alternate Nostril Breathing and had her do this for as long as she could and then to

meditate for as long as she could. Although sometimes this type of breathing was difficult because of hersinuses so I had her do it without the fingers. I also told her that she could split these up and alternate the poses

on different days.

1e. Summarize the Recommendations

To summarize my recommendations is as follows:

1. SI Exercises to stabilize the sacroiliac joint 12 times each2. Locust with straight leg and bent leg to strengthen the gluteus maximus, piriformis, gemellus superior,

obturator internus, gemellus inferior, quadratus femoris, obturator externus.


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3. Camel with pulses to continue to strengthen the gluteus maximus and the deep 6 external rotators.4. Joint Freeing Exercises to free up the stiffness in her joints.

5. Cat Bows to strengthen her triceps and middle and lower trapezius

6. Stick with leg lifts to strengthen her psoas7. Rolling Bridge to strengthen her whole back side and the front of the abdominals

8. Alternate nostril to bring calmness into her body and mind.

9. Meditation to start to feel her mind and body quieting down.

2a. Name and description of the condition

NAME OF DISEASE: OsteoporosisOsteoporosis is a generalized disorder of the skeleton in which the amount of bone tissue is reduced and the

microscopic structure or architecture of bone is abnormal. The word osteoporosismeans porous bones.

Bone is a living tissue that has cells. Both the abnormal quantity and quality of the bone make it weak and

susceptible to breaking given even minimal amounts of trauma. The result of osteoporosis can be viewed asskeletal failure. There is no documented evidence that bone loss or reduced bone tissue itself, in absence of a

fracture, is associated with pain or any other symptoms. This means that there are no symptoms of osteoporosisper se, only consequences: fractures and associated chronic pain, deformity, and disability. This is why it iscalled the silent disease.

You can think of your skeleton as a bone bank. Just as your financial health benefits from funds that you putaside and can draw on in time of need, your bone health benefits from a fund of calcium and other minerals that

you store in your skeleton. Good bone health depends on keeping your bone bank account solvent, fullysupplied with minerals and able to meet all of your bodys needs. Throughout your life, new bone is constantly

being formed and deposited. Old or worn-out bone is constantly being broken down and withdrawn. This

process is how your skeleton refurbishes and maintains itself. For adults, the ideal situation is to have about asmany deposits as withdrawals.

Some key terms when talking about the bone bank are: bone massis the total amount of bone tissue you have

in your skeleton-the total assets in your account at any time; bone density refers to how tightly that tissue ispacked-that is, how mineral-rich you bones are; bone strength refers to the ability of bone to withstand stress

which depends on bone density, mass and quality. The more bone you have and the denser it is, the stronger

your skeleton and the stronger and deeper your bone bank account.


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Generally, after about age30, our bone bank account

begins to shrink.

Withdrawals from youraccount are exceeding

deposits. You gradually

begin to lose bone mass

and bone density. This is

normal. Whats not normalis when the withdrawals

exceed deposits at such arate that portions of your

skeleton become weak and

brittle. Bone loss doesntmean you actually lose

whole bones. It is the

mineral content of the

bones that is depleted. Theouter shell of a bone

becomes thinner, and theinterior becomes moreporous. This action

bankrupts your skeleton of

its strength.

Your risk of osteoporosis doesnt depend only on your current rate of bone loss. It also depends on how muchbone you banked in your account when you were young and growing. That makes osteoporosis a young

persons concern as much as an older adults concern according to the Mayo Clinic (p. 7).

A certain amount of bone loss can be expected as you age. How much calcium and other minerals that have

been deposited in your bone bank during the years of peak bone formation is critical. A high peak bone masscan counteract or cushion the impact of bone loss in your later years and may lower your lifetime risk of

fracture. Recommended by the Mayo Clinic (p. 26) to maximize your peak bone mass:

Consume a balanced diet with adequate calories, vitamins and minerals, especially calcium and vitamin D.

Get regular exercise because physical activity contributes to higher bone mass.

Avoid smoking and excessive alcohol and caffeine.

For teenage females just starting to menstruate, avoid excessive dieting and other behaviors that can interfere

with the timing of menstrual periods.

Even if youre past the age of peak bone mass, these actions can still help keep your bones strong and healthy.

The Wisdom of Menopause (p. 369) reports: Osteoporosis begins in earnest at perimenopause, but its effectsmay not appear until twenty or more years later, often when it is too late to do much about it. When it comes to

bone health, prevention is absolutely essential. And that prevention must begin in perimenopause.

The Wisdom of Menopause (p. 371) states: We are designed to live on this planet well supported by sturdy

bones from youth to old age. Like other degenerative diseases so common in Western civilization, such as


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coronary artery disease, hypertension, and obesity, osteoporosis is either unknown or very rare amongindigenous peoples living time-honored lifestyles characterized by a strong connection with the wisdom of the

earth. A deep sense of connection to the earth shores up the health of our first emotional center the part of our

emotional anatomy that is associated with a sense of belonging, and with our basic sense of safety and securityin the world. This sense of safety affects our bones, blood, and immune systems. This information points to

the first chakra Muladhara and second chakra - Swadhisthana.

Before a diagnosis of Osteoporosis the patient might get diagnosed with Osteopenia. Osteopenia refers to

decreased calcification or density of bone. Having osteopenia places a person at risk for developingosteoporosis. Bone density is described in relationship to what it should be in young women; it is expressed as

a standard deviation from the mean (average) bone density in a 35-year-old. Within 1 standard deviation of themean in either direction is considered normal. A bone density within the range of 1 to 2.5 standard deviations

below the mean is defined as osteopenia, and greater than 2.5 standard deviations below the mean is

osteoporosis. Osteopenia is a warning -- time to sit up (actually, time to walk around the block and lift someweights!) and take measures to prevent developing osteoporosis.

It is important to make the distinction between osteoporosis and osteoarthritis. Osteoporosis is a disorder in

which the bones become weak and susceptible to fracturing. Osteoarthritis affects the spaces between thebones, or joint spaces, which contain cartilage, other connective tissue, and shock-absorbing fluid. The joint

becomes swollen, inflamed, and deformed, the cartilage is eroded, and bone spurs (small pieces of bone tissueoutside the normal confines of the bone) may grow. The causes and treatments of osteoarthritis are verydifferent from those of osteoporosis.

Osteoporosis occurs most frequently in postmenopausal women, sedentary or immobilized individuals, andpatients on long-term steroid therapy. Almost one in every two Caucasian women will suffer an osteoporosis-

related fracture at some point in her lifetime. The corresponding number of Caucasian men is one in four. Thegreater risk in women versus men is related to smaller body size, smaller bone size, lower bone mass at its peak

and greater loss of bone in midlife due to the menopause. Cosman (p.8) recommends: getting a bone density

check when menopause begins or by age sixty or sixty-five. I do not recommend getting tested in thepremenopausal years because there is no drug to take to get rid of the disease. She feels it is unnecessary and

even unhealthy. Some people argue that getting a test at an early age may help younger women stick with goodpreventative measures, but there is little evidence to support this argument, and it is hard to justify the cost of

these tests in a medical system already overburdened with expenditures. This disease is a psychologicalchallenge at any age.

The medications that are currently on the market help to slow down the bone loss process and not to activelybuild up the bone tissue. In general, premenopausal women manifest little total skeletal bone loss until they

reach perimenopausal phase of life.

Few studies suggest that women who took the pill had a higher bone mass than women who did not. However,

oral contraceptives have a risk of breast cancer.

The early postmenopausal years are associated with a specific increased risk for the occurrence of wrist and

vertebral fractures. While wrist fracture frequency does not increase further as women get older, almost all

other osteoporosis-related fractures continue to increase in occurrence with advancing age.

The key of osteoporosis is to prevent the disease before it happens. The keys to success are building a strong

skeleton when youre young and slowing the rate of bone loss as you age according to Mayo Clinic (p. 3). It is

never too late to do something about your bone health.


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2b. Common Symptoms

Osteoporosis is called a silent disease because it is common that it causes no pain initially, and there are no

outward symptoms. It is a symptomless condition for many years or even decades. However, the consequences

of this disease are pain, especially in the lower back, pathologic fractures, loss of stature, and various

deformities. Osteoporosis may be without a known cause or secondary to other disorders, such as

thyrotoxicosis, or the bone demineralization caused by hyperpthyroidism. The American Medical Associationdefines thyrotoxicosis as: Severe hyperthyroidism (overactivity of the thyroid gland). Hyperthyroidism is a

condition produced by excess thyroid hormone in the bloodstream, which leads to overactivity of themetabolism of the body.

2c. Related Challenges

The biggest challenge with osteoporosis is bone fractures. The fear of a bone fracture could limit their

activities. Typically these fractures occur in the spine, hip or wrist. Mayo Clinic (p. 27) reports: Each year

osteoporosis leads to 1.5 million fractures in the United States, including about 700,000 spinal fractures and300,000 hip fractures. The fractures can occur completely spontaneously with absolutely no precipitating

movements, or with activities so minor that people often cannot remember what they were doing. People withosteoporosis may develop compression fractures after a coughing or sneezing fit.

Most of the time (about two-thirds of

compression fractures), these fracturesoccur initially without any notice or

symptoms. A compression fracture of the

spine causes your vertebrae to collapseand may lead to lost inches and height and

possibly a stooped posture. Often chronicback pain eventually sets in, the person

then becomes very hunched over anddevelops the so-called dowagers hump, or

they lose height. Ultimately, even those

compressions that were initially clinicallysilent do produce problems and reduce

quality of life.

The classic dowagers hump deformity, or exaggerated kyphosis, is due to an uneven compression of the

vertebral bone where the front part of the bone, closest to the abdomen, crushes down more than the back of the

bone therefore assumes a wedge-type shape. This thrusts the spine forward over itself. A wedge-typecompression in the middle or lower thoracic spine (between the neck and lower back or lumbar spine) is

associated with the greatest likelihood of producing significant deformity. When this deformity occurs, the

patients head is often forced downward and chronic neck pain can result from the constant struggle to keep thehead upright. Walking is difficult and the center of gravity is off, making falls more likely.


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An important manifestation of the loss of

height in the thorax is restricted breathing,with an inability to fully expand the chest

cavity, resulting in shortness of breath

upon limited activity. This is probably

one of the reasons why multiple vertebral

fractures are associated with an increasedrisk of premature death, often due to

pneumonias and other lung problems. It isdifficult to expand the chest fully and to

clear secretions normally.

In addition, with loss of height in the

abdominal cavity, the abdomen is often

distended. The contents of the abdominal

cavity (all the organs, including the liver,stomach, and intestines) need a certain

volume of space, and if the height dimension is reduced they push outward, thereby increasing the depth or girtharound the middle. Due to the cramped space, there is often an inability to eat a full meal, abdominaldiscomfort, and constipation and excess gas. With all these chronic symptoms, patients can become depressed

and socially isolated.

By far, the fracture that causes the most misery in osteoporosis is the hip fracture. Only one-third of the people

who break a hip ever return to being as active as they were before the fracture. These fractures occur at the topof the thigh bone or femur. They increase dramatically in frequency in women after age sixty-five and in men

after age seventy, with progressive increases in risk with advancing age. Hip fractures are accompanied by

severe pain in the groin,buttock, or hip, and almost

always render the victimunable to stand or walk.

Because the hip fracture

requires surgical repair, there

are surgical complications.Infections, bleeding, and

blood clots are all possible.

The risk of dying in the yearfollowing the fracture is 15 to

20 percent higher than in a

group of individuals of thesame age with no hip

fracture. Many patients will

need rehabilitation to make

any reasonable recovery. Hipfractures are frequently on of

the ways in which healthy older people begin to suffer major disability.

Diet related challenges are not having enough vitamin D, magnesium, potassium, iron, and other minerals in the

diet, all of which are critical cofactors for moving calcium into the bone, which your body cannot absorb


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calcium efficiently. And if the body cannot absorb something, it cannot use it. Some of the unabsorbedcalcium will stay in the body where it can show up in the joints (arthritis and fibromyalgia), in your arteries

(heart disease), and in your kidneys (kidney stones). The American diet is full of a lot of calcium-wasting foods

high levels of protein and phosphoric acid which is in soda pop.

It has been found that caffeine reduces the absorption of calcium from the bone. The Wisdom of Menopause (p

379) states: Caffeine results in increased urinary excretion of calcium; the more you consume, the more

calcium you lose. If your calcium intake is relatively low to begin with, regular caffeine consumption could

result in significant loss of bone over time. If, on the other hand, your calcium and mineral intake is high, acouple of cups of coffee a day probably wont matter much. Note: Even though tea contains caffeine, both

green and black tea have been shown to build bone mass-probably because of their phytoestrogen content.Also, excessive amounts of salt and protein may increase the amount of calcium excreted in the urine. The low

carbohydrate diets are creating risks for the younger and older women on these diets.

Changes to be made in the diet are: eat less animal-derived protein, eat an alkaline diet which consists of fruits

and vegetables especially dark green leafy vegetables, carrots, almonds, tofu, miso and other soy products,

seaweed, and salmon. Include calcium rich herbs such as nettles, horsetail, sage, oatstraw, borage, raspberry

leaf, and alfalfa. Current studies show that calcium citrate malate may be the most easily absorbed. However,dont try to get the calcium from antacids that contain aluminum, which causes the calcium to be excreted.

Other diet related changes include cutting down on alcohol and stop smoking. An occasional cocktail or asingle glass of wine in the evenings may actually slow bone loss in postmenopausal women (but not in those

who are pre or perimenopausal). Chronic drinking can also elevate parathyroid hormone levels in the body,

which signals the bones to release too much calcium into the bloodstream. According to The Osteoporsis

Solution: An Australian study has shown that smoking one pack of cigarettes daily throughout adulthood

would have a deficit of 5-10% in bone density by the time they reached menopause. Plus smokers have a moredifficult time absorbing nutrients from the foods they eat. Malabsorption of calcium, magnesium, vitamin D,

and other vitamins and minerals from foods can cause the body to search for other suppliers, such as the bones.

3. Ayurvedic Assessment of the ConditionOsteoporosis is an increase in Vata and a decrease in Kapha. It disturbs the flow in the body including

assimilation of nutrients and their delivery to bone tissue. Ama is the buildup of toxins and impurities thatblock the flow of nutrients to the bone and disturb the natural biochemistry of the bone structure. Osteoporosis

is a disturbance in asthi (bone tissue) and requires tissue specific recommendations to help reverse the

imbalance. Susan Brown from Better Bones, Better Bodysays: Osteoporosis is really our magical bodysintelligent response to long-term imbalances and stressors. Vasant Lad states: According to Ayurveda, a

woman should take natural herbal estrogen that is present in shatavari and other herbal remedies. Shatavari is

effective in preventing osteoporosis during menopausal age. However, if you give a woman synthetic estrogen,her menstruation can return, or she may develop pitta symptoms, because estrogen is pitta provoking. Natural

estrogen is present in shatavari, guduchi, and aloe vera as these all decrease pitta. Every tissue requires ojas

(the essence of properly nourished bodily tissues, it maintains immunity, strength, and vitality of the body.) tohelp its proper formation. Lack of ojas leads to wasting conditions and contributes to osteoporosis. Health

problems at menopause such as osteoporosis represent an imbalance in the body that were already growing in

the body and are unmasked by the stress of shifting hormones.

First to balance Vata the Joint Freeing Series, the wave breath and a pranayama practice. To work on Kapha

they want to incorporate a yoga program to build strong bones so a weight bearing program to build strength

and stamina.


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Ayurveda can also offer nutritional guidelines and herbs to balance Vata and build up Kapha. This can beworked on by a trained Ayurvedic practitioner.

I could see a lot of increased Vata with Marilyn. Her skin was dry and she looked dehydrated. She had a lot of

worry and anxiety and I sensed some deep fear that may had to do with the loss of her parents and her health

issues. The signs of decrease Kapha were stiff joints and things had to be done her way.

4. Common Body ReadingPoor posture in the early years heightens the risk of developing hyperkyphosis later in life. Common bodysigns are shrinking in height, the vertebrae in your spine will compress or even collapse, forward head position,

collarbones move forward, collapsed chest which then the lungs will lack adequate space to function and press

against the diaphragm and move it downward against the abdominal wall. The abdominal muscles weaken,which causes more problems in the lumbar spine. Due to these imbalances in the spine ROM will be limited

and can be the cause of lower back pain.

5. Contraindicated Yoga Practices and General Activities to Modify or EliminateWith Yoga, backbends would need to be modified to make sure there was no compression in the spine. It isimportant that the person be very aware of lengthening the spine before going into a backbend. Doing spinal

flexion may compress the spine. When doing lateral poses work on elongating the waist and watch that there is

no compression while doing side bends. And of course headstand and shoulderstand would put too muchpressure on an already weakened vertebrae and should be avoided.

If the person has already begun to lose bone mass and may therefore be susceptible to vertebral stress

fractures running can put too much stress on your knees, ankles, and lumbar spine. The other problem with

confining weight-bearing exercise to walking or running is that these activities only benefit your lower limbsand do nothing to strengthen your wrists, shoulders, upper back, or elbows.

Poor body mechanics, such as slumping while in a seated chair or standing should be avoided. Always work to

stand straight and keep working to align the posture.

6. Generalized Recommendations

6a. Therapeutic/Free of Pain

A course of action to follow for preventing osteoporosis or someone who has osteopenia would be to follow the

first yoga sequence in appendix A. Also, please refer toExercises for Osteoporosisby Dianne Daniels for more

sequences to follow for someone who has osteopenia or osteoporosis.

If the person is in pain get them out of pain. The Joint Freeing Series will help with lubricating the joints and

increasing range of motion and decreasing Vata. If they have Khyphosis it is important to stretch the rectus

abdominis, pectorals and upper trapezius and strengthen the thoracic erector spinae, middle and lower trapezius.

Patricia Waldon for recommends for people who have osteoporosis forward bends to help quiet the adrenal

glands, mitigating the effects of the fight-or-flight response, and backbends to energize them. However, I haveseen other books say that forward bend may compress the spine. Regarding flexion vs. non flexion Mukunda


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recommends: keeping anatomical curves in all asanas. Have the client come two-thirds into a hip flexion poseand make sure they dont lose the lumbar curve. Keep the spine elongated in every pose. Twists are equally

effective for regulating the adrenals, which provide adequate amounts of estrogen and androgen for healthy

bones. The wave breath would be helpful here. Always end with Savasana.

6b. Stabilize the situation and lifestyle change recommendations

Continue to monitor the progress and work on weight bearing poses to increase Kapha. Keep the joints mobile

and flexible, move in and out of standing poses several times before holding the position. Do not hold a posetoo long or lock your joints, but focus on creating freedom in the joints. Starting with standing poses and Sun

Salutations done rhythmically with the breath will balance Vata. And as they become stronger incorporatesupported shoulderstand and plough pose. However, if they already have osteoporosis fractures, avoid sudden

or jerking movements. Do not do headstand or other unsupported inversions that could bring weight to bear on

the spine.

Patricia Waldon recommends when working with osteoporosis, it is important incorporating inversions

(supported so as not to compress the spine) and weight-bearing asanas in their daily practice. Downward-facing

dog pose especially down dog with the use of ropes, headstand, handstand and upward-facing bow pose are allbeneficial. If they are an advanced practitioner, standing on the hands or doing an elbow balance such as

Pincha Mayurasana works well too. These poses, as well as upward-facing bow pose, enables them to lift theirown weight, which is very important for building bone mass. Again, all of these poses would be beneficial forthe advanced practitioner. Someone in their 60s would benefit more from supported inversions such as

supported bridge.

If working with deficient lungs, asthma, or depression introduce intercostals breathing and a pranayama practice

of Kapalabhati. Continuing the wave breath and once they are comfortable with this incorporate alternatenostril breathing.

Maintain good posture, with your head over your shoulders and your shoulders in line with your hips, to preventpressure on your spine. Practice sitting, standing, and walking with the same posture you use in Tadasana.

Incorporate restorative poses that allow your body and your muscles to relax completely. Also starting a mantra

practice can be very beneficial for uplifting the persons spirits and honoring where they are at in life.

Change the diet to eating less animal protein. Research has shown that eating less animal derived protein will

loose less bone mass. Supplement the diet with calcium by taking Juice Plus+ which is 17 fruits and vegetablesin a capsule. Absorbing the calcium from a supplement is very important. According to the Journal of Current

Therapeutic Research 1996: Test subjects on Juice Plus+ showed significant increases in blood plasma levels

of key antioxidants after only 28 days on Juice Plus+. For more information on the different tests done see thewebsite given under references.

Spending twenty-five to thirty minutes three or four times a week in the sun will give you the vitamin D thebody needs to absorb calcium effectively. Taking additional supplements like vitamin K, magnesium may help

the bones stay less breakable, according to researchers at Tufts University, Boston.

It is helpful to look at the environment. Make sure there is not clutter around for the person to fall and create afracture.

6c. Maintenance of underlying issues at the root of the situation


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Maintenance of the breathing practices, weight bearing poses and Joint Freeing Series as a daily practice isimportant in stopping bone loss and building new, stronger bones. Incorporating the machines at the gym,

walking, and low impact aerobics could be other alternatives for a change of pace and to keep the patients

mood elevated.

The following recommendations could be used at any point in the therapy:

Herbs: Use of herbs that improve the absorption of calcium into the bones. Herbs that will help digestion to

increase absorption of calcium.

Meditation: To quiet the adrenal glands and produce calmness in the body.

Breath: Continuing with the wave breath and the alternate nostril breathing. Also, incorporating the agnisar

kriya to improve the digestive fire.

Foods: Eating alkaline foods such as fruits and vegetables and foods high in calcium. Possibly adding Triphala

to improve the digestion.

7. Questions and Answers from Yoga Forums

Questioner

August 5, 2004

Ive checked your forum and Structural Yoga Therapy book in search of an answer to the question of whether standing balancingposes like tree and eagle are good weight-bearing exercises to help prevent osteoporosis. I know the standing poses and inversions are

good for this, but dont find any evidence that the balancing poses like Tree Pose, Eagle, Warrior III, etc are good weight-bearing

poses for preventing osteoporosis. I have a friend with osteopenia who has asked me if balancing poses are good weight-bearing

poses. I have told her the standing poses (Triangle, Warrior II, Parsvakonasana, etc.) are good poses, but dont know about tree and

eagle. Thank you for your help. I enjoy getting your electronic newsletter and have greatly enjoyed and used your book, StructuralYoga Therapy.

AnswerIn theory any poses that put stress on the bone tissues will help prevent osteoporosis. Balance poses will certainly tone abductors and

adductors, which in turn may stress the femur and hip joint. though i suspect this theory is quite limited in its understanding of the

condition. Not being well trained in medical information, i cannot answer this. instead i would recommend you check with the yoga

research and education center, the experts on what has been tested. www.yrec.organd ask there. You can also go to esutra group [email protected] ask to be put on the list then you can ask the group of over 1000, many are medically trained yoga

professionals receiving those messages, perhaps they can answer this query. namaste mukunda

Questioner

July 15, 2003

I am looking for asanas that are beneficial for osteoporosis. My mum has this, and has been practicing yoga since the early '60s. The

teacher training that I am following is not too keen on yoga therapy, arguing that you do yoga for you whole being, and not for

therapeutic purposes -- well, I'm sure you know that sort of comments. Could you perhaps recommend a few asanas? I could imaginethat backbends are good, but perhaps not so much for a 74-year old spine. If it doesn't bother you too much, I'd be very happy to hear

from you. Thanks. Best wishes, L

Answer

Yes doing a committed yoga practice is good for whole person. But each whole person has unique challenges and so it is best to listento the motto "Modify the practice to the individual needs." In general to work with this situation you want to hold the poses longer

while doing full breathing, a kapha approach to strengthening not only bones but also immune system. So the ideal is fewer poses but

held longer. Standing poses (but not balancing poses) are best as they strengthen the hips and lower body. Also poses that emphasizestrength of spinal column -- locust and cobra -- are good second choices.


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Questioner

May 10, 2002

I have a prospective student with severe osteoporosis. (51 yr. old female -- spine cracked during hysterectomy 18 months ago.

Sedentary since then. 25 pounds overweight.) Any recommendations would be appreciated.

Thanks! M

Answer

To build up the bones I would recommend that you look to Ayurvedic principles for increasing Kapha and its subtler component Ojas.

See Prakruti by Robert Svododa for recommendations here. On the Asana level focus her on doing my Joint Freeing series asdescribed in Structural Yoga Therapy book for strength (chap. 18 - pg. 171). She will benefit greatly by identifying the specific

muscles that she is strengthening as described in the chapter 16 on anatomy. The objective is not necessarily for her to learn anatomy

as it is to feel her anatomy responding with contraction forces in the specific places that are ideal for each motion. Learning to feel the

feelings of strength as distinguished from stretch is often a surprisingly confusing experience for many students. Often what is

perceived as a stretch is really strength and tone. When this is clarified the student makes progress in toning the muscles, bone strengthis necessarily built on this foundation over time. I would keep this woman to only doing this series with mild modifications to

compensate for the tendency to be bored. I would not recommend asanas except those done lying on the floor to strengthen the spinal

column (erector spinae muscles not latissimus - in other words do not use arm strength), until she is feeling emotionally and physicallystronger.

Questioner

July 1, 2002

Pertaining to the question about osteoporosis...Ayurveda does not promote the increase of ANY DOSHA. The goal is to reduce the

Vata dosha that is causing dryness, emaciation, weakness, constipation, dry skin, dry hair, inability to go to sleep easily at night and

stay asleep, and all the other signs of Vata provocation. The increasing of any dosha is very, very different from DECREASING THE

AFFECTED DOSHA through proper diet, lifestyle, Asana and pranayama practices, even proper mediation for specific dosha...vikrutiand Prakriti. To increase Kapha dosha will only created congestion in the nadis...the individual needs to be assessed with a

consultation and pulse diagnosis for proper protocol to be determined.

As much as we would like these steps to be a simple answer, osteoporosisis usually do to a Vata type Prakriti, leading a very typical

Vata provoking lifestyle and diet and even Yoga practice for years which has lead to osteoporosis. Eliminating deep seated Vata

AMA and then going through Rasayana (rejuvenation) practices like Abhangas (sesame oil massage...must make sure the dhatu AGNIis strong enough to support the obligation therapy) is one practice that could be helpful. The most important step is to stop provoking

Vata.

Love, blessings and health to all. P

Answer

P is on the staff at Rocky Mountain Institute of Yoga and Ayurveda (www.earthlink.net/rmiya) with me. I highly respect her advice.


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8. References

Books

YOGA FOR HEALTHY BONES,by Linda Sparrowe & Patricia Walden

MAYO CLINIC ON OSTEOPOROSIS,KEEPING BONES HEALTHY AND STRONG AND REDUCING THE RISK OF FRACTURE,by

The Mayo Clinic This book is very clear and understandable about the disease and how the bone grows.

THE WISDOM OF MENOPAUSE,by Christiane Northrup I highly recommend this book.

THE WOMANS BOOK OF YOGA AND HEALTH,by Linda Sparrowe & Patricia Walden

MOSBYS MEDICALDICTIONARY,6TH

EDITION

WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT OSTEOPOROSIS,by Felicia Cosman, M.D. I highly recommend thisbook.

MENOPAUSAL YEARS: THE WISE WOMAN WAY,by Susun Weed

THE OSTEOPOROSIS SOLUTION;NEW THERAPIES FOR PREVENTION AND TREATMENT,by Garl Germano, RD, CNS,

LDN & William Cabot, MD

EXERCISES FOR OSTEOPOROSIS,by Dianne Daniels, MA I like this book a lot as well. It has a great deal of

beneficial exercises for osteopenia and osteoporosis

AYURVEDA FOR WOMEN,by Robert Svoboda

General Information about Osteoporosis

National Osteoporosis Foundation: www.nof.org

Osteoporosis and Womens Health: www.osteoporosis_and_womens_health.com

Osteoporosis Education Project: www.betterbones.com

Womens Health Initiative (WHI): www.hhlbi.nig.gov/whi.com

Dietary Supplement Information

Juice Plus+: www.juiceplus.com/+sc13461


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9. APPENDIX A

YOGA AND RELATED EXERCISES FOR BONE STRENGTH AND PREVENTATION

The type of exercise that most experts agree is exercise that involves either weight or resistance is

the most bone-beneficial. Weight-bearing activity is a term used to describe work performedagainst the force of gravity, like walking, jogging, hiking, tennis, climbing stairs, yoga.

Resistance training, on the other hand, involves the use of weights, such as barbells or Nautilusequipment.

Weight-bearing exercise may be more likely to increase skeletal mass because of its role in

stressing the bones through both gravitational force and muscular contraction. This dual action

places the bone at an above-average stress level and stimulates it to adapt. Resistance trainingputs only muscular stress on the bones, and its benefits may not be as great as when implementing

weight-bearing exercises.

A Yoga Sequence for Preventing/Reversing Bone Loss

CAUTION Do not do this sequence if you already have osteoporosis or have suffered fractures

in the past.

1. Wide-Angel Seated Pose (Upavistha Konasana)

2. Bound Angle Pose (Baddha Konasana)

3. Reclining Big Toe Pose (sputa Padangusthasana)

4. Tadasana with various arm positions

5. Standing Forward Bend (Uttanasana)

6. Downward-Facing Dog (Adho Mukha Svanasana)

7. Extended Triangle Pose (Utthita Trikonasana)

8. Warrior II Pose (Virabhadrasana II)

9. Extended Side-Angle Pose (Utthita Parsvakonasana)10. Warrior I Pose (Virabhadrasana I)

11. Intense Side Stretch Pose (Parsvottanasana)

12. Revolved Triangle Pose (Parivrtta Trikonasana)

13. Wide-Angle Standing Forward Bend (Prasarita Padottanasana)

14. Four-Limbed Stick Pose (Chaturanga Dandasana)

15. Upward-Facing Dog Pose (Urdhva Mukha Svanasana)

16. Camel Pose (Ustrasana)

17. Upward-Facing Bow Pose (Urdhva Dhanurasana)

18. Childs Pose (Adho Mukha Virasana)

19. Bridge Pose (Setu Bandha Sarvangasana)

20. Legs-up-the-Wall Pose (Viparita Karani)

21. Corpse Pose (Savasana)

A Sequence for Osteoporosis or Kyphosis

For women who have osteoporosis or kyphosis, this gentle, safe yoga sequence will relax tension,

encourage deeper breathing, open the chest, and build strength in the upper back. When lying on

the back pad the head with one or more folded blankets so that the chin is not pointing toward the

ceiling and youre not compressing the back of the neck.


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1. Corpse Pose (Savasana) with the wave breath

2. Corpse Pose with Arms Overhead (Urdhva Hastasana in Savasana)

3. Shoulder Girdle Press lye on the floor, knees bent. Inhale into the chest and as you exhale

press your shoulders and the backs of your arms into the floor. Repeat 5 times.

4. Pelvic Tilt (Setu Bandha Sarvangasana)

5. Locust Pose (Salabasana) with different arm positions6. Twisted Stomach Pose (Jatara Parivartanasana)

7. Corpse Pose (Savasana)

A Chair Sequence for Hyperkyphosis

This is designed for people who can do the above floor sequence comfortably. Make sure you

can stand up from a seated position and then sit back down with relative ease. Use the chair as aprop in the standing poses to help you balance; go slowly and mindfully, using your breath to

gauge your progress. This series of poses will strengthen the spinal erector muscles, improve

your posture, which will take pressure off of the spine, create better balance and more self-

confidence. This combination of gentle weight-bearing poses and isometric movements will

serve to build muscle and bone mass slowly and safely.

1. Staff Pose in a chair (Dandasana) with Ujjayi Pranayama

2. Staff Pose in a chair with Arms Overhead (Urdhva Hastasana in Dandasana)

3. Staff Pose in chair with Arms in Prayer Position and then out to side (Namaskar in Dandasana)

4. Leg Raises while sitting in chair (Utkatasana prep)

5. Tadasana while holding onto chair

6. Tadasana with Arms Overhead while holding onto chair (Urdhva Hastasana in Tadasana)

7. Fierce Pose while holding onto chair (Utkatasana)

8. Warrior I Pose while holding onto chair (Virabhadrasana I)

9. Half Downward-Facin Dog Pose with hands on the wall (Ardha Adho Mukha Svanasana)

10. Simple Seated Twist Pose (Bharadvajasana)

11. Corpse Pose with legs up on a chair (Savasana)

Osteoporosis Exercise Program

This program works on the neck, upper and mid back, lower back, hips, wrist, chest-arms,

abdominals, balance, breathing and skeletal alignment.

1. Resisted Neck Place a hand on the back of the skull and resist with the hand. Place the hand

on the front of the skull and resist with the hand. Place the hand on the side of the skull and

resist.

2. Retraction Squeeze the shoulder blades together.

3. Bent Arm Retraction Arms at a 90 degree angle and bring shoulder blades together.

4. Spinal Press Lie on the back with the head into a pillow. Press the head into the pillow andfeel the chest begin to lift off the floor.

5. Knee to chest Bring one knee to the chest and repeat on other side.

6. Modified Trunk Lift Lie on your stomach, head resting comfortably. Place your forearms on

the floor, elvows close to your sides. Engage your abdominals and press the hip bones into thefloor.

7. Bridge

8. Buttock squeezes While on the back, knees bent squeeze the buttocks without lifting the

back off the floor.


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9. Inner thigh squeeze On the back place a pillow between the knees and squeeze using the

inner thigh muscles.

10. Hip flexion On the back place the hands on your hip bones and engage the abdominals.

Bring the right knee up 6-12 inches off the floor, then lower slowly, all while keeping the hip

bones level (do not allow the left hip bone to sink down as you lift the right leg).

11. Hip Rotation Lie on the right side, place your head on a pillow and bend both hips and

knees to about 90 degrees. Lift up your left knee and feel the work deep in your buttocks.12. Towel wrings hold a towel with your elbows bent and next to your side. Try to wring out a

towel so that one wrist extends as the other wrist flexes.13. Angel Arms Lie on the back with the arms by the side, palms up. Bring the arms off the

floor 1, keep the elbows straight which bringing the arms in an arc until they are overhead.

14. Chest stretch starting in the fetal position bring the top arm to the other side until you feel a

stretch.

15. Breathing In and up With the hands on either side of your stomach around the belly button,narrow the waist as you contract your abdominal muscles. Feel the hands moving slightly closer

together as you exhale.

16. Knee Twist lie on the back with knees bent and feet together and slowly lower both knees

towards the right side, but do not let them touch the floor. Then slowly lower both knees to the

left side.17. Ankle Circles

18. Toe Taps While keeping heal on the floor lift your toe up toward your shin.

19. Breathing into the chest place one hand on the chest just below the collar bone. Inhale as

deeply as you can into your hand.

20. Breathing into the ribcage place both hands on the back of your lower ribcage and inhale as

deeply as you can into your hands.

21. Diaphragm Breathing place one hand over your stomach at the level of your belly button.

Inhale as deeply as you can and direct your breath into your hand.

Staying Active

Ideally, exercise should become an intrinsic part of the patients daily life. It is best to

incorporate at least half an hour a day to half an hour a few days a week. Even during regular

exercise times, they can still incorporate ways to add more activity to their daily life:

Look for more opportunities to walk: stroll to the store and take a walk in the park with a friend

after lunch.

If you drive to work, park your car farther away from the office and walk the extra distance.

Take the stairs instead of the elevator.

Do light calisthenics while watching television.

If youre doing chores around the house, set a pace and time yourself, then try to break the old

record the next time you do that chore again.

osteoporosis - sally champa

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