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Friday, January 25, 2013

Friday Q&A: Spinal Stenosis and Osteoporosis

This question of the week for this week came in about an older post from A Pair of Serendipities Re: Spinal Stenosis.

Q: Hello, I found this article very helpful and appreciate your information. I have a student who just started my class at a community college who has spinal stenosis, which as described here can be relieved by mindful forward bends. However, she also tells me she has osteoporosis (all on an intake form), which from my understanding is an indication to avoid forward folding. My class is very large and is beginners yoga, and I plan on talking with her about self monitoring and awareness, emphasis on hip hinge for forward folds, however I am wondering if you have any other thoughts in that these two conditions exist in one student simultaneously. In her early 60s, she is very motivated to be in my class.

A: Thanks for your question, and I am so pleased that you were checking out a much older post. I worry they will get cyber-dusty from not being read anymore. And your question is a great one! Even if we were not talking about spinal stenosis and osteoporosis, this sort of conundrum happens quite often for those of us who are teachers and for those of us who are students: two or more difficulties happening at the same time in the same body! Can a person get a break here!  Which one takes priority, are the recommended practices for each applicable for both, are the conditions somehow connected, and other questions can come up.

But to address your question directly: If someone has symptoms from their spinal stenosis already, but has only a diagnosis of osteoporosis without ever having had any complications (such as a fracture of wrist, thoracic vertebrae or hip), this may make your approach easier. One certainly would want to be cautious about practice intensity, opting for milder styles of practice, and since we’d like to keep the osteoporosis asymptomatic, you’d want to avoid techniques that would transmit hard, sudden forces into the bones. This can happen when jumping into and out of poses, as well as coming out of arm balances without control, in a thumping manner. But since arm balances would not serve the osteoporosis person due to the fracture risk, particularly handstand-like hand positions, this last group of poses should usually be avoided.

Regarding the safety of forward bends in osteoporosis, which we have noted can be helpful for spinal stenosis, I usually suggest that osteoporosis folks can try most beginning level poses, so spinal movements, but not to their limit. I recommend entering and exiting the poses slowly and mindfully, and not pushing or pulling on the spine once in the pose. Since most of the vertebral fractures in osteoporosis that I have seen were in the thoracic area and often associated with sudden thumping action through the spine as described above, such as jumping while dancing, if cautious, your basic beginning level yoga practice would be fine for the student with double the trouble. More specifically, I would try forward bends, back bends, twist and side bends, but gently and not to maximum range of motion. If you want to modify for this person, standing forward bends are safest, seated on a chair version the next safest, and on the floor versions the least desirable. But that still does not mean that doing seated forward bends on floor could not be included if done carefully and not to full intensity. 

As far as poses you might recommend for osteoporosis, including those that are weight bearing for both the legs and arms, it is the standing poses that are good for osteoporosis. However, those are the very poses that might make the symptoms of spinal stenosis worse. So when your class is weighted towards more standing poses, you will need to check in and make sure your student is doing OK!

So keep the conversation going with your enthusiastic student, checking in for a moment before and after class. Perhaps, if you provide that kind of service, you could even offer to meet one on one with your student to design a practice more personally suited to her needs. 

—Baxter
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