Osteoporosis & Exercise: Safe movement guidelines for yoga and Pilates teachers
Osteoporosis has become a hot topic recently, and I’ve been receiving an influx of questions from Harmonise graduates and teacher trainees and also from colleagues seeking guidance about safe exercise options for their classes or 1:1 clients. I also have two current teacher trainees (1 yoga, 1 Pilates) living with an osteoporosis diagnosis and have been contacted by a couple of graduates who who have recently been diagnosed with Osteopenia or Osteoporosis, despite maintaining an active lifestyle.
With many people living with this condition, it’s essential for instructors to be equipped with the right knowledge to support these students in their classes. The Universe, I feel, is guiding me to share some reflections on the subject. So here we go!
What is Osteoporosis?
Osteoporosis, meaning “porous bones”[1] occurs when bone density decreases, the tiny pores in the bone increase in size either because the body loses bone or doesn’t make enough bone, this causes bones to become brittle and prone to fractures.
We are constantly losing old bone and forming new bone through a process called remodelling and we replace most of our skeleton every 5-10 years. While a reduction in bone mineral density (mass) is a natural part of aging, there are lifestyle changes and exercises that can help slow the progression or even improve bone health.
Osteporotic fractures commonly occur in the hips, spine, and wrists, and with balance also being affected as we age, including fall prevention and management exercises in movement-based classes is of paramount importance.
Statistics:
- An estimated 3,775,000 people in the UK were living with Osteoporosis in 2019. [The Osteoporosis foundation]
- 21.9% of women and 6.7% of men over 50 are living with Osteoporosis. [The Osteoporosis foundation]
- Around 50% of women and 20% of men over 50 will suffer a fracture due to poor bone health. [The National Osteoporosis society (NOS), 2013]
Risk Factors for Osteoporosis and Osteopenia (the precursor to Osteoporosis)
Sedentary Lifestyle:
Lack of exercise decreases bone density. Incorporatin weight-bearing, strength and resistance exercises will stimulate bone to produce more tissue.
Menopause:
Lower oestrogen levels decreases bone production, increasing the risk of osteoporosis for older women. Oestrogen plays a key role in metabolism and increases osteoblast
activity, the cells that builds bone. It can also play a role in calcium absorption.
Stress:
Physical and emotional stress can disrupt hormone balance and even digestion, affecting bone health.
Hormonal Imbalances:
Overactive thyroid, adrenal, or parathyroid glands can weaken bones.
– Medical procedures, such as an Oopherectomy, which affect hormonal balance.
– Kidney disease which causes mineral imbalances which in turn can increase Parathyroid hormone (PTH) levels – PTH moves calcium from the bones to the blood.
Medications:
Certain treatments, including cancer therapies or those that affect hormones, can elevate risk.
Diet:
Insufficient calcium or Vitamin D3 (which aids calcium absorption) can negatively impact bone health, B12 may also be a factor. Digestive conditions that affect the absorption of nutrients can also have an impact.
… and hereditary factors.
The importance of a holistic approach
The good news is that there are plenty of proactive steps we can take to reduce the impact of these conditions.
By adopting lifestyle changes, it’s possible not only to manage the diagnosis effectively but also to significantly lower the risk of developing it in the first place, even for those who have pre-existing risk factors.
Supporting clients with Osteopenia or Osteoporosis requires more than just weight-bearing exercises (known to stimulate bone growth). A holistic approach that considers stress levels, nervous system balance, posture, balance, functional breathing techniques, and nutritional support can offer significant benefits. By addressing the whole picture, we can help prevent falls and fractures, improving both quality of life and confidence.
Key Considerations for Working with Osteoporosis Clients
In your Pilates or Yoga classes, it’s vital to incorporate the following, whilst teaching within a safe range of movement, to support students with Osteoporosis:
Weight-bearing exercises
using resistance bands or small weights (the stronger the muscles, the stronger the pull on the bones).
Progressive overload
starting gently to avoid injury.
Core stability
exercises to support overall strength.
General mobility
exercises for overall joint maintenance
Postural alignment
exercises to prevent or counteract hyperkyphosis (spinal curvature, common in advanced osteoporosis), e.g: neutral and gentle extension which helps hydrate intervertebral discs
Functional breathing
to balance the nervous system, regulating hormones and to enhance lung capacity (reduced by kyphosis).
Standing balances
to reduce fall risk – safely practised with the support of a wall or chair
Wrist strengthening
to avoid landing on the hips in the event of a fall, and to aid in getting up safely.
Safe transitions
between floor and standing to avoid falls (assuming this is possible).
Fall prevention techniques
like coordination exercises
Confidence-building exercises
to help empower students to feel secure in their movements and overcome fear (for example after a fall event).
8 Essential Cautions for Osteoporosis
- Avoid combining spinal flexion and rotation, these joint actions put the most stress
on the vertebrae. - Avoid loaded flexion exercises like the full hundred in Pilates or any supine leg over the head posture/exercise.
- Steer clear of deep and closed twists; use gentle open rotations, within a functional range
movement. - Skip advanced postures and exercises; always assess risk versus benefit.
- In group classes, ensure the student’s ability aligns with the level – assess posture, breath, quality of movement and ability to listen to one’s body. Refer to a specialist class as required.
- Reduce fall risks with props like chairs and walls during balance exercises.
- Omit spinal flexion with advanced spinal Osteoporosis (especially hyperkyphosis) to prevent injury.
Know your client(s)
When working with clients who have an osteopenia or osteoporosis diagnosis, always take a case history and find out if there is a history of fractures. If there is, was it the result of a fall (impact) or a stress fracture (bending over, coughing – no impact). The latter is a clear indication to be extra cautious. Unless you are appropriately trained, this would require GP clearance or a referral to a specialist instructor / physiotherapist. Similarly, as mentioned above, if a student with a diagnosis joins a group class – always assess and know when to refer to a more suitable class (older adults, chair, back care) or to a specialist.
Osteoporosis is a manageable condition, and with the right modifications, Yoga and Pilates can be highly beneficial. It is possible to go through the entire Pilates repetoire and yoga asana and create a modification or alternative that would be safer for non-extreme Osteoporosis, but it’s important to have the right training. That’s where we come in…
Upcoming Training Opportunities:
Adapting movement for Osteoporosis Workshop:
27th November, 2pm-5pm
If you would like to understand what you can include in your classes to help reduce the risk of Osteoporosis, increase your confidence in working with students with Osteopenia or Osteoporosis, or if you would like to attend for your own personal interest, then this workshop is for you.
Older Adults & Back Care Course:
14th – 17th November, 2pm-5pm
If you’re ready for more advanced training and/or looking to specialise in working with this client group, this 4-day CPD course is for you. It covers various health conditions, including frozen shoulder, arthritis, hypertension, hip replacement, diabetes, cancer, lymphedema, postural deviations, Alzheimer’s and Dementia, depression and anxiety as well as back care and Osteoporosis. Class plans for many of these conditions alongside chair, wall and somatic based classes are included.
Got questions? For further information about anything covered in this article, or about our related training opportunities, email clare@harmonisetrainingacedemy.com.
Article by: Clare Francis
References:
[1] ‘Osteo’ means bone and ‘porosis’ means porous.
‘Wrist bones’ photo by Otto Norin on Unsplash
