Bikram Yoga and Osteoporosis

We would like to believe that our bones will always be as strong and healthy as they were in our youth. Unfortunately, around the age of 30 we all reach peak bone mass. Our job at that point is to maintain at all costs as much bone as we can. Osteoporosis is not limited to women, but a much more common diagnosis. Bone loss begins for most women in perimenopause, but bone loss numbers jump dramatically during menopause due to dropping levels of estrogen and progesterone.

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Bone density is no joke. The figure on the left shows healthy bone; the figure on the right shows osteoporotic bone. No one wants to enter their golden years on fragile pins. Luckily, there is hope.

In addition to a healthy diet high in calcium and Vitamin D, yoga can be an excellent tool in helping maintain peak bone mass, slow bone loss and prevent fractures. Yoga is a weight bearing activity that creates torque on the bones to help build bone density, much in the same way you build muscle strength, through Wolff’s Law. Bones get stronger and stay strong when they are called upon to do more.

Yoga also helps to improve balance to prevent falls as we age. Improving spinal alignment reduces the risk of wedge fractures in the vertebral bodies that lead to that stereotypical, kyphotic, osteoporosis look. Yoga improves flexibility, lubrication of the joints and range of motion, all of which contribute to preventing the most common hip, wrist and vertebral fractures associated with osteoporosis.

In a University of Southern California and Orthopedic Hospital of Los Angeles study published in June 2010, Bikram Yoga practitioners had above average bone mineral density at the lumbar spine, hip and in total body scores. Even more impressive, each of the subjects had a total body calcium Z-score one standard deviation above the norm for their age and ethnic cohort. These findings led researchers to suggest that Bikram Yoga may hold promise in preventing or arresting bone loss in women.

While yoga can be extremely helpful in preventing or stopping bone loss, some yoga postures are risky for individuals with osteoporosis or osteopenia. There is no reason to practice with fear, but a healthy dose of caution is wise. Individuals with osteoporosis or osteopenia should use the following guidelines:

  • Limit Flexion of the Spine. Flexion=Forward. Avoid deep forward flexion like plough pose or shoulderstand and limit flexion in poses like all versions of the head-to-knee poses or rabbit. In a Bikram Yoga class, you can still execute the poses, but bend forward at the hip joint, not with the spine and avoid the chin-to-chest compression. A pose like Padahastasana should be done with the back flat, even if the trunk is far away from the thighs (no more Japanese Ham Sandwich) to ensure that the forward bend occurs at the junction of the femur and pelvis and not in the spine. Head-to-knee pose can be done in the Ashtanga tradition where the back is kept flat as shown here.
  • Backward Bending Increases Bone Density. Work your back bends to help keep your vertebrae strong and healthy as you age. In cases of extreme osteoporosis, deep back bends or extreme hyper-extension of the neck may need to be avoided. Move slowly with strength and awareness.
  • Twist with Moderation. The flat bones of the body like the ribs can be prone to breakage. Spinal twists are a great addition to your practice, but don’t try to be the girl from the Exorcist. Everything in moderation.
  • Avoid Challenging Inversions or Arm Balances. Once diagnosed with osteoporosis, your bones are not as strong as they were. Most breaks come as a result of a fall. Now is not the time to try to perfect one-armed handstand. Move your body with care and awareness.
  • Avoid Postures that Weight Bear on the Neck. The spongy vertebral tissue in the neck is prone to fracture. No plough or shoulderstand pose. Headstand should only be attempted if you are adept at the posture and can bear the body’s weight in your forearms and not the top of your head. Rabbit pose is not appropriate for individuals with osteoporosis.
  • Sit with Good Alignment. Sitting is an activity that puts a lot of pressure on the spine. When sitting or standing, align the shoulder over the hip and the ear over the shoulder to accentuate the natural curves of the spine and utilize the inherent strength in the spine.

The more frequently you practice, the better you feel. See you in class!

sara and bella headstand

Sara Curry is a Certified Bikram Yoga Instructor, studio owner and mother of two from Maine. She started practicing yoga in 2001 to rehabilitate from herniated discs.

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Practicing Bikram Yoga After a Mastectomy

Don’t let surgery limit your practice. Physical therapy is a must to improve range of motion and quality of life going forward. And, what do you know, the handouts and pamphlets with which I was sent home depict exercises straight out of the yoga tradition. Following are notations of how I modified the postures. Please incorporate what benefits your physical situation; don’t feel limited by my experience.

First, you will experience pain so move slowly into the postures. That being said, don’t let your fear of pain limit your achievements. Many times I stopped reaching at the same point I left off during the previous class, or even at a weeks old measure. I went through all sorts of pressure-relieving  modifications during the cobra series savasana because I assumed it would take months and months AND months to bear weight. It didn’t.

Test your limits every class. I’m not saying it’s okay to pop your stitches, but your body and your abilities change every day. It’s a good idea to check them every day so you don’t get stuck in last week’s temporary inability. For convenience, I’ll refer to a ‘well side’ and ‘surgical side’ to avoid all the rights and lefts.

Pranayama: One elbow will not be able to lift as high as the other, or as high as the class before you had surgery. Look in the mirror. Look. In. The. Mirror. Right away, with the first breathing exercise, accept where you are. You will be amazed how much the mirror helps the healing process. Lift surgical-side arm to tolerance and hold it. Focus on the expansion and stretching you feel in your chest on the inhale. With each class, continue to lift that elbow and breathe deeper. Don’t pay attention to the uneven appearance. Worst case scenario: with your arms at your side, shrug or lift your shoulders up and follow the same inhales and exhales. Tensing up or holding my breath amplified the pain. Slow, conscious breathing carried me through everything.

Half Moon: Think of your well-side arm as a stake, and your surgical-side arm as a vine that’s going to climb up that stake. Start by lifting your surgical arm as high as you’re able. Maybe you place your hand on your same side shoulder to form a stubby wing. Gradually creep your fingers towards the well shoulder, then the arm and pull yourself up on it. Your goal is to reach the top and interlock your fingers. I felt more when the surgical-side was on the bottom in the side bend. When it became too much, I lowered that arm and let it fold across my ribs. I used the same modifications with backward bending.

Hands to Feet: Don’t be in a hurry to fold forward with both arms stretched out in front of you. I started out squatting down and grabbed the back of the well-side heel. Surgical side arm was bent like T-Rex. Let it down slowly. Don’t go crazy pulling on the good side. It hurts to squish in the beginning.

Awkward: Think ‘I Dream of Jeannie’. Stretch well side arm out as usual. Fold surgical-side arm across your front and start by reaching up towards the opposite shoulder. Once there, start creeping your hand down well side’s arm. As you feel more comfortable, separate into two outstretched parallel arms.

Eagle: At first you’re not going to be able to swing your arms without popping a stitch. Do your best to entwine your arms in eagle formation. For me, this posture was the least effected. You may be surprised to realize prior to surgery you pulled your arms into your chest rather than down from your shoulders. The pain you feel now due to that compression will reinforce the need to make that correction going forward. Ahhhh, the silver lining.

Standing Head to Knee: As with Half Moon, the well-side knows what to do. I started out with my surgical-side arm pressed at my side and bent at a right angle. As I leaned forward surgical-side arm crept down my leg towards the ball of my foot until I was able to interlock my fingers. This was my screw-you-you’re-not-going-to-get-to-me posture. It was helpful to have a posture I wanted to attack; a posture I didn’t want to defeat me.

Standing Bow: For the surgical side, I grabbed my foot and kept my heel against my butt while stretching forward. Slowly I started to kick my leg back as far as my pectoral muscles and arm pit could tolerate the stretch. You will feel the difference between kicking back and up on your surgical side. Here’s where you realize just how much the kicking and stretching keep you balanced. For the well side, go back to the image of the T-Rex arm. As I healed I let the surgical-side arm hang straight down while the well side kicked. When the pain eased, I started raising the arm first with a bend at the elbow and then outstretched.

Balancing Stick: Refer to the hand/arm positioning in Half Moon. If it becomes too much, either wrap surgical-side arm around your torso and give a hug, or hold it against your side, parallel to the floor. As you feel better, allow surgical-side arm to hang straight down at a right angle to your body. Next step: slowly raise your arm.

Standing Separate Leg Stretching: Do what you can, what feels comfortable, but do something.

Triangle: This was my horror show. There’s just no comfortable place to put your arm. As with Standing Bow, you realize the importance of opposing forces: right arm stretch up, left arm stretch down. I couldn’t figure out what to do with my head and neck when the surgical-side arm was supposed to be stretching up. Don’t get discouraged. Do your best. It was a great opportunity to focus on patience and acceptance.

Standing Separate Leg Head to Knee: Treat it like Balancing Stick.

Tree: I kept my surgical side arm at my side and bent at the elbow.

Toe Stand: Scary at first because there’s a good chance you’re either going down face first, or you’re going to stretch surgical-side arm out to make a landing and be in pain. I tried to turn this posture into a positive challenge. Slow down the bent knee descent and try it with one good arm. It’s great preparation for the advanced entry in to the posture.

Savasana: It really helped me to regroup, slow down my breath and let go of what was upsetting me.

Wind Removing: Hold surgical-side arm folded in on itself; keep it close to your body. As you heal, open up the angle.

Sit up: Keep surgical side arm down, fold at elbow across your torso like a belt at your waist. You’ll be surprised how much more you use your abs! At first it’s really challenging to keep your spine straight, but that’s the goal. I chose attempting the sit up rather than rolling over. Rolling over leads to being belly down and the necessity of pushing up and I just didn’t want to deal with that.

Cobra: You know that saying ‘when a door closes, a window opens’? That was my Cobra. It was too much pressure to start cobra from a belly-down position. I was forced to squeeze my elbows into my side at a right angle and find the back muscles needed to stay lifted! Add in the arm strength and you got yourself a damned good Cobra.

Cobra Series Savasana: Oh good lord, really?! Just lie on your side fetal-style.

Locust: Ok, so I just panini-ed my tits in Savasana to *relax* and now I’m supposed to do it intentionally?! Do your best. As with Cobra….you’ll find those back muscles.

Full Locust: Rather than take off from a belly down position, I approached the posture with landing gear up. Surgical-side wing was tucked in at first.

Bow: Well-side hand grabbed a couple inches below the toes. Surgical-side arm was pressed to my side like I was going into a nose dive. My Bow was intentionally lopsided to keep pressure off the surgical side. It was more of a weeble roll at first, but gradually improved to where I could set up the posture and with healing, add the kick.

Fixed Firm: I lowered down into the posture with surgical-side arm folded over at my waist. With time and stretching I was able to reach for the opposite elbow.

Half-tortoise: Another T-Rex arm posture. You may feel like the entire ninety minutes is an exercise in futility because one side is laid up and you will be sorely wrong. Just as those with limited or no ability to see or hear often sharpen their other senses, you will locate those underutilized muscles and master a posture. Half-tortoise is one of those postures.

Camel: As if Camel isn’t emotionally or physically challenging enough to begin with! While Standing Head to Knee was my posture to rally the troops in the standing series, Camel was my touchstone in the floor series. It has all the elements: back bending, stretching, being upside down and completely exposing your chest. Attack it. The release feels so good.

Rabbit: Keep surgical-side arm close to your side for support. Add in the pull as you’re able.

Head to Knee: I used the same modifications for Standing Head to Knee

Final Stretching: I started to feel the feeling of accomplishment. I’m almost there! Don’t focus on the lack of range of mobility in your surgical side, turn your attention to how far you’ve come and how good it feels to flex your feet and stretch your calves, how good it feels to squeeze your quads and release your hamstrings and how good it feels to fold your torso over your legs. I started with BOTH arms in a pike position with my elbows by my hips. This was my release.

Half Spine Twist: My biggest challenge was for surgical-side arm to grab the knee. I hugged the top of my opposite side knee instead and stretched up like crazy. Add the twist.

Kapalbhati: Woo-hoooooooo! Give yourself a pat on the back, you did great!

So, that’s my practice, with a few peeks into my stream of consciousness during class. What I’ve noticed with my practice is that the past events have not limited my depth or expressions of the postures. As I mentioned earlier, I am extremely fortunate to be able to return to the place where I left off prior to surgery. Sure I feel a slight tug or tightness at times but no physical limitations. I have the mental ones! That is the crutch I grab for every so often. The one that says it’s ok to take it easy, the one that reaches for the modification not because I need it, but because I don’t feel like squeezing or kicking or sucking it in….the one that is still enjoying hiding in the back row. There it is, I said it.

bridget headshot 2Bridget Dubravsky is a Certified and Practicing Bikram Yoga Instructor from Maine. She is also the author of Bikram Yoga and Breast Cancer.

Powerful, successful women

We have seen a troubling trend in class recently: mature, successful, adult women fainting.  Powerful, successful women in the prime of their lives falling down on the floor in the middle of a yoga class. Women aged 40-70 years old. Career women. Mothers. Caretakers. Lovers. Brilliant and inspiring powerhouses. Women who regularly take care of 100 different things a day. Experienced and seasoned yogis, blacking out doing a pose they have done at least a hundred times. The common thread underlying these episodes? Food.

By food I mean, not enough.

Women who haven’t eaten in 24 hours. Women who have had less than 200 calories since they woke up. Women who consider egg whites and steamed vegetables enough fuel to last them 8 hours. In each case, the woman who had fainted was shocked when I suggested that starving her body might leave her light-headed during exercise.

I could expound on a myriad of reasons why we waste so much energy focusing on our weight. I won’t because I am fed up. I am fed up with women who can build and grow successful international businesses, but don’t know enough to feed themselves. I am fed up with women who work full-time, volunteer in the community, raise their kids, care for their aging parents, are loving, devoted spouses, support their friends in times of need and cannot take the time to care for themselves, too. It’s endemic. It’s pervasive. It is enough. I am not fed up with you, woman, I am fed up with us. That we agree to this as normal. That we accept it as okay.

There is an end game to not caring for yourself before you take care of others. There is a toll from under-eating for a week, a month, a decade or a lifetime. The brain will get what it needs, even if you don’t eat. Once you have no more available energy, your body begins to consume muscle for energy. Your brain doesn’t care if it is your hamstrings or your heart; it just wants food. When you are thinking of starving yourself into that smaller pair of slacks, have you ever stopped to think, maybe my waistline isn’t worth having a heart attack over?

The most upsetting part of these stories is that not one of these women who has been chronically starving herself was overweight. Not. One. And all of them felt they were doing the “right” thing by not eating or by under-eating. We feel a strong pride for having fought the drive to feed our bodies. For having obsessed all of our waking hours about each morsel that did and did not pass our lips. Can you imagine what we could have accomplished if we spent the same amount of time thinking about how to change the world?

What if you shifted your thinking about food for a week or even a day from an exercise in control to a mechanism to fuel your singular body? Why should you? Because you don’t get a redo on bone density. No one else cares that you fit into a size 2 for three blissful weeks in ’89. What the people who love you care about is: are you happy? Are you healthy? Are you loved? Are you safe? Are you challenged? Are you inspired?

Because you deserve to be. And obsessing about calories is not going to get you there.

Seventy percent of the calories you consume are used to keep you alive. Think breathing, digesting, pumping blood, staying 98 degrees and making insulin and estrogen. If 2,000 is the average, that means around 1,400 calories are required at a minimum to keep your heart beating while lying in a bed in a warm room. The rest is used for your daily activities. It is recommended that the average, moderately active woman consume 1500-1800 calories, and this is if you are trying to lose weight. The average woman burns about 330 calories in a 90-minute Bikram Yoga class.

So eat up. Make it healthy. Eat clean. Get your 9 servings of fruits and vegetables a day. Don’t forget your complex carbs along with that grilled chicken breast. Add a nice, healthy slab of avocado on your baked tofu sandwich. You are a woman. You are a yogi. You are an athlete in this life. Your body deserves to be treated as such.

Sara HeadshotSara Curry is a yoga teacher, studio owner, wife and mother of two from Southern Maine.

Breast Cancer and Bikram Yoga

September 27, 2013

Hi, I’m Bridget. I’m your yoga teacher and I am seven months cancer free. During a routine mammogram in January they discovered a large area of concern. On that Wednesday doctors performed several wire insertions, core samples and a biopsy. While the procedures were not incredibly painful, I was anxious and didn’t know what to expect or what to feel from one to the next. I practiced breathing slowly in through the nose and slowly out through the nose to head off the rising panic and to give myself a calming focus. I get savasanas now and how comforting it is to be still in the standing series.

They sent me home with ice packs, gauze, bandages and a very misshapen profile. The swelling continued as did the bleeding. I stopped practicing that week. And then I started to talk myself out of teaching that Sunday morning class. You know how it is. Just like with my practice or rather my excuses not to practice: “Ok, you can stay home just this once. There’s nothing wrong with taking a break and, of course, oh why not?!? This is the perfect excuse.”

I taught the Sunday class not because of any great feat of courage, but because I listened. You can do this: one breath at a time, one posture at a time….you’ve got this. And as a post script, the next time you think someone is judging you for what you’re wearing or what your postures look like, let that thought go. They are not looking at you.  And if they are, its about them, not you. Because I couldn’t raise my arm or wiggle into a snug fitting elastic top, I wore a loose button front shirt. The only shirt I had was tacky and Hawaiian. And no one noticed, or at least no one said a word…

On Monday the biopsy results confirmed breast cancer, specifically ductal carcinoma in situ or DCIS. I am very fortunate. DCIS is the most common form of non-invasive breast cancer.

I don’t remember the next few weeks very well. During the day I had an incessant urge to get things done; at night I couldn’t sleep. Surprisingly, I didn’t want to go online to research the possibilities. I poked around looking up a few definitions here and there and when things became too scary I logged off. Thankfully I did not venture onto any blogs. I do recall having one hissy-fit. I had an appointment to have my hair colored. As I grabbed my car keys some of the thoughts and unknowns that I had stuffed began to spiral to the surface and I let them grow and take up too much space. The arms started waving, the voice grew very loud, the tears erupted and everything inside ripped wide open. Why am I bothering? This is a waste of money. I’m probably going to lose my hair anyway. Drama and probably a little fear. Its no different than being in the hot room. Don’t allow fear of the unknown or the attention-seeking drama to take over. If you do you will never move forward. So feel the feelings They will pass. Its okay to flop around like a fish the first class, but after that don’t be a drama queen. Just breathe.

I had to decide between a lumpectomy or a mastectomy. A lumpectomy would be minimally invasive, but there would also be the risk of recurrence. It would be followed by radiation and five years of medication, or chemotherapy. Luckily for me the estrogen and progesterone receptors were positive so I would not need chemotherapy. In my case, if I chose a mastectomy, I would not require radiation or chemotherapy. And there might be that little added peace of mind that they “got everything”, although it comes with its own set of issues. My initial choice was to have a mastectomy, however that changed after learning that with a mastectomy I would most likely have a loss of range of motion and some degree of pain for some part or possibly the rest of my life. I decided to go through with a lumpectomy and marginalize the possibility of recurrence. The first surgery was not completely successful. Sixteen days later I had a second surgery with clear margins. I ended up with a partial mastectomy.*

I took my first class a week after surgery. It felt good to feel normal. It was comforting to go through the routine of the same twenty six postures with two breathing exercises. It was a safe place to unburden some of the feelings and some of the tears without making anyone feel they needed to give me some there-there. How often is anyone able to be in the moment by themselves, in the company of a wonderful group of people all struggling together? It was a great cover except for the fact that my nose lights up when I cry. Read Bridget’s post about how she had to adapt her postures post-op.

In the beginning my range of motion was limited. I did not have the same degree of stretch that I had before surgery, but I was able to stretch! In my mind I stuck out in class and I felt embarrassed, when in fact, what I felt was ego. Prior to surgery I thought there were only a handful of arm strengthening/pectoral enhancing postures. Now I know better. They all do. You just have to want to work those muscles.

Every posture required a modification. I was not in pain when I practiced, but I was aware of where the edge was. If I started to force something I would be reminded with a sharp feeling or an immediate muscle constriction after I finished the posture. Savasanas in the Cobra series, wow… those were another story, but that was an easy fix: I did the third trimester pregnancy modification. Unlike my tacky Hawaiian shirt, someone noticed. A student practicing next to me smiled after class and asked if I was pregnant. I’m in my fifties…..

Two weeks after surgery I began a six week stretch of radiation. Think heavy-duty sun burn pain with a cheap spray tan discoloration. Added insult to injury. While the area was more sensitive, I don’t think the radiation limited my practice. During the day I felt fatigued and had no zip. Oddly enough, I didn’t feel tired when I practiced. I felt energized.

I finished radiation in time for Memorial Day weekend. I “woo-hooed” for three days and started taking a medication called tamoxifen that Tuesday. I will be on this course for the next five years. Possible side effects are weight gain, mood swings and, my favorite, hot flashes. So far I have been able to avoid the weight gain. I don’t feel moody or irritable although I heard my husband cautioning someone under his breath, “Just don’t look her in the eye and you’ll be okay”. And I’ve got the market cornered on hot flashes. Winter can’t come fast enough! But in the hot room… I feel absolutely fine.

My recovery has been incredible and for that I have to thank the yoga both before the surgery and while I heal. It helps me with so much: being present, being mindful, accepting myself with my abilities and limitations for that day…accepting you with your abilities and limitations for that day, and obviously all the stretching and range of motion. Sure, some days are more challenging than others, but that was true before all this happened. When I practice, I feel better. Muscles slide over each other easier, tendons have just a little more give and I have added strength and energy. When I don’t practice, I age very quickly. Simply stated, I can’t afford not to practice yoga.

I am not alone in class. Several students shared their experiences, their thoughts and helpful insights. Thank you, thank you, thank you! Maybe you have your own fears or questions and would like to talk about it. Please set your mat up next to me. You’re not alone. There is so much healing to be found in the hot room. It’s a shame not to reach out to it.

bridget headshot 2Bridget Dubravsky is a yoga instructor, wife and entrepreneur from Southern Maine. You can find her teaching classes at Bikram Yoga Portsmouth.

* Oh give it up already! There is so much scar tissue and traumatic swelling you can’t tell which side.