In the past few years, we've seen a number of studies suggesting that yoga may be effective for reducing various types of musculoskeletal pain. However, a new article published in the journal Pain Practice points out that for some people, certain yoga poses may lead to painful spinal fractures.
In the article, Mehrsheed Sinaki, MD, of the Mayo Clinic, Rochester, Minnesota, describes three otherwise healthy women — ages 61, 70 and 87 years — with osteopenia (low bone mineral density) who experienced painful vertebral compression fractures as a direct result of doing yoga exercises. The specific type of fracture — lumbar, thoracic or cervical — varied with each woman depending upon the type of spinal flexion exercise she did.
Osteopenia is the thinning of bone mass and is considered to be a serious risk factor for the development of osteoporosis, which is characterized by a significant loss of bone mass. Both conditions are most commonly seen in people over 50 — especially in post-menopausal women.
While exercise is generally recommended for people with osteopenia to help prevent further bone loss, this article points out that certain exercises — like yoga poses that require significant spinal flexion — should be avoided. Any exercise or yoga pose that involves bending the spine forward or arching the spine backward are potentially risky for this population.
The author concludes, “The development of pain and complications with some flexion yoga positions in the patients with osteopenia leads to concern that fracture risk would increase even further in osteoporosis...Exercise is effective and important for treatment of osteopenia and osteoporosis and should be prescribed for patients with vertebral bone loss. [However,] some yoga positions can contribute to extreme strain on spines with bone loss. Assessment of fracture risk in older persons performing spinal flexion exercises and other high-impact exercises is an important clinical consideration.”
The gold standard for medical research is usually randomized controlled trials involving relatively large numbers of subjects. Case reports such as this are considered to be weak evidence. However, in this particular case, controlled trials would be far too risky for the participants.
In situations like this, I think there is enough evidence to see that it would be wise for people with osteopenia and osteoporosis to heed the warning and avoid exercises that involve significant bending of the spine (like touching your toes). There are still plenty of excellent low-impact exercises that don't require spinal flexion which can help you stay fit and prevent further bone loss without putting you at risk for spinal fractures.
If you're a woman over 50 or have any reason to think you might have some loss of bone mass, be sure to check with your doctor before beginning any new exercise program.
For more information on osteopenia and osteoporosis, visit HealthCentral's osteoporosis site.
Sinaki M. Yoga Spinal Flexion Positions and Vertebral Compression Fracture in Osteopenia or Osteoporosis of Spine: Case Series. Pain Pract. 2012 Mar 26. [Epub ahead of print]
Published On: March 31, 2012