Osteoporosis and back pain

Namaste Mukunda,

long time student of mine, over 60, osteoporosis in upper back resulting in kophosis. Long time student of meditation and philosophy, she is leaving for India next friday, one intention for the trip is to find a teacher/guru to help in the releasing of her heart center. I noticed tonight when she was in parsvottenasana with left leg forward and hands to wall a short severe curve to the right from about t3 or 4 to t7 with the apex being at t5 where she says all her pain is. when legs were parallel the curve was gone, but the t8 still very pronounced with the ES muscles very sunken around this area. She wants to see if we can work up a personalized program for her to deal with the pain in this area. she said over the years of practice many aliments have fallen away, but this remains, the pain in T5 and in her words her “closed heart center” . Over the last year I have realised she works thru a lot of pain, almost always there for her, but she pushes on. She has backed off of a lot of stuff in class lately. immediatly I thought the curve was scoliosis of the spine, then realised it is degeneration from the osteoporosis and perhaps working assymetrically as for scoliosis would not be as effective. it is such a small area. My original thought was we would work at poses seeing if she felt positive sensation in the area as it seems like she rarely feels anything from the poses unless I really get specific with her and get some vata balancing happening. Example tonite in a pose when I asked her where she was feeling it she said all she was feeling was the severe pain in her back, then we worked with lifting heart (hands on wall, sphinx, with my finger on heart center for her to lift up towards) on inbreath and holding that ground on the exhale, lifitng more again on the inhale. this lit up her face and she felt something good.

I see her as needing to balance vata and become more aware of her sensations, but also feel like she needs to be working on some strengthening at the same time . However in viewing a post on osteoporosis in the forum I saw a comment made by an aryvedic dr where she pointed out we should not seek to increase a dosha, just work to balance the elevated one. I had thought to give her kappalabhatti breath, is this a appropriate practice for her?
when this student does the jfs I think she is just always in pain. when we did the more active sphinx, she responded positively. she said to me in class she likes to work hard for 15 mins and do restorative the rest of the time. Should I work with her along those lines then?

With this assymetry, regardless of whether it is due to scoliosis or kyphosis or osteoporosis does not matter, let us gently work on elongation of the spinal column. Latest advice from PT world is to avoid forward bends when there is osteoporosis due to tendency for thoracic vertebrae to fracture. I would recommend you consult my NYC training assistant Hamsa Stone at stoneyoga@aol.com for latest on this and perhaps have client see her as she is doing her paper on this topic so is quite up to date on the nuances of this condition. My recommendations can only be generalized. so backward bending may be most appropriate to help with freeing this region gently and with emphasis on retaining natural spinal curves. If so then i would do assymetric cats with left hand forward will slightly straighten a right thoracic curvature. For many people opening physical body results in emotional or spiritual experiences.
For opening her heart best is to search for inner teacher and connection to what and who she loves. It that is in India then this trip will be a blessing but if not then inner search is best.
Ayurvedic doctors hold a different strategy than me. I agree that in general diminishing the increased dosha is how to proceedjust not in all cases. If the mind is strong one can actually increase the dosha in trouble and then with strong discernment learn what symptoms of that increase to back off on. It is like boiling water when it is too high we adjust it downward but often that adjustment is too low so must be increased until we set finer tuning. Kapalabhati is fine better would be agnisar dhouti.
Student can guide you better rather than theories. Follow her lead as to what feels best. However be sure to do follow up calls to make sure that what feels good during practice remains good for 24-48 hours afterwards. Often there can be after taste of practice. If sattva comes then proceed with stronger practice to include sphinx. namaste mukunda

Namaste Mukunda,

I did consult Hamsa and have included her thorough response below for interested students so they may benefit from her knowledge.

I worked with client already and the kappala bhaddhi did not seem a comfortable for her. I will see if agni sara is better once she returns. she left for her trip the morning after we worked so no chance yet for follow up call.

question; she starts to experince pain in the predominate veterbrae when she is physicaly active, including just everyday activities. could this indicate that there may be a fracture in the anterior spine from the osteoporosis?

Namaskar Bonnie,

Some comments within the text …

long time student of mine, over 60, osteoporosis in upper back resulting in
kophosis. Long time student of meditation and philosophy, she is leaving for
India next friday, one intention for the trip is to find a teacher/guru to
help in the releasing of her heart center. I noticed tonight when she was in
parsvottenasana with left leg forward and hands to wall a short severe curve
to the right from about t3 or 4 to t7 with the apex being at t5 where she
says all her pain is.

>In Phoenix Rising, they called this the “back door to the heart centre”

>What happens when she puts RIGHT leg forward - does this flatten the right curve in her T-spine?

>You might experiment with hand positions - right hand higher or lower then left - see how this feels.

>You could also have her lengthen her right side from hand-on-the-wall to right hip … this should give her more space/length in the right side where she experiences pain. Her iliac crest will end up being uneven, but that’s ok - more important to address the curvature that is causing pain and feelings of her heart being closed. Explore other side also - how does this affect her?

>Let her start to feel, understand what she is feeling, trust herself more.

>Explore Vira I with 1 knee against wall, other foot back, hands & arms reaching up the wall (arms & palms flat against the wall - big stretch!), chest against the wall (or as close as she can get): good for T-spine and heart-opening intention.

>All-4’s: place R knee 2 inches forward of L knee. Then, do gentle vinyasa:
Inhale in All-4’s (with displaced knee), lower spine (Cow)
TO …
Exhale into Child’s Pose … she will feel lengthening and flattening in right side of back
Repeat, riding the breath, several x

>Do on other side - see how this affects her curvature

>Experiment w. various knee placements to see which ones bring her to optimal alignment

when legs were parallel the curve was gone, but the t8
still very pronounced with the ES muscles very sunken around this area.

>Explore no-hands Bhujangasana … then Bhuj. with hands

>Do “W” lifts = modified Cobra lifts w. hands placed as follows:

  • Lie prone, hands and head form a “W” (palms down)
  • Inhale and lift head, chest, hands / arms all together
  • Lower on exhalation

repeat as appropriate

watch for sensations of heart opening, sensations at back door to the heart.

>Explore doing modified Cobras & “W’s” with her upper body shifted to the R / L … note how this affects her T-spine & the erectors / lamina groove

She wants to see if we can work up a personalized program for her to deal with
the pain in this area. she said over the years of practice many aliments
have fallen away,
clearly, your teaching has already benefited her a lot!

but this remains, the pain in T5 and in her words her
"closed heart center" . Over the last year I have realised she works thru a
lot of pain, almost always there for her, but she pushes on. She has backed
off of a lot of stuff in class lately.

>that’s good; she is moving out of avidya into better understanding of what’s good for her. that’s the right direction for her.

immediatly I thought the curve was
scoliosis of the spine,

>it probably is

then realised it is degeneration from the
osteoporosis and perhaps working assymetrically as for scoliosis would not
be as effective.

>I think it’s still a good idea to work asymmetrically because you got a different result based on foot placement - but do movements on one side, then on the other (not just 1 side)

>In the presence of osteoporosis, it’s good to emphasize T-spine & erector spinae strengthening poses … can do this bilaterally, or 1 side at a time

>These are also heart-openers, so this fits w. her intention

it is such a small area,

>doesn’t matter. let her get in touch with what she is feeling. if she has pushed herself in the past, maybe ignored pain, it’s good to give her something to focus on, and let her begin to feel her feelings. This may bring up a lot of emotion. A small thing can be a very big thing.

I am not even sure how we would
access such a specified place.

>Let her find it, the entryway to her heart. You mentioned that she is a meditator - she can focus on this place in her meditation; you can support this with guided imagery and your touch (as you indicate you already have been doing).

My original thought was we would work at
poses seeing if she felt positive sensation in the area as it seems like she
rarely feels anything

>yes - have her attune to her feelings
you can ask her what is happening, while she is in a pose … with your finger placed on this small space, let her bring breath and loving awareness there … many emotions will come up - good for her to experience & express.

>this can be very powerful emotionally for her.

>you’ll ride the rapids with her; just stay with her.

from the poses unless I really get specific with her
and get some vata balancing happening. Example tonite in a pose when I asked
her where she was feeling it she said all she was feeling was the severe
pain in her back,

>Can she back off to a place where she is in a modified version of the pose where the pain is lessened, then continue to explore sensations? feelings?

>And: are you willing/able to let her have her pain?

then we worked with lifting heart (hands on wall, sphinx,
with my finger on heart center for her to lift up towards)
that is beautiful

on inbreath and holding that ground on the exhale, lifitng more again on the inhale. this lit up her face and she felt something good.

>yes!

you can also have her feel that the inhalation is for her heart centre, and the exhalation is for her power/hara center … she will feel taller and more open with each inbreath, and increasingly feel the power in her hara with each outbreath.

This can help her feel grounded and powerful while she is opening her heart centre.

>Also, restorative poses like “Mountain Brook” - soft bolster/blankets lengthwise along the spine, or across (at right angle to the spine) - gentle, lots of padding due to osteoporosis - can be very heart-opening. Your finger at her heart centre, invite breath, feeling her feelings … she may need this after some active yoga

>When she is on her own, she can recreate this restorative pose and direct breath to heart centre & back door of the heart

>Also: nice to develop affirmation for the heart, to support her intention.

>Move her increasingly toward heart-centred sadhana. If she is very vata, give some vinyasa, then some holding / kapha to develop strength & stamina. Kapha is devotional … could be good for her to move in that direction to balance her vata.

take Hamsa’s advice. blessings. mukunda