More than 100 readers submitted questions about aging and yoga to Dr. Loren Fishman, a back-pain and rehabilitative medicine specialist who has long incorporated yoga into patient care. In 1972, before applying to medical school, he studied yoga with B.K.S. Iyengar for a year in Pune, India. Dr. Fishman is medical director of Manhattan Physical Medicine and Rehabilitation in New York City, an assistant clinical professor at Columbia Medical School and an associate editor of the journal Topics in Geriatric Rehabilitation. He is also an author of eight books, including “Yoga for Osteoporosis: the Complete Guide.”
Here is part one of his responses. More from Dr. Fishman will be posted next week, but because of the volume, not all questions may be answered.New questions are no longer being accepted.
Is yoga good for the aging population? My answer is yes. A couple of years ago I ran into my yoga teacher, B.K.S. Iyengar, at a conference in India. Though he was over 90 years old, he was capable of traveling to China and giving a three-day workshop consisting of classes that lasted for many hours each day. When he saw me he rose gracefully from his chair and greeted me by name, though we hadn’t seen each other for more than 20 years. I think Mr. Iyengar is an example of what yoga can do for an aging human. To me he seemed like a man 30 years younger. And, in a way, beyond age.
AGING AND YOGA
Q. Are there any aspects to yoga practice that the over-50 practitioner should give up if she/he is healthy and otherwise feeling well? How about after 70? What poses cause the most injuries, and which might help protect or rehabilitate common yoga-associated injuries? — Elizabeth, Lenox, Mass.
A. Yes, there are things you may need to give up in your yoga practice as you get older. People age differently, and yet there are characteristic aspects to aging. Chronic conditions are cumulative. With osteoporosis you can doforward bends to as far as your hips will carry you without pushing, keeping your back slightly arched if possible, and preventing it from slouching forward no matter what. As my fellow yoga devotee Leslie Kaminoff has rightly noted, this avoidance of forward bending too can be carried to phobic extremes: good posture and sensible bending and lifting is an antidote to osteoporotic fractures; flexibility, coordination, balance and strength are the best prevention of hip fractures. Standing poses like the tree, the warrior trilogy, and half-moon promote these positive traits and are among the last poses one should give up as one ages.
Arthritis will respond to yoga. Supta padangusthasana is as safe and as good as a pose gets, and will help with safe forward bending, too, by lengthening the hamstrings and stretching the hips’ capsule. We will come to many more suggestions and caveats in the questions and answers that follow.
Q. For fit people without specific health issues in middle age who already practice yoga, it would be nice to have knowledge about and access to a series of poses appropriate for this age group, which can be arranged into routines of various difficulties to form the core of a yoga class. Also targeting areas, like the lower back, with specific poses for this age group would be helpful. We can then take this knowledge to and practice it with our local yoga community. Thanks. — David, Maine
Q. Which yoga styles are best if you’re starting at age 50? — LOL, Ithaca
Q. I am 61. Very inflexible, have a history of low back and neck pain that are currently minor. I get regular exercise at a gym and I hike in the mountains several times a week. What is the best way to get introduced to yoga? — Burrito’s, Westbrook, Maine
A. Besides these readers, Big Bird from NYC and SH and Pinotman from Chicago wrote in wanting to know the best place and the best way to begin or resume yoga when you are over 50. The absolute best way is to find out what your liabilities are, and this is an individual matter, requiring a medical visit or summary. The next step is an appointment with an experienced and smart yoga teacher, one on one. Group classes are an artifact of urban economics: the teacher cannot afford to live in the city in which she teaches any other way. But chronic conditions are cumulative, by definition: when you’re older you need the individual attention that yoga has traditionally offered.
I believe the teachings of B.K.S. Iyengar are the most anatomically sophisticated and therapeutically oriented, but there are many other good types of yoga. You’ll need a resourceful and sensitive person to get you started, and to introduce you to an appropriate yoga practice that you can do every day. Then, after a month or two or three, you should go back to that person for a reassessment and suggestions about how to progress to the next step. Yoga, practiced consistently, does good things to your temperament and perceptions.
Q. Any age-related additional risk factors with respect to the vertebral artery during shoulder stand and plow poses? — JPT, Ohio
Q. I am 55 and began yoga two months ago. I go every other day, but I still have problems with the balance poses. I did not have these issues in my youth. Is it typical to have more balance issues as you get older? — AJT, Madison
A. Most arteries become more brittle, and are more easily injured, just as the skin gets more delicate with age. Shoulder stand, plow, and poses like the gate should be trimmed back from their extremes for safety after the age of 70. The vertebral artery actually figures in nourishing a number of neurological structures critical to good balance and coordination, so it is worth our care. Our sense of balance can also be degraded with age decreased sensitivity to changes in direction and momentum in the semicircular canals(offshoots of our hearing apparatus that detect changes in speed and direction of movement), decreased proprioception (lowered awareness of position and relative location) in the joints and in one’s feet, and less acute vision. These are the three determinants of balance: the inner ears, proprioception and vision.
Do the precarious poses against or very close to a wall. The wall is a wonderful, supportive teacher.
BACK PAIN AND SCIATICA
Q. I am 48, in good shape cardiovascular-wise (runner), and decided to try yoga recently. All went well initially but of late I have had considerable back pain both when sitting and lying flat. Could I have an injury? If it’s just sore muscles, will it eventually get better if I keep doing it? — MB, Ohio
A. First, much back pain is discovered in yoga class but really has its origins elsewhere. Second, yoga can cause back pain, and then, as always, the question is: what is the diagnosis? Pain is a symptom, not a disease. Without a diagnosis you’re left to guess about proper treatment, for the same pain can have causes so different that treatments are diametrically opposite.
One way to decide if it’s sore muscles or a neurological injury is if the pain goes down one or both legs or radiates. Does anything tingle, is some part of your leg numb? If so, it’s nerve pain, indicating an injury that merits further inquiry. If not, it’s probably a muscle spasm or strain, and stretching should make it feel better. I say probably because someone could also have a spinal fracture, facet arthritis, spondylolysis or other problem. The bottom line is that you need a diagnosis before yoga or anything else can be used rationally to help.
Q. I have sciatica and a herniated disc so bad I want to cry. I’m on prescription pain killers but I’d rather be better, not drugged up. Will yoga help sciatica? — Linda, Oklahoma
A. Sciatica — nerve pain that goes down the leg along the course of the sciatic nerve — can be helped with yoga, but it must be done with extreme care. A herniated disc responds to extension, and may be worsened by flexion; spinal stenosis improves with flexion, and is exacerbated by extension — yet both can cause sciatica, and the same exact distribution of numbness, weakness and pain. And about 5 percent of the time, the treatments reverse: extension helps stenosis, flexion is good for herniated discs. So start tentatively, be sensitive to the changes you feel, and progress slowly.
My colleagues and I discuss back pain more fully on our Web site,Sciatica.org. I have poses — many of them modified for those in pain or unable to do the full pose — in a book I wrote with Carol Ardman, “Yoga for Back Pain.” There are chapters on herniated disc, spinal stenosis, and how to tell the difference between the two. Yoga with physical therapy is an excellent choice for someone with either a herniated disc or spinal stenosis. But first, the diagnosis.
Q. I had disk surgery in the 1990s and sciatica has returned. I have tried interventions to avoid additional surgery. I was told, however, to stop yoga and continue with Pilates on the reformer. I stretch my hamstrings and do a few poses daily after a hot shower. I walk a lot but want to maintain my upper body strength. What are your thoughts? Thanks. — RNC71, DC
Q. Can yoga help in dealing with sciatic pain? Are there particular poses that can relieve sciatica? — Henry Rabinowitz, San Francisco
Q. I have sciatica and a herniated disc also. I used to practice yoga years ago on a daily basis until my back started to bother me. I cannot do any forward or backward bends at all. I miss the yoga postures and how limber it made me feel. Is there any yoga postures that people with back problems can do? — Cate, New York
A. To RNC71, if sciatica has returned after an initial surgery, I would not confine myself to Pilates on the reformer. Pilates is good for the healthy, and there are people who describe themselves as Pilates therapists, applying and modifying Pilates practices to form a healing regimen. Still, I have not encountered the type of rigorous scientific work, nor the long of therapeutic benefit that you find in yoga. Instead of Pilates, I would do gentle yoga, restorative yoga, lift weights while lying down on your back (taking all weight off the discs) and continue walking a lot.
Henry Rabinowitz — along with others like Shulumu in Colombia and Linda in Oklahoma — get the same advice: first find the cause of your sciatica, then consider the suggestions given above to RNC71.
Unfortunately, Cate in NY, who also has sciatica and a herniated disk, cannot do either forward or backward bends. But she can do sideways poses like vasisthasana (side plank), which we have shown with M.R.I.s to reduce stenosis and herniated discs. Also, she may be pushing too hard; she should consider trying the poses that used to make her feel good — but only 10 percent of the way — until she feels stronger. Start back bends very slowly. Self-pacing is a critical part of any self-discipline, and applies to all parts of yoga, from beginning to end.
Q. At a healthy 61, I took up Iyengar yoga last year with an experienced teacher and felt better and limber than I had in my whole life. Six months later, I experienced low back pain and sciatica. I have a L4-5 and L5 – S1 disk bulge. I had physical therapy and two epidural steroid injections. The pain and numbness is only marginally better and has kept me from yoga, which I miss greatly. I don’t think I overdid yoga. My doctors think I will recover slowly. Is there remedial yoga for sciatica, and what is the best way to get back to yoga once I am better? — DGR, Ann Arbor
A. DGR, with bulging discs, is inhibited from back bends by a yoga-phobic physician. But back bends will very likely help. Find one of the excellent Iyengar teachers in Ann Arbor and you will likely benefit from the locust, the bridge and the camel, among others. Again, progress slowly.
JOINT PAIN AND METABOLISM
Q. I am 58 and a breast cancer survivor. I have been doing vinyasa yoga for about five years. In the last two years, I have had problems with my sacroliliac joint and I understand this may be the result of too much flexibility in the hip joint. In addition, I am interested in whether yoga can slow the metabolism. I would greatly appreciate advice on protecting the sacroiliac and whether the metabolism issue is a myth. Thanks. — MR New York, Port Washington, N.Y.
A. Both MR and a yoga teacher in Boston asked about sacroiliac joint pain. For those with this problem, I describe some unusual but easy versions of difficult poses, like the two-armed support in peacock, in the new edition of “Yoga for Back Pain,” which I wrote with Carol Ardman. Also helpful is the eagle, the cow and “leaning” as described in an earlier book, “Low Back Pain.”
Several people, including MR, have asked whether yoga slows metabolism. Yes, it does. It lowers blood pressure and reduces atrial fibrillation and in general calms things down. But that does not mean yoga cannot be used to trim your weight. Yoga does it differently, by stretching the organ, the stomach, which will then send turn-off signals to the appetite centers in the brain. Poses like the warrior III, the twisted janu sirsasana, and parivrtta parsvakonasana, done 10 to 20 minutes before a meal, will probably work. This requires a small amount of self-discipline, but then again, so does just about anything that succeeds.
More answers will be posted on Booming next week. Previous Ask an Expert columns can be found here.