Patients With Osteoporosis Should Avoid Yoga Poses Involving Spinal Hyperflexion, Hyperextension

April 9, 2019

By Jill Stein

PARIS -- April 8, 2019 -- Patients with osteoporosis or osteopaenia should steer clear of yoga poses that call for hyperflexion and hyperextension of the spine, according to results of a retrospective analysis stated here on April 5 at the 2019 World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO).

Such poses may increase the risk of compression fractures and deformities in these patients, explained lead author Mehrsheed Sinaki, MD, Mayo Clinic, Rochester, Minnesota.

Dr. Sinaki and colleagues reviewed the medical records of 89 patients who were referred to a musculoskeletal clinic by their primary-care physician from 2006 to 2018 for evaluation of pain that the patients ascribed to participation in yoga classes.

Patients described pain in their back, neck, shoulder, hip, knee, or a combination. They also cited 12 poses that they said caused or exacerbated their symptoms; the poses most often mentioned involved hyperflexion or hyperextension of the spine.

The Mayo team categorised the injuries as soft tissue, joint, or bony injuries.

Within the soft-tissue group, 66 (74.2%) patients had mechanical myofascial pain due to overuse. The investigators documented rotator-cuff injury in 6 patients (6.7%), and trochanteric bursopathy in 1 patient (1.1%).

In the axial group, the investigators documented exacerbation of pain in degenerative-joint disease (n = 46 [51.7%]) and facet arthropathy (n = 34 [38.2%]). They recorded radiculopathy in 5 (5.6%) patients.

Within the bony-injury category, Dr. Sinaki and colleagues saw kyphoscoliosis on imaging in 15 patients (16.9%). They recorded spondylolisthesis in 15 (16.9%) patients, anterior wedging in 16 patients (18%), and compression fractures in 13 patients (14.6%).

Dr. Sinaki said that most patients in this population were female, which is consistent with surveys reporting that women practice yoga more often than men. Additionally, osteopaenia and osteoporosis are more common in women because of changes associated with hormonal differences. At puberty, she added, women start to develop less musculature than men of the same size, which leads to fewer “stabilising forces” in the spine.

The majority of women in this study were postmenopausal.

Dr. Sinaki emphasised that patients in the study were seen at a specialty clinic in a tertiary-care centre, which may limit the generalisabilty of the findings.

In addition, the investigators did not have precise information on how long patients had been practicing yoga. As a result, they were not able to determine whether new practitioners were more prone to injury than experienced yogis, or whether patients practising at home without instructor supervision were more likely to report injuries.

[Presentation title: Musculoskeletal Injuries Caused by Yoga in Osteopenia and Osteoporosis: A Retrospective Analysis. Abstract P203]