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Loren Fishman, MD, B. Phil., is one of the few physicians practicing medicine who incorporates yoga into his regular treatment protocols and offers patients individual yoga therapy. He joins us at the Art of Living Retreat Center to share his unique and effective program with yoga practitioners, yoga teachers and therapists, physical therapists, nurses, physicians and health insurance leaders. Loren shares his journey to developing his unique method.
Yoga and Osteoporosis
I’d heard from my friends and colleagues that it was extremely dangerous to teach yoga to osteoporotic or even osteopenic people. However, I wanted to explore whether that was accurate or not. So I did DEXA scans (the definitive test of bone mineral density) on a number of patients with osteoporosis and osteopenia, and invited half of them to come to classes I taught in my office after patient hours, and kept the other half as controls. I did this for two years, up to 2008.
When we got DEXA scans again, the yoga group had gained quite a bit of bone mineral density. The controls lost a little, and there were no significant injuries of any kind. Not even repetitive stress injuries—if you’re practicing yoga properly, stress injuries are quite uncommon.
It worked well, but I didn’t think these results were publishable yet. My son happened to pass by my desk and said, “Dad, give me the data.” In five minutes, he showed me that these results were statistically significant. A few months later, we published “Yoga for Osteoporosis – A pilot study.” Topics in Geriatric Rehabilitation 25, No. 3, 2009 pp. 244-250.
Creating the Program
At this point, I really became enthusiastic. It seemed to me that there might be a way that any person could use yoga to improve bone strength, so I hired a camera man from Harvard, a director from Columbia, and a friend who is sometimes a Broadway actor, took two friends and myself as models, and created a DVD of yoga for osteoporosis.
We made a thousand copies of the DVD, and gave them away to people willing to do blood tests, a urine test, and give a current DEXA, as well as another one after two years of practice. The tests ruled out nutritional, hormonal, and metabolic reasons for weak bones.
I chose poses that I thought would strengthen the most frequent fracture sites; the spine, the hip, and the femur. Happily, those are also the three sites measured by most DEXA scans. We made the DVD with three versions of each pose; a beginner’s version, an intermediate version, and the classical version of each pose.
The difficult part was that we needed an older DEXA scan too, in order to make this into a before-after study. We needed to compare what happened to people in the two years before they started doing this yoga (although many had done some yoga before), with how their bones fared after they did this yoga daily for two years.
This was an Internet-recruited study, and the 1000 people that received the DVD were from all over the world. Eight years later, over 240 of the recipients complied, and sent in previous DEXA scans, and many sent before-and-after X-rays, too. All the information went to Bernard Rosner, Professor of Biostatistics at Harvard.
The Results Are In: Yoga Improves Bone Density
It took more than a month to get anything back from him. In the meantime, I was ruminating as to whether I’d just wasted ten years of my life.
Eventually, we got the statistical results: .001 significant improvement in the spine and femur, with improvement in the hip as well.
We published this study soon after as Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss.” Lu, Yi-Hsueh; Rosner, Bernard; Chang, Gregory; Fishman, Loren M. Topics in Geriatric Rehabilitation: April/June 2016 – Volume 32 – Issue 2 – p 81–87.
Over 80% of the people in the study reversed their bone loss and began to gain bone. No fractures or serious injuries of any kind were seen or reported in over 100,000 hours of people doing this yoga daily. Over 80% of them had osteoporosis or osteopenia when we started. Fewer had these conditions when we finished.
The Future of Yoga and Osteoporosis
We are now working on another study which we call a dose-response study,. In these, we have participants see a teacher who is trained in our yoga every two weeks to see what “dose” of yoga the participants are giving themselves. Then we’ll see what happens to their DEXA scans in two years.
We’ve also developed alternative sets to ward off the inevitable ennui of doing the same poses day in and day out. New alternatives also strengthen the bones in the wrist, the fourth most probable fracture site. We have put the first group, the group we’ve already proven to work, online for free on Youtube, (and below) and offer DVDs on sciatica.org.
In this video, you’ll see three versions of each pose most of the time. A beginner version for those with osteoporosis and/or little yoga experience, an intermediate pose for those with osteopenia or that level of skill, and in the center is the classical pose and is the one being described in the video.