Q: You say that people should not do the same poses all the time. What about programs like Dr. Fishman’s osteoporosis study, which has participants doing the same sequence of poses every single day?
A: Thanks for this question. Indeed, if a person does the same sequence day in and day out, you could run the risk of a repetitive strain injury. The fact that Dr. Fishman’s sequence is only supposed to take 10 minutes a day to do means that the practitioners are not holding the poses terribly long, which would reduce this risk considerably. However, a review of the poses taught (see here) reveals several poses that I feel could be potentially injurious to the wrists, neck and lower back, these being Upward Bow pose and the deep seated forward bends. I would consider other poses if I were to design such a practice, but Dr. Fishman does mention tailoring the sequence to students individual needs. I would suspect that this had to be done quite a bit.
Recall that the number of patients that started the study was much larger than those that completed the study (117 vs 11). Interestingly, there is no discussion as to what caused so many to drop out and why they were unable to do a 10 minute practice everyday. One factor could have been boredom, which is why I often suggest that students alternate practices from day to day to help maintain better focus and follow through. And it is possible that some found the sequence too advanced, despite the individual adjustments offered. The bottom line, in real life, when you can vary your practice, I highly recommend you do so.
—Baxter
A: With Baxter’s blessing I’m going to tell you why I wouldn’t want to do this sequence on a daily basis. I’ll start by telling you that the three yoga injuries I’ve sustained have all been repetitive strain injuries. I was a pretty enthusiastic practitioner for a number of years, and did a lot of standing poses and Sun Salutations. And the injuries I had were: sacroiliac joint injury (common among dancers and yoga practitioners, but not the general public), tennis elbow (possibly from Sun Salutations), and housemaid’s knee (from kneeling too much on the bare floor).
Now let’s look at the sequence:
1. Triangle Pose (Trikonasana)
2. Downward-Facing Dog Pose (Adho Mukha Svanasana)
3. Upward-Facing Dog Pose (Urdva Mukha Svanasana)
4. Bridge Pose (Setu Bandhasana)
5. Upward Bow Pose/Rainbow Pose (Urdva Dhanurasana), without or with a chair
6. One-Legged Forward Bend (Janu Sirsasana)
7. Two-Legged Forward Bend (Paschimottansana)
8. Boat Pose (Navasana)
9. Reclined Leg Stretch (Supta Padangusthasana)
10. Marichyasana 1 Twist
11. Lord of Fishes Twist (Matsyendrasana)
12. Reclined Twist (Jathara Parivarthasana)
After I got over the shock of trying to imagine doing all those poses in 10 minutes, without any warm-ups, I examined the poses in detail. First, two of the poses in the sequence are known for causing sacroiliac joint injuries, Triangle pose (Trikonasana) and One-Legged Forward Bend (Janu Sirsasana), with One-Legged Forward Bend a particularly guilty party. For me, personally, I’ve concluded it’s just not good to do either of those poses every single day. Then, as Baxter mentioned, there is a very deep backbend in the sequence, Upward Bow, and doing this every day could put a lot of strain on the wrists and elbows, but of just as much concern to me is that it is followed immediately by a deep forward bend, taking the lower back into such extreme movements with no rest between. In particular, the Two-Legged Forward Bend is known for causing lower back strain. The combination of the deep backbend followed by the deep forward bend could cause a lot of back strain (personally, I would have moved the forward bends to the end of the sequence). The sequence ends with three twists, asymmetrical poses that are also hard on the sacroiliac joint, with no symmetrical counter pose to finish the sequence. (On the bright side, no danger of housemaid’s knee here.)
I understand some of the thinking behind this sequence, which tries to engage all the different muscles of the body to strengthen as many bones as possible, within a short sequence, and uses the twists to “release” the back after the strain of the backbends and forward bends. However, if I were to design an osteoporosis practice, for safety’s sake, I would develop five or more different sequences that the practitioner could alternate between on different days, rather than trying to cram everything into one single practice. There are so many wonderful poses in the yoga tradition, why would you limit yourself to just 12?
UPDATE: Shortly after we originally published this post, it was brought to our attention that the osteoporosis sequence designed by Dr. Loren Fishman for the osteoporosis study that we discussed on above is not the sequence he currently recommends. The sequence he currently recommends is described in great detail (with many photographs) on his website under “A Dozen Poses vs. Osteoporosis”. This sequence is not only much more accessible (and by that I do mean easier) than the original sequence, but it now excludes forward bends entirely (probably because forward bends are contraindicated for people with osteoporosis rather than due to concern about back strain). After we got this information, we did publish an update (two days later), which you can find here. For those of you who have not already seen the update, please check it out.
—Nina
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The poses you discuss are the ones from the original study. They are NOT what he has people doing now. He found that they were too hard. The ones listed on the web site, sciatica.org, under "Twelve Poses Versus Osteoporosis" are easier than what you show, and he also gives modifications. A friend of mine is in this study and she said the ones on the DVD that he sends are even easier than the ones on the web site, because he found that they were still too hard.
That is very, very interesting! Thanks for taking the time to let us know. And, yes, we were discussing the sequence in the study, because we assumed that was the sequence the person asking the question was concerned about. We'll try to take a look at the sequence on the web site, and possibly amend this post. (If you'd like to tell us what's on the DVD, that would be great as well.)
I still think, however, that Baxter's observations about the sequence are useful for people to consider when they are deciding what to practice on a daily basis.
More later….
Indeed there are several benefits that you can gain from doing Yoga which is a physical, mental, and spiritual discipline, originating in ancient India. It may help a person from developing health problems such as arthritis and also good for those who has undergone hip surgeries. a good exercise but needs a doctor supervision.
I just found your site and I'm really excited because I am now teaching a yoga for seniors class and am soaking up as much new information as possible. I just ordered the book by Dr. Fishman, but certainly will be varying the practice (and it's only once a week). I orginially came from an Ashtanga based practice (which does the same postures daily)….I found some benefit to that but I understand why this could be problematic–especially if bad habits are formed.
Question– I'd like to know more about janu sirsasana/trikonasana and the sacroiliac joint. Is there a post you can point me too? thanks!
Sincerely hope all are also investigating proper alignment i.e. Iyengar yoga as injuries are often sustained due to being improperly set up in the pose, as well as holding too long, which is the responsibility of both student and teacher as every "body" has its unique construction!