Advice on Practicing Yoga in Middle Age, Part 1

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.

INTRODUCTION

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 do forward 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.