by Loren Fishman and Ellen Saltonstall
W. W. Norton, 2010
Review by Beth T. Cholette, Ph.D. on Sep 21st 2010
This book is the second collaboration between Loren Fishman, M.D., Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, and Ellen Saltonstall, a certified Anusara Yoga instructor, as they co-authored the previous book Yoga for Arthritis. In the opening chapter of Yoga for Osteoporosis, Fishman and Saltonstall make a compelling case for the current crisis of osteoporosis facing Americans. They roll out statistic after statistic: 55% of everyone over age 50 is known to have low bone mass; osteoporosis is responsible for more than 1.5 million hip fractures annually; women are just as likely to die after a hip fracture as they are from breast cancer; and so the list goes on.
Unfortunately, as the authors point out, most people seem undaunted by these alarming numbers, even when DEXA scans (the current definitive test for osteoporosis) indicate presence of the disease or its precursor, osteopenia. However, those of us who have reached our 30s and beyond need to be particularly concerned, as bone mass in the body reaches a natural maximum around the age of 30. After this, the rate of bone loss accelerates; although the bones can continue to be strengthened after age 40, for the most part, the rate of this deterioration can not be outpaced.
But there is hope, and according to Fishman and Saltonstall, the best hope for both the prevention and treatment of osteoporosis is yoga. The authors emphasize that yoga is most effective when utilized as preventative practice, particularly when started at a young age. They state that yoga can serve to both strengthen bones and to raise peak bone mass. The authors have also been studying the effects of yoga on those who already show signs of osteopenia or even osteoporosis. Although this study is still in progress, preliminary results have shown definite improvements in bone density (DEXA scores) for these subjects. The authors do acknowledge that other types of exercise could serve to produce these same results. However, they distinguish yoga for several reasons, including its portability, its accessibility to all ages, its low cost (free to do in one’s own home), its promotion of independence, and its timelessness.
The final four chapters of the book center around building an actual yoga practice. The first of these, “Before You Start,” provides a basic overview of how the remaining chapters are organized, discusses contraindications, suggests useful props (including 3-5 blankets, 3 blocks, 2 bolsters, 2 belts, and 2 yoga mats), and reviews a few basic guidelines on form. The three chapters which follow offer postures which focus on Bone Strength, Muscle Strength, or Balance. Every single pose listed is shown at three levels: the first is the most modified Osteoporosis Variation, the second is the Osteopenia Variation, and the third is the Prevention Variation, with step-by-step numbered instructions given for each. Clear black and white photographs also accompany every pose. For those who already have prior yoga experience, this level of detail might feel somewhat cumbersome, but for those new to a yoga practice, the intelligent combination of text and illustration presented by Fishman and Saltonstall is likely to be invaluable. The authors conclude the book with an Alphabetical List of Poses, Glossary, and an invitation to readers to join their study.
I am in my early 40s, and I generally believe I am doing the “right” things to be fit and healthy: I exercise nearly every day, and I actually already practice yoga an average of about 3-4 times per week. However, my yoga sessions tend to be more on the gentle side, and after reading Fishman and Saltonstall’s book, I realize that striving for greater variety in my routines might better serve me in the crucial task of osteoporosis prevention. Although I am obviously a proponent of yoga myself and wholeheartedly agree that yoga is a practice which can be of benefit to all, I also found the authors to be a bit unfair in their criticisms of some other fitness disciplines. For example, they are rather dismissive of Pilates other than to say that “many Pilates exercises are derived from yoga poses” (there is actually no evidence for this; Joseph Pilates developed his system out of his work as a gymnast). Similarly, they fail to note that weight-lifting (which they do acknowledge is effective in building bone strength), like yoga itself, can be easily modified to reduce the risk of injury.
Overall, this book is an important work. Certainly it is a must-read for anyone diagnosed with osteopenia or osteoporosis, particularly those who are motivated to proactively treat their condition. But I would also recommend it for those who, like me, are in 30s or 40s, are active and healthy, and simply want to stay that way.
© 2010 Beth Cholette
Beth Cholette, Ph.D., is a clinical psychologist who provides psychotherapy to college students.