A: Let’s start by figuring out what OPLL disease is! If you are like me, you may not have heard of this condition before. OPLL, which is short for Ossification of the Posterior Longitudinal Ligament, is a gradual hardening and calcification of one of the long ligaments that runs the vertical length of spine.
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| Posterior longitudinal ligament in the thoracic region (runs vertically at center) |
This ligament runs the length of the spine from the base of the skull to the sacrum, and it is located along the posterior surface of the vertebral bodies, just in behind of cushiony discs. It helps to keep the vertebral bones together and usually limits the degree of forward rounding (flexion) that the spine can do. It also acts as a barrier for the discs when the spine goes into forward rounding (flexion), preventing the discs from pushing or bulging back into the spinal cord.
Now about the ossification of this ligament. To ossify means to turn into bone or boney material. Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, in the elderly, and in Asian patients. The disease can start with mild or no symptoms, but some patients progress slowly to develop symptoms of myelopathy (disease of the spinal cord). It most commonly affects the cervical spine area. An X-Ray, CT scan or MRI can allow diagnosis of the condition, and these tests are often repeated to monitor the progress of the disease. When symptoms are mild and are not progressive, conservative treatments and periodic observations are considered adequate treatment from a western medical perspective. However, once symptoms of myelopathy are present and neurologic symptoms are progressive, the treatment of choice is surgery, even though it is controversial, to relieve spinal cord compression.
(A quick aside about myelopathy: According to the Columbia Medical Center, myelopathy is, “The clinical syndrome that results from a disorder in the spinal cord that disrupts or interrupts the normal transmission of the neural signals is called a “myelopathy”. For anatomical reasons, cervical myelopathy may involve the arms and hands, legs, and bowel and bladder function.” But OPLL is only one of the conditions that can cause myelopathy.)
OPLL not a very common condition, except in Asian populations, where the incidence of OPLL is 2.4%. It is twice as common in men as it is in women, and symptomatic OPLL usually presents in the 5th to 6th decade of life. OPLL can be associated with other musculoskeletal diseases such as Ankylosing Spondylitis. The underlying cause or pathogenesis of OPLL is still unknown, although many factors are being investigated, including the role of lifestyle and environment. With the much higher incidence in Asian populations, genetic factors are also being closely looked at. A few of the more interesting lifestyle factors that have been suggested include family history of myocardial infarction, high body mass index at age 40, long working hours, and working the night shift. I mention these in particular since yoga could influence heart health, weight management and work choices. Good sleep habits may lower the risk, and yoga can help with this as well (see Five Tips for Better Sleep).
As a yoga instructor, you would be more likely to meet someone with mild symptoms. At the early stage, most OPLL sufferers do not have symptoms, or only complain of mild pain, discomfort, or numbness in hands. As OPLL progresses, symptoms increase in severity due to compression of the spinal cord and nerve roots. The most common symptoms in the early stages of OPLL include unpleasant and tingling sensations in hands, and clumsiness.
The typical western medical approach to early symptomatic OPLL consists of pain medication, topical agents, anti-inflammatory drugs, antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs and opioids, along with bed rest and assist devices, such as a brace for local stabilization of the spine.
Yoga and OPLL
There have been no studies done to date on yoga for OPLL. Therefore, the following suggestions are my educated guesses based on yoga being used for other forms of cervical arthritis and disc issues that share some similarities to OPLL. As always, in such unusual cases, proceed slowly and gradually, and allow some time to see how the person you’re working with responds to your yoga recommendations.
Start by asking the person with OPLL to share with you any movement restrictions they have been given by their MD or Physical Therapist and integrate those into what you suggest.
Avoid any poses that add stress to the cervical spine or worsen any symptoms that might be present. Obvious examples include any pose that bears weight on the head, such Shoulderstand (Sarvangasana), Headstand (Sirsasana), and Rabbit Pose (Sasangasana).
Approach preserving cervical range of motion through gentle dynamic poses, even something as basic and simple as Cat/Cow pose. I have a simple dynamic series I often teach that includes simple neck rotation I call Owl Turns, and side-bending I call Curious Dog Tips (see Friday Q&A: Safe Neck Movements). You could also move the neck in gentle rotation in such standing poses as Warrior 2.
If weakness, especially of the extensor muscles at the back of the neck, is a concern, practicing low Cobra (Bhujangasana) and Locust (Salabhasana) poses dynamically or for very short holds can help to build more muscular strength and support for cervical neck extension.
As for restorative poses, most of them could be fine as a way to allow for some gentle neck stretching and also to provide support to the neck for general muscular and fascial relaxation. But let the student’s responses to the poses guide you in deciding which poses to remove or keep in your original sequence. Reclined Cobblers pose (Supta Padangusthasana), Legs Up the Wall pose (Viparita Karani), and Supported Child’s pose (Balasana), are a good place to start (see see Featured Sequence: Mini Restorative Practice). But keep an eye on Child’s Pose, as the rotation of the neck may be more challenging for some students and if it causes pain, you will need to help them modify it.
Avoid any poses that add stress to the cervical spine or worsen any symptoms that might be present. Obvious examples include any pose that bears weight on the head, such Shoulderstand (Sarvangasana), Headstand (Sirsasana), and Rabbit Pose (Sasangasana).
Approach preserving cervical range of motion through gentle dynamic poses, even something as basic and simple as Cat/Cow pose. I have a simple dynamic series I often teach that includes simple neck rotation I call Owl Turns, and side-bending I call Curious Dog Tips (see Friday Q&A: Safe Neck Movements). You could also move the neck in gentle rotation in such standing poses as Warrior 2.
If weakness, especially of the extensor muscles at the back of the neck, is a concern, practicing low Cobra (Bhujangasana) and Locust (Salabhasana) poses dynamically or for very short holds can help to build more muscular strength and support for cervical neck extension.
As for restorative poses, most of them could be fine as a way to allow for some gentle neck stretching and also to provide support to the neck for general muscular and fascial relaxation. But let the student’s responses to the poses guide you in deciding which poses to remove or keep in your original sequence. Reclined Cobblers pose (Supta Padangusthasana), Legs Up the Wall pose (Viparita Karani), and Supported Child’s pose (Balasana), are a good place to start (see see Featured Sequence: Mini Restorative Practice). But keep an eye on Child’s Pose, as the rotation of the neck may be more challenging for some students and if it causes pain, you will need to help them modify it.
As for yoga suggestions for pain management, see our postYoga for Pain Management, which is relevant for OPLL as well as many other pain conditions.
Disclaimer: This article is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities.
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