Patients with osteoporosis or those at risk of developing osteoporosis will benefit from working with a physiotherapist at Evidence Sport and Spine.
The goals of our physiotherapy treatment is to educate you on proper posture, teach you safe ways of moving and lifting, and to provide you with exercises you can do at home to help prevent a decline in bone mass and prevent fractures. The exercises we prescribe will particularly focus on activities that help to increase the strength in your bones, as well as exercises that help to maintain or improve your balance. Optimum balance helps to decrease your risk of falling, which can easily fracture an osteoporotic bone. We will also suggest exercises for your flexibility to help decrease the stress placed on the bones by tight muscles as well as improve your overall mobility. If you have experienced a fracture from osteoporosis, physiotherapy at Evidence Sport and Spine can also help with controlling your pain and gradually returning you back to your regular activities.
Maintaining good posture is of utmost importance if you have osteoporosis. A stooped upper spine posture, called kyphosis, is common in osteoporosis due to the wedge-like fracturing of the thoracic spine that often occurs (the front part of the vertebrae collapses leaving the posterior portion higher and the overall vertebrae appearing wedge-like.) Losing height as a result of these fractures is a common occurrence in osteoporosis. For this reason accurately measuring and recording your body height is a key part of our physiotherapy evaluation. A height measurement gives your physiotherapist an idea of how osteoporosis is affecting your bones and posture, and by comparing the recordings over a period of time it can help us track your success with treatments.
With posture exercises, the goal is to get your body lined up from head to toe, with weight going through your hips. In a healthy spine posture, the head is balanced on top of the spine rather than jutted forward which is common in osteoporosis. In people with advanced osteoporosis, the upper body is also commonly bent forward at the hips. This prevents the hip bones from getting the right amount of stress and weight through them. As a result, the bones weaken and become more prone to fracture. It is therefore important at all times to try to “be tall” which can both prevent a loss of height as well as help you regain height lost from an already fractured osteoporotic spine.
Your physiotherapist will explain ways you can put good posture into practice. This is called body mechanics, which is the way you align your body when you do your daily activities. Remember that a healthy posture is balanced with the body aligned from the head to toes. The same posture should be used when you bend forward to pick things up. Instead of rounding out your shoulders and upper back, keep the back in its healthy alignment as you bend forward at the hip joint. This keeps your back in a safe position. When bones are weakened from osteoporosis, rounding the spine forward when bending and lifting pinches the front section of the vertebrae and increases the risk of a spine fracture. This pinching is exacerbated when any weight at all is lifted in this position. Even the weight of a purse or shopping bag can add detrimental stress to an osteoporotic spine leading to a fracture. Along with maintaining proper posture, gently tightening the muscles around your core area can also help to protect the back during activities such as lifting. Your physiotherapist will educate you on how to use your core muscles to protect your spine. Rapid bending forward of the osteoporotic spine, such as that experienced when one sneezes or coughs, can be enough to cause a fracture of the osteoporotic spine. For this reason, your physiotherapist will educate you on consciously extending rather than flexing your spine during these activities.
Another motion particularly stressful for the osteoporotic spine is a twisting motion. The normal structure of bone is not designed to withstand twisting very well so combined with the weakened bone state of osteoporosis, the motion of a twist can easily cause a fracture. Although difficult to eliminate from every day life, twisting should be avoided whenever possible especially in combination with higher velocity motions such as a golf swing, tennis swing or bowling action.
Strengthening exercises for your bones are of utmost importance in maintaining the health of osteoporotic bones. As mentioned above, as your muscles get stronger, the bones underneath them also get stronger as they react to the added stress placed on them. In this way, strength training and weight-bearing activities force the bones to build mass. Your physiotherapist will prescribe some gentle weighted exercises, using either elastics or weights, for your upper and lower extremities. Using an appropriate weight is of utmost importance and your physiotherapist can educate you on how much resistance is appropriate for you. If using free weights, handling the weights is just as important as doing the exercises themselves. Never lift weights in the flexed forward posture described above, and be careful to gradually increase the resistance you use as weights that are too heavy will naturally cause your body to slip into the flexed forward posturing that is detrimental to people with osteoporosis. Performing exercises while your upper back is supported in good alignment is also recommended to avoid added stress on the thoracic spine. Exercises that incorporate flexing of the spine, such as toe touches, abdominal crunches, and dead lifts should strictly be avoided. Strengthening exercises for your upper back, however, will be encouraged by your physiotherapist in order to counteract the stooped forward posturing.
Weight bearing cardiovascular exercises such as walking outdoors or on a treadmill, gentle non-pounding forms of dance, and stair climbing are useful activities to put weight through the bones and encourage an upright posture while also improving cardiovascular health. Cycling is not a recommended activity as it does not provide the benefits of weight bearing and it also encourages the detrimental flexed forward posturing of the spine. Pool exercises are not weight bearing either so are not recommended unless severe pain from osteoporosis limits physical activity on the land in which case exercising in the pool would be acceptable and recommended. High impact activities such as running, jumping, and pounding forms of dance should be strictly avoided. Your physiotherapist at Evidence Sport and Spine can educate you on safe cardiovascular activities specific to your interests and your physical needs.
The next part of our treatment will focus on your balance. As stated above, poor balance can lead to a fall which can easily fracture an osteoporotic bone. In some cases a fracture from a fall can be a potentially life-threatening situation. Exercises to improve your balance can be as simple as standing with your feet close together, standing on one foot, or standing with one foot in front of the other. Closing your eyes can make any of these activities even more difficult. By challenging your balance, your reaction time to unexpected situations such as tripping will improve and your likelihood of falling will decrease. The most important aspect of working your balance is ensuring that you are doing it in a safe environment. Your physiotherapist will provide you with exercises that are specific and challenging to your current level of balance. As your balance gets better, more challenging exercises will be provided. Tai chi, which is an exercise form originating in China, is another great way to improve one’s balance, and many patients benefit from practicing this on a regular basis.
The final component to our treatment at Evidence Sport and Spine will be to provide you with some flexibility exercises. By improving and maintaining your flexibility, the stress put on your bones by tight muscles will decrease and the ability to practice good posture and body mechanics will be improved. Good flexibility also improves your mobility, which in turn improves you balance and decreases your risk of falls. Stretches for your upper back and chest in particular will be prescribed to decrease the likelihood of developing a stooped posture. Stretches for your hips, calves, and neck are also important if you have osteoporosis and will be included in your stretching regime.
Your physiotherapist will continue to compare your test results of body height, posture, strength, balance, and flexibility to see how well you are improving and to encourage you in continuing with your exercise program. Once you can safely and proficiently perform your home exercise program, regular visits to Evidence Sport and Spine will not be required, however, we will continue to be a resource for any further questions you may have or problems you may encounter.
If you are seeing one of our physiotherapists at Evidence Sport and Spine because you have recently had a fracture related to osteoporosis, our treatment will start with a focus on decreasing your pain. We may use hands on treatment as well as modalities such as ice, heat, ultrasound, or electrical current to assist in managing your pain. We will liaise with your doctor to determine the most appropriate time for you to begin the more advanced exercises involving strengthening, balance, and flexibility as outlined above, and will proceed with them as appropriate in order to allow you to return to your normal activities as quickly as possible.
Evidence Sport and Spine provides services for physiotherapy in Calgary.