"Dual energy X-ray absorptiometry (DXA) assessment performed at a median of 10.5 months prior to the index VCF showed that . https://melioguide.com/services/phone-or-online-consultation/. I am tired of just sitting and waiting! She is now paying the price. I answer each of these questions in this blog post. I am now 71 years old. Would you be kind enough to tell me what stretches I can do safely in the meantime. She finds that she cannot wear tight clothing that might press on the bone that is protruding in her back. She is the creator of the continuing education course, Working with Osteoporosis and Osteopenia. Specific clinical signs in physical examination: Note: Signs 1 and 2 are useful adjuncts in evaluation symptomatic osteoporotic vertebral compression fractures and are reliable indicators of the presence of a fracture. To practise these exercises, follow the film or download the accompanying fact sheet, ' Exercises for back pain after spinal fractures '. This movement could cause a compression fracture. Wall push-ups Bow-and-arrow pull: This exercise helps improve back muscles to promote good posture. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. that your chin is in at the level of the middle of your breastbone). She was excited because she felt she had turned the corner. We prefer to work with them when they are still able to hold their ear over their shoulder and their shoulder over their hip in nice alignment. In the 1980s, we werent sure whether flexion or extension exercises were a safe thing to give to a woman with osteoporosis or people with back pain. In the video, you will see Pat, one of my clients, demonstrating how to garden safely. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. It sounds like you are in good hands and with this Physical Therapist you should be given exercises to make your spinal muscles (and your bones) stronger. I had a fragility fracture of T9 mid August 2019 (about 6 months ago). The exercises I have listed are appropriate as spine fracture treatment exercises and thoracic compression fracture exercises. My GP, an internal medicine specialist, has began slowly tapering me off of the high dose steroids, introduced vitamin D and hormone replacement therapy to my daily regime, and as well started me on the first yearly/bi-yearly round of the IV infusion medication Reclast. I have just watched Brendas interview and it is everything I have experienced. You should not be doing any active exercises at this time, it can make your pain worse. I too have been active most of my life and am finding the overall adjustments I have to make as a result of my osteoporosis a bitoverwhelming at times but this video has been very inspirational. In the garden, Brenda wears a heavy-duty compression fracture brace for lumbar support. L1 Compression Fracture: Causes Symptoms And Treatment I too have been very mindful of bone strength and my genetic vulnerability way before menopause. Compression fractures of the spine generally occur from too much pressure on the vertebral body. It is important that you keep this in mind and I recommend that many people consider couples therapy during times of stress. It subsides if I lay down. Your article was very informative. My thoughts after reading your article is that I may not should flex forward to tie my boots. For the last 15 years, she has concentrated on bone health and has treated thousands of patients for their osteoporosis, osteopenia and low bone density. If you are not sure whether you have a compression fracture but have any of the six symptoms listed above have it investigated. VCFs were identified in the thoracic (n = 6), lumbar (n = 4) and cervical (n = 1) spine. Once your muscles have started adapting to the change in height caused by the spinal compression fracture and the compression fracture has had time to heal (usually 8 to 12 weeks after the episode of increased pain) you should start a compression fracture exercise program. Doing some gentle exercises helps to improve muscle tone, ease tension and reduce muscle spasms in your back. It was a thoracic compression fracture and four other vertebrae had some level of compression. I do not wish you to break a bone. A crush vertebral compression fracture is the least common type of vertebral compression fracture. Margaret graduated from the School of Physical and Occupational Therapy at McGill University in Montreal, Canada in 1984. Input from radiologists is needed because there is a lack in knowledge for diagnosing those fractures without images and the symptoms might be absent or it is difficult to determine the cause of the complaints. You should not hesitate to purchase Exercise for Better Bones. A simple activity like bending to lift an object or twisting can cause a compression fracture. But one has to stand up for ones rights and its their professional duty to find out if they dont know. Thank you so much for these videos and information. Many thanks and my sincerest appreciation in advance for your help! Safe compression fracture exercises and safe movement are critical to reducing your risk of another compression fracture. Every time she improves in her exercises, her muscles are activated; and every time those muscles are activated, she is stronger in whatever she does, whether its getting off the toilet, getting out of a chair, getting out of bed in one smooth motion. Margaret operates her Physical Therapy clinic, MelioGuide Physical Therapy, in Ottawa, Ontario where she focuses on patients with osteoporosis, osteopenia and low bone density. I got a second opinion from a specialised spine doctor, this person was more empathetic with my situation and said sometimes this takes longer to heal BUT that the fracture was old and I had sprained my spine all over and perhaps spinal cord. My clients who regularly do their exercises feel stronger and have less pain. A pre-existing spinal fracture: Having one spinal fracture greatly increases your chances of having another. After a high impact fall from my horse I broke my pelvis and whilst rehabbing from this I hurt my back from a minor movement and then again and then again. Here are my recommendations for patients with compression fractures who want to know how to get out of bed with a compression fracture: A comprehensive study published in the Journal of Bone and Mineral Density in September 2017 (7) identified a relationship between the incidence of compression fracture and back pain. This time I wasnt offered advice as to timing, and had to ask if this would be the appropriate way to take the medication. Martin Dunitz, 1998, Sujoy M, Yu-Po, L. Current concepts in the management of vertebral compression fractures. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program. Theimportance of good body mechanics and diligence during your exercises is really important despite having that type of intervention. Use a heating pad to help your muscles relax. Also, I cant seem to find the kyphosis weighted vest that Brenda is wearing. The lumbar area of the spine contains five vertebrae known as L1 through L5, situated between the thoracic or chest area and the buttocks. When she does her stretching exercises, she has it underneath her as well. There is no need to give up an enjoyable sex life because of a compression fracture. Studies have shown that exercises that involve flexion increase your chance of spinal fracture. I bought a long handled grabber. A recent study looked at how 12% of people that are post menopausal are going to have a vertebral fracture in their lifetime. She is putting a lot of force on her spine, especially in her mid back, through this position. MelioGuide Physical Therapy for Osteoporosis, Physical Therapy Osteoporosis Prevention and Treatment, August 22, 2022 By Margaret Martin 55 Comments. 3 lbs and resting between the lower third of the shoulder blades. [8]It is important that the patient overcomes his fear of movement (kinesiophobia) and continues with his/her activities. Find the most gentle exercise he can do without making his pain worse and progress from there. Ensure that your MD gives you the green light. The pain is not in my back! I will share your comment with Deborah. No one with low bone density should be manipulated as the forces can cause a (another) spinal fracture. The weighted kypho-orthosis vest helps her walk more upright because it counterbalances the weight of her head and allows her to control where her posture is taking her. Using self-reports of pain and other variables to distinguish between older women with back pain due to vertebral fractures and those with back pain due to degenerative changes. Compression fractures are not static. My Physical Therapist recommended it to me. I have a patient with lumbar compression fracture and hes afraid of doing any exs or even getting up from a chair because he thinks hes gonna break his back. The percentage of men in the study reporting back pain with undiagnosed compression fractures (70%) exceeded those without compression fractures by 11 percentage points (59%). It was very handy in the initial stages because everything seems to drop when you dont want it to drop. I feel very good and had been at Mary Free Bed, a rehabilitation facility to build core muscle. Let your partner know how you feel and discuss the support you need. Hi Callum, If you do work with a chiropractor ensure that they are knowledgeable about osteoporosis. Brenda concluded that her bones were healthy because of her exercises, diet and Prolia injections. There are four subtypes for compression fractures. Get fit and exercise. What is unusual is that the pain comes later in the day and it is on the right side of my abdomen in the front (just under my ribs). Watch on 6 Compression Fracture Symptoms Watch on Compression Fractures: Exercises to Avoid Watch on Flexion and Extension of Vertebral Column Watch on Did I mention Im ONLY 39 years old, and have had ZERO trauma to my back? He is lucky to have you as a therapist. The classic radiographic finding is an anterior wedge fracture.[14]. The bending is happening in the knee and hip as opposed to the spine. While sitting, hold an exercise band out in front with arms extended. Brendas husband has health issues of his own and he is very limited in what he can do. In White AA, Panjabi MM, eds: Clinical Biomechanics of the Spine, 1990, Bogduk N. Clinical anatomy of the lumbar spine and sacrum. My pain lasted approximately six months each time. Brenda has had to hire young women to help her with the garden because gardening involves hauling, lifting, heaving, and shovelling. Unfortunately, there are a lot of movements that they are doing (under the guidance of a fitness instructor or book that is not familiar with osteoporosis) that might be good for the general public but not for individuals with low bone density, osteopenia or osteoporosis. She puts it on her spine because it absorbs shocks from the potholes in all the roads that we have in Canada. I walk approximately 5-6 miles daily. Due to the Personal Health Information Protection Act of Ontario, I do not use a public forum to discuss individual situations. No guidance has been given at all. Take it one day at a time, one exercise at a time, and progress at a pace that works for you. As far as cold the physician who came up with RICE (rest, ice, compress and elevate) recently wrote a book explaining how he wished he had never suggested Ice. Pain is still there but getting better. I still suffer pain and discomfort. Approximately 60% of older men with small osteoporosis-related compression fractures reported new or worsening back pain. Brenda has had to retrain her brain in terms of what is a safe way to move, as opposed to what she used to do so easily and without thinking. My chief disappointment was that the actual injury was so quickly glossed over in the rush to get me onto pharmaceuticals. All the best, Margaret. If the fracture occurs from a traumatic injury, the skin over the affected vertebra may appear red. Finally, I encourage you to work with a health care professional who can provide soft tissue massage, postural taping, or taping and gentle spinal mobilization. Agents for treating osteoporosis include: These agents act through either antiresorptive or osteogenic mechanisms.[1]. I agree that it is very important that your Dr has knowledge and experience of Osteoporosis and will refer you without a battle to the experts. Oh- and tying shoes is definitely a problem! I am going for Kyphoplasty in 10 days time. Brenda uses a heating pad a lot. Journal of Clinical Neuroscience 2006; 12: 31-38 (Level of Evidence 1B). A compression fracture can happen anywhere along the spine. Fracture risk increases with age, with four in 10 white . Any notable event the patient experienced in the history, causing the symptoms and complaints.High-Risk Mechanism of injury [2], It is important to know that there are no fully validated screenings for diagnosing lumbar compression fractures. One is 5 minutes in duration and the other is 10 minutes. Brendas story shows that every persons experience with compression fracture is going to be different. The pain is axial, non-radiating, aching, or stabbing in quality and may be severe and disabling. [2][7][8], A lumbar compression fracture is a serious injury, both when caused by osteoporosis or by trauma. Their pain returns, some experience another vertebral fracture. The incidence of thoracic compression fracture is the highest among all parts of the spine because this area is the one where the postural stoop (or kyphosis) will occur. With biconcave fractures the top of the vertebral body takes on what looks like a smile while the bottom of the vertebral body takes on a grin. She has said walking and stretching, but not what kind of stretching. (Brenda uses the Bauerfeind Brace in the illustration to the right.). Accupuncture has helped me immensly I felt relief after the first session and its made my muscles relax and starting to let go after around 6 sessions. Patient is standing in the front of a mirror with the examiner behind him. But I am glad it helped you! I encourage readers to read my blog post on Osteoporosis Posture Explained where I discuss, in detail, key concepts related to postural alignment and how good posture practices can fend off compression fractures. Brenda finds the dynamic tape to be another kind of little miracle worker. Because she was physically fit before the compression fracture, her muscle memory is coming back. The expense of Forteo would be for 18 months whereas the expense of Prolia would be for 10 years. There are considerable benefits to being fit before the compression fracture. The reacher is a terrific little device. Top Contributors - Remko De Smedt,Ivakhnov Sergei, Andreas De Feyter, Lucinda hampton, Kim Jackson, Lien Hennebel, Lauren Lopez, Rachael Lowe, Sam Verhelpen, WikiSysop, Alexander Ghyssels, Joshua Samuel and Aminat Abolade. I decide the appropriate mix of strength and trunk control exercises based on my assessment of the individual. During a a vertebral kyphopasty surgery, the surgeon re-inflates the vertebra with kyphoplasty and then injects a form of cement into the vertebral body. Brenda has a pillow that she takes where ever she goes. A normal inward curve in our upper spine, which is the cervical lordosis, is at our neck. The white vertebra is compressed. Like Brenda I was extremely disappointed with the medical profession as I grappled with such a loss of mobility and independence. We have a normal small outer curve in our upper back, referred to as the thoracic spine. You should keep a hard copy of all tests that you have even in this day and age of electronic copies. As I have even more recently had a second in 2 spine x-rays that indicate demineralization along with additional vertebral compressions, I am confused, as well as alarmed. Hi Margaret, I have been reading your book, and I have been doing your DVD. Have a greater mobility in flexion and extension. These can include getting out of a car, sneezing, coughing or twisting suddenly. The specific exercise mix is dependent on the individual needs of my clients and I choose what is appropriate after an assessment. I have asked many health care providers and no one has ever heard of this type of residual pain from a thoracic compression fracture. [2] Midline back pain is the hallmark symptom of lumbar compression fractures. Finally, lumbosacral orthoses are also available for lumbar fractures but are only effective in restricting sagittal plane motion in the upper lumbar spine (L13). Treat Spinal Compression Fractures Without Surgery - WebMD Please bring this question to your physician. Here are several movement strategies that will reduce your risk of a compression fracture. A compression fracture may make you feel fragile and vulnerable. They are more like a fascial stretch. As for the weighted kypho-orthosis the company that was making them is no longer but you can try using a little backpack purse. Both of these items are covered in this blog post and in the Exercise for Better Bones program. Acute VCFs may be treated with analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, narcotics, and calcitonin (be mindful of medication adverse effects in older patients). The heating pad is nice when youre taking your break before bed or taking siesta in the afternoon, for example, to bring some blood flow to the muscles and give them a little break throughout the day. [Epub ahead of print], Kim L Bennell, Bernadette Matthews, Alison Greig, Andrew Briggs, Anne Keppy, Margaret Sherburn, Judy Larsen, John Wark. Lets take a closer look at what happens to your spine when you do flexion exercises or perform activities that cause a flexion motion. To protect your bones from further limiting your movement and your quality of life it is very important that you make time to move intelligently everyday. Most of the fractures occur at the thoracolumbar junction. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. My suggestion is to use them appropriately for tasks that you actually need that extra support such as when you work in your garden. All of those exercises are incredibly safe and progressive. All the best, Margaret. This presentation, created by Mel Kaplan, Jacob Landersm Kari Mann, and Kelsie Martin; Texas State DPT Class. > than 80 years (40% of the women at this age have received at least one compression fracture). She does every single compression fracture exercise I ask her to do. While calcium is important, you should make sure you have adequate amounts of nutrients including vitamin D, magnesium and vitamin K. Pruneshave been shown to play an important role in bone health. As a result, Brenda was used to muscle soreness from vigorous exercise. I want to talk about a topic that is especially close to my heart: movements that increase your risk for spinal fractures or compression fractures. In elderly patients with severe osteoporosis, however, there may be no pain at all as the fracture occurs spontaneously. I instructed him on body mechanics and to avoid forward bending and twisting his back. All tell me that the decline in strength impacts their quality of life. I had to suggest the paracetamol/ibuprofen protocol myself, ask what were the best actions to promote healing lying down vs sitting vs standing etc. Certain medications: eg oral steroids, anti-depressants, diabetes drugs. The pain is not in my back! I cried watching this. I have a referral to an endocrinologist, but Im not starting drug treatment until Ive weighed up all the options, risks and benefits. After the first 8 weeks of a new vertebral fracture you can gradually incorporate more extension exercises/movements into your day. I had been advised many years previously to take ibuprofen and paracetamol alternatively every 2 hours (with limits on total amounts taken in 24 hours). This usually results from a combination of bending forward and downward pressure on the spine. Hold your stretches for 30 seconds and then relax. When she starts to feel achy, she sits down for 15 minutes and puts it on. For some with minimal compression(s) in the mid thoracic spine, little may change for you. Hi Sue: Thank you for sharing your story and experiences. The Reclast infusion seems to have been the best pain relief and benefit thus far. Safe Exercise Program for Compression Fractures Margaret Martin, Physical Therapist 127K subscribers Subscribe 554 Share 32K views 1 year ago Physical Therapist, Margaret Martin, describes. My patient, Brenda, is here to share with you how her life has been impacted by compression fractures. Posted 03/19/2010, Clark E.M., Gooberman-Hill R, Peters TJ. Any advice? I have ordered your book through Book Depository but it has not yet arrived. Association of yoga exercises and vertebral compression fractures Brenda says the vest helps her stay more upright because her body naturally wants to go forward. I have had the impression that now I have this disability I just have to live with it! I just fractured my fifth thoracic vertebrae from severe osteoporosis. Hi, thank you for very informative video. Repeat to the other side. The loading through trabeculae and the whole vertebral body is much more even and safe. All the best to you and your Mum. No specialist/MD i have seen will recommended Kyphoplasty, due to the volume of fractures I have, and even so much as a brace recommendation has been hard to yield from anyone, due to me having both Lumbar & Thoracic fractures. That is usually the journal article where the information was first stated. Gave me some hope. There is a risk of neurological damage, when this is the case, surgery is recommended, [10] Neurologic deficits are quite uncommon. I have ordered your book and hope that will give me some guidance to nurture my strength and hopefully can contact you for a more individual consultation. I am waiting for an appointment at the spine clinic to see if I am a candidate for vertebroplasty or kyphoplasty. prognosis after simple compression fractures is excellent for most patients to improve with little or no residual back pain and no functional impairments. Key components of an osteoporosis exercise program. Brendas experience shows that you should find a health practitioner that you trust and has knowledge in treatment of osteoporosis and compression fractures. Thanks! Whom is this specialist I need, and how do I find them? 2016 Mar 16. In this section we will cover the nutrition advice Brenda follows and the devices she uses to reduce the pain associated with her compression fracture. Rather, it is meant to inform you that it is in your control to help yourself reduce the further risk of a compression fracture. The group that did just extension exercises (group #1) had a very low rate of fracturing. Hi Jack, Thank you for your kind comments and feedback. For example this is a good source of couples therapy in Toronto. Lumbar compression fracture clinical presentation. Heat is especially helpful since it relaxes the muscles. Compression Fractures: Causes, Symptoms, Treatment & Prevention Not only will the actual fractures themselves get worse but you are at a higher risk of fracturing more and more levels. You may also perform thoracic stretches. So its a personal decision that youre going to have to make to keep you safe and feeling well. I also prepared a video explaining flexion and extension. She is lifting a heavy bag in a flexed position. Compression Fractures | Johns Hopkins Medicine They ended up with Tramadol at least at night but I am nervous about going this route. Exhaling thru pursed lips as he visualizes drawing up the big boys as they would say in Australia. Thanks for your thoughts. The physiotherapist learns the patient how to use that orthosis. It provides details on Yoga poses you should modify or avoid. Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO comprehensive classi cation. Osteoporosis Exercises to Strengthen the Spine, Improve Posture, & Stop Compression Fractures. Many thanks again. We identified six symptoms that you might have a compression fracture. Mechanical low back pain (Clinical pain presentations), Primary OsteoporosisSecondary osteoporosis, A plain radiograph may be all that is necessary for a majority of compression fractures, especially if one proceeds with conservative, medical management, DEXA scan: Roughly half of patients with vertebral fractures have. With it she cannot bend, twist, or pick up a stick. I asked Brenda knowing what you know now, what would you tell your younger self? (Level of evidence: 2A), Meunier PJ. The group that did no exercise at all (group #4) still had a very high rate of fracturing. Prevention the compression fractures could have reduced the onset of back pain and further disability in the study group. Be vigilant about your activities of daily living go back often to the link to safe moves located inside Exercise for Better Bones. . Fortunately there were physicians who studied this issue. Stay clear of exercises that involve flexion and rotation. Keep your knees bent, roll your shoulders and knees simultaneously. Core strength and osteoporosis why is core strength important if you have osteoporosis? Sudden pain when you take a deep breath, cough, sneeze, and/or move your spine in certain directions. She has done research with McGill School of Physical Therapy into the use of a web-based exercise program for patients with osteoporosis. Others have asked and although Brenda would love to have the time and energy to reach out individually lifes challenges do not allow her to do so. The goals of compression fracture exercise program are to: I recommend that you invest time and understand how compression fractures occur and learn how to avoid all activities and postures that can make your compression fracture worse. Brenda finds that ittakes the 10 minutes for her body to release and relax into the stretch. Fracture types. Before the fracture I was very active and exercised regularly. This is a transition zone (T12-L2): the thoracic vertebrae are more rigid in compare to the mobile lumbar region which means that the transition zone receives the biggest load during impacts. Keep well. Use extra pillows to ensure a supportive sleeping position. As you realize there are many factors, cost being one of them, to consider. I walk approximately five miles daily and as of this October, I will be at a year since a fracture. He has to regain trust in his body. If you are a side sleeper, make your head pillow wide enough that it supports your head in a neutral position (i.e. I was in pain that was basically intolerable. at age 40 I had a T5 fracture from a fall on ice. She is also wearing theweighted kypho-orthosis vest when she prepares her meals. Women and men who have not exercised before think that something has gone wrong.