Regarding the difference between osteoporosis and osteopenia: Basically we must assume that if the person has osteopenia of the lumbar spine that they may very likely have osteoporosis of the thoracic spine. 1)The thoracic spine is more oriented to kyphosis and anterior loading of the vertebral bodies, 2)The vertebrae get smaller as we go up the vertebral column and 3) The most popular fracture site of the spine is at T6-T7 and T8. We also have no way of determining whether or not the disease is progressing as we are working with our clients. There is no way we can determine how much force it would take to cause a fracture in the spine. The statistics are clear; 1 in every 2 women over age 50 will have an osteoporotic fracture in their lifetime. Then after the 1st vertebral fracture the risk of having another one within 1 year is 500%!! We need to be very vigilant about preventing the 1st fracture. It’s not a good idea to “experiment” with clients when the research is very clear. A physical therapist is guilty of malpractice if they put a patient who has known osteoporosis in spine flexion.(Carole Lewis, PT) I am in support of “evidence-based” practice in PT and Fitness. I want to give my clients/patients SAFE exercises that WORK! Unfortunately with so many flexion exercises in our beloved Pilates method we are forced to be creative and compliant. Yes, we WILL narrow their options for movement somewhat but my clients from age 20-84 are completely happy with their exercise programs and feel very confident about their guidelines and exercises! They don’t want to have any/anymore fractures! I know very few people on the planet these days that need to increase their degree of thoracic flexion!
There is an article that explains all of the reasons for avoiding flexion, Modifying Pilates for Osteoporosis, published April 2005 in the IDEA Fitness Journal. It is downloadable on the Osteoporosis News page of this TheraPilates website.
8 Comments
March 9, 2008 at 7:18 am
In an exercise like the double leg stretch then, is it OK to raise the head while you do it, or should you keep the head down flat with osteoporosis. I know it’s flexion, but it seems like so little.
March 9, 2008 at 7:40 am
In Double Leg Stretch, the position of the upper spine and neck is the same as in the Hundred. Actually just lifting the head is not the correct way to perform the exercise. You are meant to roll the thoracic spine into flexion so that the head just “floats” up. So in the correct performance of the Double Leg Stretch there is a significant amount of thoracic flexion in the upper and middle thoracic vertebrae. So, please keep the head down or on a pillow or wedge cushion.
March 10, 2008 at 5:03 pm
My instructor has been having me do mat exercises – reaching across my body with one arm to touch the floor on the opposite side, and also lying on the mat with legs in the table position and swaying the knees from side to side. Having done some reading on your site it seems to me that that is twisting and not a good idea with osteoporosis.
If that’s right I worry about how to tactfully refuse to do them.
Annette
March 10, 2008 at 9:36 pm
If you have osteoporosis of the spine, even a partial curl up has been shown to cause micro fractures in the vertebral bodies. Read the Sinaki and Mikkelson article on the osteoporosis page of my website. If you curl up and twist, this puts the vertebrae at even greater risk of fracture due to the increased pressures on the vertebral bodies with the combined forces of rotation and flexion. Bring a copy of the article “Modifying Pilates for Osteoporosis” and have your instructor contact me with any questions they have. I am happy to help them understand in a positive and non-threatening way.
Sherri
March 12, 2008 at 8:48 am
Thank you Sherri. I have read the article a few times. I will print it and give her a copy. I have become stronger despite the RA and osteoporosis, so I plan to carry on.
I find it difficult to set goals in Pilates and know objectively whether I am progressing
Annette
March 13, 2008 at 8:06 am
Hi Annette,
Your instructor should have performed some type of fitness assessment at the start of your program and then periodically re-assess to see how you are progressing objectively. I use an assessment devoloped by Polestar Pilates Education for teaching my fitness instructors how to assess clients. Sherri Betz
August 5, 2008 at 4:58 pm
Hi Sherri!
So, I have some clients that are “border line” or have osteopenia. I know this sounds a little repetitive, but this means NO flexion, in any direction, what so ever, right? So everything must (for safety) be done in extension or neutral. I just want to make sure I’m doing what’s best for my clients without limiting them too much. Hope all is well.
-Nikki
June 21, 2009 at 6:27 pm
Dear Nikki,
Neutral or Extension are your safest positions. Flexion is the most at risk for causing fractures. Rotation and Sidebending are next. The thoracic spine is most likely to fracture at T6-7-8. So, upon discussion with Kathy Shipp, PhD, PT, Wendy Katzman, DPT, Carleen Lindsay, PT and other experts in this field at a symposium last year, we all thought that articulating bridges would be safe for osteopenic clients. This would allow a small amount of lumbar flexion. I do not allow clients to do exercises in thoracic flexion. Some cervical flexion is permitted. Avoid endrange movements of sidebending and rotation and do not combine flexion and rotation (like the saw). Combining extension with rotation is permitted. (like Swan with rotation). Exercises such as: Rolldowns, Rollups, Rollovers, Hundred are contraindicated.
The only research we have on vertebral compression fractures shows that there is a pretty clear correlation between flexion, low bone density and fractures. (Sinaki, et al 1986, 1992, 2002, 2007)