As bones in the spinal column grow weaker or collapse due to disease or injury, they compress against other bones, nerves and tissues, causing limited movement and range of motion, pain and numbness. 1984 Oct; 65(1): 593-6, Association of Incident, Clinically Undiagnosed Radiographic Vertebral Fractures With FollowUp Back Pain Symptoms in Older Men: the Osteoporotic Fractures in Men (MrOS) Study, Howard A Fink et al, Journal of Bone and Mineral Density, September 7, 2017. Her General Practitioner recommended bisphosphonates, but she couldnt tolerate them. Have ordered the book, and looking forward to taking charge of my own recovery! In both cases, your surgeon injects a type of medical cement into your damaged spine to heal the fracture. Medium-firm mattress is often recommended but you have to find the one that is right for you. If you want more information or have an instructor who wants more information, consider Yoga for Better Bones. I was given a brochure listing calcium-rich foods, which I pretty much knew about anyway. The mean age or the average age for the women in this study were 49 to 60 years of age. Preventing and treating osteoporosis is the best way to decrease your risk for compression fractures. Start at the beginner level, gradually work your way up, see what your body allows you to do, and maximize the weight that you can lift safely. There is a risk of neurological damage, when this is the case, surgery is recommended,[10] Neurologic deficits are quite uncommon. 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. Brendas experience shows that you should find a health practitioner that you trust and has knowledge in treatment of osteoporosis and compression fractures. That initially helped with the general pain. It says my comment is awaiting moderationwhat does that mean? The x-ray image of the spine below shows a compression fracture. Bend both your knees. Are there any studies done with that scenario? There is always room for more caring in health care. Hi Debbie, I am sorry about your T8 crush fracture. I asked Brenda knowing what you know now, what would you tell your younger self? Gave me some hope. She became more careful, watched the calcium in her diet, her vitamin D levels, and continued her exercise classes. 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. I was told today that complete healing can take a year. The clients think that they are doing things that are sound and right for them given the fragility of their bones. Do not bounce. Have a file so that you can trace back your health history. Fracture types. And they wont know everything. Tapering the steroids will help. Wedge compressions are most commonly seen in the mid back, around the level of the lower angle of the shoulder blades. But if you look at somebody with good alignment, youll usually see a nice shape to the spine. Here is my recommended osteoporosis sleeping position for people with compression fractures. Dr. gave me back brace and ask me to visit him in 5 weeks. Would you be kind enough to tell me what stretches I can do safely in the meantime. Is there a best way to sleep with a compression fracture? I went to Mary Free Bed Rehabilitation Facility in Grand Rapids, Michigan for PT. She finds this motivating. Certain medications: eg oral steroids, anti-depressants, diabetes drugs. Symptoms of a compression fracture of L1 include pain in the lower back or buttocks, numbness in the legs, and difficulty walking. Pain is still there but getting better. Find that your back pain might not be sharp but a lot of people with vertebral fractures will describe their back pain as crushing in nature. However, this does not distinguish whether the anterior or posterior column is involved. Everyone is different and the exercises will need to be broken into groups and delivered at apace that works for you. 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. I have quite a few clients that have compression fractures and do not even know they ever had them. The image provides a closer look at the actual trabeculae or the cross-bridges within the vertebral body. Brenda uses a heating pad a lot. Be sure you communicate openly with your physio so that she/she can ensure that all the exercises you do do not increase our pain. I wish I had the opportunity of working one on one with you. thank you for sharing your experiences it helps and makes me feel not so isolated. I am quite active and have not had any height loss or fractures since I was seen by a specialist in 2001.T5 is stable. The biconcave vertebral compression fracture, like the wedge fracture can have different levels of compression. Vertebroplasty entails injecting liquid cement into a collapsed vertebral body through a needle inserted transpedicularly. Thank you for ordering Margarets book. There are four subtypes for compression fractures. Osteoporotic spine fractures can be graded based on vertebral height loss as: The figure on the right gives an illustration of the anatomy of the lumbar spine: The lumbar vertebrae are the 5 largest and strongest of all vertebrae in the spine and the strongest stabilizing muscles of the spine attach to the lumbar vertebrae. I am unsure how best to treat it. After the diagnosis of compression fractures, Brenda was given strong painkillers that helped manage the pain and allowed her to sleep. Take care, Margaret, Hi Melissa, I hope that the information provided in my sleep blogs gives you some sleeping options. Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, is controversial, but can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life. I had a client who went tobogganing with her grandchildren. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Repeat to the other side. Its a reminder to keep upright. A compression fracture of the L1 vertebra can cause pain in the lower back and buttocks. Thank you again. Recall that Brenda experienced severe back pain during her trip to Africa likely brought on by a compression fracture. You could experience a lumbar compression fracture when you have an impact. Compression fractures of the spine generally occur from too much pressure on the vertebral body. Not knowing your general health or your ability to regularly strength train aggressively enough to build bone makes it impossible to provide an appropriate response. Compression fractures happen when there is too much pressure on the vertebra. They relieve her pain or her aches. Im glad you talked about being able to use heat pads and I think that being able to try that would be good. She is lifting a heavy bag in a flexed position. Each time we meet she arrives with her completed checklist and asks me questions specific to compression fractures. Is there any way to forward my email to Brenda? Keep your knees bent, roll your shoulders and knees simultaneously. I am glad the combination of medications helped you. . She is fastidious about her chart and can see her progress. Braces which extend to the sacrum are termed thoracolumbar sacral orthoses. I am 60 years old. The vertebrae itself is actually quite a bit shorter in stature than the vertebrae above and below it. If it doesnt feel right, it probably isnt right. This usually results from a combination of bending forward and downward pressure on the spine. Compression fractures are caused by trauma, osteoporosis, infection and neoplasm. You can look at the videos at anytime and as often as you like. The physiotherapist learns the patient how to use that orthosis. I would love to know the best way to sleep. hamstring stretch can be done lying on your bed with the support of a bathrobe or yoga belt wrapped around your foot. People who have severe osteoporosis can fracture a bone during daily activities. This is why she wanted to share her story. MelioGuide Physical Therapy for Osteoporosis, Physical Therapy Osteoporosis Prevention and Treatment, August 22, 2022 By Margaret Martin 55 Comments. This field is for validation purposes and should be left unchanged. The only constants in advice I encounter, are to not start any sort of physical therapies until 12+ weeks after my last fracture, which is becoming impossible because I continue getting compression fractures, and multitudes of apologies in not being able to recommend how to move forward, because theyve never seen such. . I have always had an active lifestyle, my nutrition has always been really good especially from the calcium angle and I have never smoked and had very little alcohol BUT I couldnt change my mother! It does take up to six months plus. Unfortunately, a lot of women and men do not exercise until something happens and their body does not have a positive association with exercise. A recent study (4) shows that a 12 month duration of exercise had a very positive effect for people who had experienced vertebral fractures. The illustration to the right shows the cross section of a vertebra of the spine. She is the proud recipient of the 2011 Award of Distinction from the College of Physiotherapists of Ontario for her significant contributions and achievements as a Physiotherapist. Brendas husband has health issues of his own and he is very limited in what he can do. A repeat DEXA showed that she had improved, so she discontinued her Prolia injections in the spring of 2015. Ann Bouwkamp, Hi Ann, Sorry to read about your vertebral fractures. Effect of twelve-month physicalexerciseprogram on patients with osteoporotic vertebral fractures: a randomized, controlled trial. Also can you still exercise if you are still in pain? These small compression fractures can cause the spine to lose height and stability over time. The research team examined data from 4,396 men over the age of 65. April 2016,Volume 27,Issue4,pp 1459-1467, EvstigneevaL et al. Exercises you should avoid if you have osteoporosis. Stay safe. Many new clients come to me for Physical Therapy compression fracture treatment because they receive advice from fitness trainers or books that does not take into account the fact that they have osteoporosis, osteopenia or low bone density. [2] Midline back pain is the hallmark symptom of lumbar compression fractures. She used to walk five kilometres plus a day. Some clients might have had a bit of back pain that goes away after six to eight weeks. Compression fractures. Margaret is the author of three books on osteoporosis and exercise. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. . With time I encourage you to progress the chest stretch by lying on your back over a rolled-up blanket. This medication is a synthetic form of calcitonin, a hormone that regulates levels of calcium in the body. If you understand intellectually what the exercise will do, then she really motivated in terms of her everyday life. This is so much more information that I have received from all the health professionals I have been consulting with. A routine DEXA (Dual-Energy X-ray Absorptiometry) test and FRAX score, in 2011, showed that Brenda had some bone loss. Spinelive Spinal compression fractures. Thank you for reaching out and caring. Will I ever be pain free?! There are two more videos later in the blog. Weighted vesta are a popular exercise device for many people with osteoporosis but should you wear one if you have a compression fracture? Weight-bearing exercise is extremely important to prevent progression of osteoporosis and prevent future lumbar fractures. I recommend a compression fracture exercise program that includes a combination of postural, flexibility, strength and trunk control exercises. I encourage listeners to exercise in a regular basis. Once she got the clean bill of health, Brenda planned a dream holiday for her and her husband a five week trip to Africa. Most of the fractures occur at the thoracolumbar junction. Sudden pain when you take a deep breath, cough, sneeze, and/or move your spine in certain directions. Brenda has had to hire young women to help her with the garden because gardening involves hauling, lifting, heaving, and shovelling. Oper Tech Orthop 2011; 21:251-260 (Level of Evidence 2A), Kim DH, Vaccaro AR. Exercise is an essential ingredient to bone health. Multiple compression fractures. A lumbar compression fracture is a serious injury, both when caused by osteoporosis or by trauma. I am also going through the decision of what to do re pharmaceuticals have not taken anything yet. 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. (Brenda uses the Weighted Kypho Orthosis Vest in the illustration.). Decrease your pain at rest and with movement. Use extra pillows to ensure a supportive sleeping position. at age 40 I had a T5 fracture from a fall on ice. 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. Due to the Personal Health Information Protection Act of Ontario, I do not use a public forum to discuss individual situations. Here are Brendas thoughts on that question. I asked her not to emphasize her frustration but, instead, share the tactics that have helped her deal with her compression fractures. Brenda says the vest helps her stay more upright because her body naturally wants to go forward. She is putting a lot of force on her spine, especially in her mid back, through this position. She has done research with McGill School of Physical Therapy into the use of a web-based exercise program for patients with osteoporosis. She broke the study set into four exercise groups: Within a year and a half, if they had back pain or if they were due for a follow-up, members of the study set would report back in. Hope you improve and daily living becomes easier for you. Keep your head pillow as low as you comfortably can when on your back. She finds that the prolonged fascial stretches make her feel good. It can help you both feel more comfortable with the situation. Sometimes she will put her purse in her back and adjust it so it is in the small of her back. I just fractured my fifth thoracic vertebrae from severe osteoporosis. These have been taken that away completely. Occasionally life gets in the way of being able to devote time to her regular exercises. As you realize there are many factors, cost being one of them, to consider. Compression fractures happen when there is too much pressure on the vertebra. I have to sleep in a hospital type bed due to the fact of not being able to lay flat, and sleep at nearly a ninety degree angle. Keep your elbows by your side. What else can I tell him? This is really terrible because it affects their quality of life. Good luck as you heal. Examples include the Jewitt, cruciform anterior spinal hyperextension, and Taylor brace. Effects of an Exercise and Manual Therapy Program on Physical Impairments, Function and Quality-of-life in People with Osteoporotic Vertebral Fracture: A Randomized, Single-blind Controlled Pilot Trial. Earlier Brenda recommended that people make sure calcium be part of their diet. The lumbar area of the spine contains five vertebrae known as L1 through L5, situated between the thoracic or chest area and the buttocks. Stay clear of exercises that involve flexion and rotation. Fracture risk increases with age, with four in 10 white . All the best, Margaret. So I guess my question besides the video should I begin now with meds or just continue eating well and up my strengthening and wait til I break a bone? 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. All the best to you and your Mum. A compression fracture of the lumbar spine is also known as a wedge fracture. I was not familiar with paracetamol/ibuprofen protocol. Brendas story is meant to help all of those individuals, men and women, with compression fractures who are suffering in silence. These lumbar vertebrae (or lumbar bones) contain spinal cord tissue and nerves which control communication between the brain and the legs. In White AA, Panjabi MM, eds: Clinical Biomechanics of the Spine, 1990, Bogduk N. Clinical anatomy of the lumbar spine and sacrum. Before the compression fracture, Brenda was the Energizer bunny. She could not believe that it actually works. Yoga and osteoporosis should you practice yoga if you have osteoporosis? Following surgery for relief of lumbar fracture compression injury or trauma, your doctor may suggest short-arc exercises that promote flexion and extension of the quadriceps, such as pelvic stabilization exercises like the pelvic clock, says spine surgeon Dr. Matthew Cubbage. I too have been very mindful of bone strength and my genetic vulnerability way before menopause. Have open and honest conversations about these feelings with your partner. Dr. Sinaki did spinal x-rays and would see whether or not they had sustained fractures of the spine. The lumbar disk works as a cushion for the mechanical loads. 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). It helps take the ache away. (Level of evidence: 2A). Any advice? WOW! These problems started 6 mths ago and I was just diagnosed with the fractures a month ago. Here is one I recommend from amazon(dot)com: https://amzn.to/2MePiGd And the same from amazon(dot)ca: https://amzn.to/2B3jC1T In the study using the weighted kypho-orthosis the weight was limited to approx. The Bennell study (2) looked at the effects of compression fracture exercises and manual therapy on physical impairments, function and quality-of-life in persons with osteoporotic compression fractures. My son is 54 years of age and has cerebral palsy (spastic quadriplegia) he has had Prolia injections twice a year for five years. Mary Free Bed has been a God send as they have specialists in osteoporosis. I do not recommend that every one with a compression fracture do all of these exercises. I have just watched Brendas interview and it is everything I have experienced. Ensure that your MD gives you the green light. Today she is up to three kilometres walk at a snails pace. All she can do now is deadhead plants. Further, thevertebral kyphoplasty could be detrimental because it could make one strong section with weaker bones around it. Other conservative therapeutic options include limited bed rest, bracing, physical therapy, nerve root blocks, and epidural injections. It increases the level of calcium in bones and can also relieve pain at the site of a fracture. Neurosurgery 77 (2015): S33-S45. It subsides if I lay down. In crush fracture the posterior portion of the vertebral body collapses. Extend one foot towards the ceiling as you support it with the belt. Other causes include injuries to the spine and tumors. The lumbar spine is located in the lower back below the cervical and thoracic sections of the spine. You should not hesitate to purchase Exercise for Better Bones. Start at the thoracolumbar junction and extend to the promontorium of the sacrum. With it she cannot bend, twist, or pick up a stick. I started Prolia last December with my second injection being in June of this year (2020). Some people can compress their vertebral body so much that they cant see it on an x-ray anymore. Can lead to a reduction of the abdominal space and/or a decreased ventilator capacity. Osteoporotic compression fractures of the spine; current options and considerations for treatment. I went through 6 weeks of physical therapy, but I still have pain. But, Brenda was not aware of the kinds of exercises that were detrimental to her spine. I have been on Prolia for 4 years. "Dual energy X-ray absorptiometry (DXA) assessment performed at a median of 10.5 months prior to the index VCF showed that . Thats the go-to position and she has to fight that all the time. Compression fractures occurred at the following rates by group: The study found that fractures occurred at a very high rate, 89%, in the group that had done flexion exercises (group #2), such as sit ups and toe touch exercises. Im convinced that at some point some sort of healing and/or mending must begin, if nothing more than my own bodies fight to heal itself. If you are a side sleeper, make your head pillow wide enough that it supports your head in a neutral position (i.e. Rest is not recommended, its important that the patient remains active. The orthopedic spine MD stated that it was too severe to do a vertebroplasty. That way the therapist can gauge their reaction. You can unsubscribe from my mail list at any time. My Physical Therapist recommended it to me. The cortical bone is the thick non-porous bone at the rim on the cross section of the spine. Margaret graduated from the School of Physical and Occupational Therapy at McGill University in Montreal, Canada in 1984. These activities can be bad for your back when done incorrectly. I fractured T7 in March of 2017. The bending is happening in the knee and hip as opposed to the spine. When the test is positive there is reason to rationalise and refer the patient for a MR scan. Possibly they are caused by high load impact trauma with a flexion compression mechanism. I will also be getting my third Prolia treatment. Available from: Kinematics of the Spine. Following surgery for relief of lumbar fracture compression injury or trauma, your doctor may suggest short-arc exercises that promote flexion and extension of the quadriceps, such as pelvic stabilization exercises like the pelvic clock, says spine surgeon Dr. Matthew Cubbage. However, you should take a look at how your bone mineral density (BMD) scores have been changing over the last decade. In the next lessons I cover in more detail what types of movements have been shown to increase the risk of both wedge and biconcave vertebral compression fractures. They should be able to answer the questions you have and anticipate the questions that you dont have the things that you should know. Fractures may be mild to severe. Use a pillow between your knees and ankles when sleeping on your side. We have a normal inward curve in our lumbar spine, or our low back, which is referred to as a lordosis. The study concluded that there are positive benefits of physical therapy prescribed compression fracture exercises for patients with compression fractures. They are more like a fascial stretch. Strengthening of abdominal, gluteal and hip muscles is important to support spinal structures with noncompressive forces and can be done for integrating the exercises into a more functional rehabilitation programme. Glad you are walking, it is good for our body and spirit as well as being good stress management tool. Brenda uses a similar one when she is out at galleries etc. The daily activity guide which is far more extensive than what I have online is a must after a compression fracture. A compression fracture of L1 is a break in the vertebrae, which is the bone that makes up the spine. This type of fracture can be caused by a fall, a car accident, or any other type of trauma to the spine. You will see all the safe stretches in the book. Brenda says you should not be afraid to get a second opinion. (Im 69 years old and need to do whatever I can to keep upright.) Physical examination reveals- tenderness when palpating or directly percussion over the area of the fracture, spasm in paraspinal muscles. Your situation does not sound unusual. If you who are not familiar with flexion and extension exercises, I have two photos showing each type of exercise. In 1984, Dr. Mehrsheed Sinaki at the Mayo Clinic did a study (5) on postmenopausal osteoporotic women that looked at the effects of flexion exercises versus extension exercises. This type is an unstable fracture and may cause severe spinal cord compression. Ive been thinking about some different options for my grandmothers osteoporotic fracture treatments, and I think that being able to get some help would be good. The best thing you could do is to work closely with a Physical Therapist who is knowledgeable in the treatment of compression fractures. Thank you so much for these videos and information. I am now on my third physio and have improved a heap but had my first four hours on my own at work today and an in a lot of pain now. Keep well. Hi Margaret, I may have misused the term protocol, I was referring to the timing and amount of medication. I asked Brenda if either the physician that gave her the diagnosis or the initial physiotherapist who treated her told her that the compression fractures could get worse by how she moved. When she does her stretching exercises, she has it underneath her as well. Posted 03/19/2010, Clark E.M., Gooberman-Hill R, Peters TJ. Will be purchasing book but was wondering whether your video would be of benefit as well. Like Brenda I was extremely disappointed with the medical profession as I grappled with such a loss of mobility and independence. When she does her stretching exercises, she has it underneath her as well. We know from previous tutorials that the vertebral body is composed of a hard outer coating. [2], Acute phase: Localised tenderness over the involved level is a known characteristic for acute fracture. Osteoporosis: diagnosis and management. 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. Patient is gently asked to take place on the examination couch and lie supine, using only one pillow. A vertebral compression fracture can create stress in your relationship. Keep your back straight and your chest lifted, and then lean slightly forward with your upper torso. Other than acute pain control, medical therapy should be aimed at improving bone quality and thus reducing the risk of future fracture. She does every single compression fracture exercise I ask her to do. Here are several movement strategies that will reduce your risk of a compression fracture. Core strength and osteoporosis why is core strength important if you have osteoporosis? Watch on 6 Compression Fracture Symptoms Watch on Compression Fractures: Exercises to Avoid Watch on Flexion and Extension of Vertebral Column Watch on Margaret's work in osteoporosis and Physical Therapy has been cited in a number of Physical Therapy textbooks. Third group did a combination of flexion and extension exercises. And is there a method for tying my shoes? The bones that make up your spine (vertebrae) can weaken to the point that they crumple and collapse, which may result in back pain, lost height and a hunched posture. As time goes on, your spine has to work a little harder if you have compressions because the forces in the spine have changed. I bought a brace and am taking tylenol, and using Lidocaine patches, The pain is difficult. 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. In this tutorial, were going to look at why the lumbar and thoracic spine is more at risk than other bones in the body of a compression fracture. Brenda uses a Weighted Kypho Orthosis Vest for walking, while preparing her food and any activity anything where she is standing around a long time. I instructed him on body mechanics and to avoid forward bending and twisting his back. I have a referral to an endocrinologist, but Im not starting drug treatment until Ive weighed up all the options, risks and benefits. There is no need to give up an enjoyable sex life because of a compression fracture. Following 8 weeks of healing you can gradually go back to strengthening and following a regular exercise program. He is lucky to have you as a therapist. Lets take a closer look at what happens to your spine when you do flexion exercises or perform activities that cause a flexion motion. Place the blanket lengthways. 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. My pain lasted approximately six months each time. I decide the appropriate mix of strength and trunk control exercises based on my assessment of the individual. During this discussion of the movements that cause a fracture we will get into detail on what is a compression fracture. Could these rib pain incidents be related to osteoporosis? My ribs were not fractured, but it took several weeks for the pain to resolve. Hi Colleen, You are very welcome. The decision to take a pharmaceutical needs to be discussed with your health care provider, including your PT. The key findings and conclusions were: The studys main author, Dr. Howard Fink, concluded: Back pain is the most common symptom (of compression fractures). The study results are similar to findings in elderly women.