Osteoporosis (OP) means porous bones. The bones become fragile as the bone mass is lost, and the structure therefore weakens.
• Women are more commonly affected than men, 80% in fact.
• OP related hip, spine and wrist fractures are reported at a rate of one in 2 women and 1 in four men, aged 50 and older. It can have an earlier onset, so if there are risk factors present in you, investigate with your GP.
• It is not a normal ageing process, but rather a systemic skeletal disease.
• Osteopenia is a milder form (less measurable bone loss) and is generally a precursor to OP.
This means that for every two women over 50 that walk into a Pilates studio seeking to start Pilates, 1 of those will have OP, and be at risk for fracture. This is very important to consider in the type of exercises you undertake. Therefore your Instructor, and more importantly YOU need to know if you are affected, to ensure your lifestyle reflects this condition.
Risk factors include –
1. Inadequate exercise that doesn’t allow the bone cells to lay down new bone. Weight bearing exercise is especially important for this process. More on this later.
2. Inadequate consumption of nutritious food that provides the fuel for you building healthy, strong bones. Insufficient Vitamin D and calcium are relevant.
3. Family history, long term medication use or a health event that has affected your bone health, eg, arthritis, chemotherapy treatment, menopause, anorexia etc.
Scarily enough, most fractures are caused by activities taking place in daily living, especially as the disease progresses. Something as simple as bending over to pick something up, or a sneeze can result in fracture.
Studies show that the bones between the shoulder blades are the most at risk for fractures. You may not even feel the fracture, but signs can include a gradual loss of height, an increasingly stooped posture with stiffness in the area, and back pain. Testing usually looks at the lumbar spine area, (the lower back bones) but all exercise therapists should assume that if there is a diagnosis of osteopenia or OP in that area, the shoulder blade area (thoracic spine) is probably affected too.
How can Pilates help?
Pilates incorporates weight bearing exercise, this is where you push your own body weight through the bones in the movement. This is done on your hands and knees on the mat, or utilising the spring loaded equipment for standing, seated or lying exercises.
Pilates Intructors with studio certification and full accreditation through Pilates Associations (APMA, Polestar Pilates and Pilates International) will have learnt about the management of OP clients in their training. Make sure of this when you start.
My advice -
• Gain clearance from your specialist or GP before you start a Pilates program.
• Avoid spinal flexion exercises (bending the spine in a forward rounded position). The front of the spinal bones are compressed when you do this and the weakened bones have the least capacity to bear this load at the front.
• Side bending and rotation movements are to be avoided also.
• If you are doing mat exercises, do not do any lifting of the head as part of the movement. This compresses the thoracic bones into the floor and is not recommended, head stays down.
• Get your Instructor to teach you how to breathe into your side/lower back, you want to encourage that lower rib flaring movement.
• Get your Instructor to teach you the concept of neutral spine and axial elongation.
• Backward bending exercises (extension exercises) are a valuable part of your exercise program. Learn these from your Instructor who will supervise you closely to ensure your form is good. Perhaps place a pillow under the tummy when you start these lying face down on the mat.
Research shows -
A 1996 study showed that clients with stronger back extension muscles, had higher bone density in their spines.
A 1984 study showed that 89% of clients who performed only flexion exercises suffered additional fractures in the study. When a client has OP it is clearly inappropriate to be bending forward into that stooped position, bend the knees to lower yourself down, keeping a neutral spine position. This can be practised using a long piece of dowel held against your back.
References
Sinaki, M., & Mikkelsen, B.A. 1984. Postmenopausal spinal osteoporosis: Flexion versus extension exercises. Archives of Physical Medicine and Rehabilitation, 65 (10),
593–96.
Sinaki, M., et al. 1996. Can strong back extensors prevent vertebral fractures in women with osteoporosis? Mayo Clinic Proceedings, 71 (10), 951–56.
Fast Facts on Osteoporosis – National Osteoporosis Foundation 2008
Betz, S. 1999. The Osteoporosis Exercise Book. Osteo Physical Therapy.
Melissa Turnock
Level Three Pilates Practitioner, APMA.
www.pilatesscene.com
