Compression Fracture: Movements that Increase Risk Fracture

Hi, my name is Margaret Martin. Today on MelioGuide,
we’re going to be talking on a topic that’s especially close to my heart. And that’s movements
that increase your risk for spinal fractures or also referred to as compression fractures.
Many of my clients come to see me with advice from other trainers or advice they got from
books, and they’re doing things that they think is sound, and things that they think
are the right things for them. They are trying their very best. But unfortunately there’s
a lot of movements that they do that might be good for general public, but not for individuals
with low-bone density or osteoporosis. So hopefully by the end of this tutorial, you’ll
have a good understanding of what movements, be it in yoga or pilates or just exercises
or movements around the house, that you may be doing that you should consider modifying. So in this tutorial, we’re going to look at
why the spine is more at risk than other bones in the body. This would be a good time to
review, if you haven’t yet done, the tutorial on understanding bone. Here, looking at the
spinal column, we have on the left, are normal curves in our spine. We have a normal inward
curve in our lumbar spine, or our low back, which is referred to as a lordosis. A normal
inward curve in our upper spine, which is the cervical lordosis, which is at our neck.
And we have a normal small outer curve in our upper back. Now, these look really pronounced in our photo
here. But if you look at somebody with good alignment, you’ll usually see a nice shape
to the spine. Looking closely at the vertebral body, we know, and as we’ve talked about in
previous tutorials, that it is composed of a hard outer coating, referred to as cortical
bone, which surrounds the trabecular bone in the inside, the softer bone, which is also
referred to as cancellous or spongy bone. Back in the 80s, we weren’t sure whether flexion
or extension exercises were a safe thing to give to a woman with osteoporosis or people
with back pain in general. So fortunately there were physicians who were studying this.
Now, for those of you who aren’t familiar with flexion and extension, that’s why I’ve
brought up these two slides here. These photographs here on the left showing extension exercise,
and on the right, showing flexion exercise. Back in 1984, Dr. Sinaki did a study on postmenopausal
osteoporotic women looking at the effects of flexion exercises versus extension exercises.
The mean age or the average age for ladies in this study were 49 to 60 years of age.
She had four groups. And in these exercise groups, one group did extension exercises,
one group did flexion, the other group did a combination of flexion and extension exercises,
and the last group did no exercise at all. Within a year and a half, if they had back
pain or if they were due for a follow-up, they would report back in. She did spinal
x-rays and would see whether or not they had sustained fractures of the spine. These were
the findings. The findings were that fractures occurred
at a very high rate, almost 90%, in the group that had done flexion, that had done sit up,
toe touch type exercises. The group that did no exercise at all still had a very high rate
of fracturing. The thought behind that is that for a lot of things that we do in life,
a lot of common activities such as picking out the laundry, reaching forward, coughing,
sneezing, there’s a lot of flexion that occurs. So unless we counteract that with some extension,
as you see in the third group where they did some extension and some flexion, as you start
to introduce extension movements into the spine or into your life, you start reducing
your rate of fracturing. The fourth group that did just extension exercises had a very
low rate of fracturing. Sixteen percent in comparison to 89%. Very substantial. Looking more closely on what happens with
flexion exercises, in flexion motion, here we see the image of this spine. It’s actually
a beautiful image where you can see more closely the actual trabeculae or the cross-bridges
within the vertebral body. And when we do a lot of flexion motions of the spine, as
well as side flexion and extremes of rotation, but for today’s tutorial, we’ll just talk
about flexion, those motions have been implicated with high forces. The trabeculae that are weakened in osteoporotic
bone just can’t withstand those forces. As a result, they start to fracture. As you see
in this vertebral body, up here, you start seeing larger pits where you actually have
fracturing occurring of the trabeculae so much so that you actually see holes or spaces
that would be filled with marrow. On the lower vertebrae, you actually see the
loss of height of the vertebrae. And what’s happened here is that there’s been so many
forces that the disc is actually starting to push through the vertebrae. The vertebrae
itself is actually quite a bit shorter in stature than the vertebrae above and below
it. It has just compressed in on itself. So if we look at stopping the stoop and stopping
the progression of this forward flexing of the spine that happens with continual wedge
fracturing like we see on the right, we need to do this at a stage ideally where someone
hasn’t yet fractured, where they’re still holding their ear over their shoulder and
their shoulder over their hip in nice alignment. Not only is exercise implicated, but all the
movements that we do day in and day out. So we’re looking at compressing the spine, or
when we’re moving in as best alignment as possible. So here you see Pat, one of my clients, demonstrating
how to garden safely. Pat’s bending forward in an unsafe manner here in the upper corner,
where she’s putting a lot of force in her spine, especially in her mid back, through
this position. Whereas if she took the time to get down and kneel as she’s demonstrating
down here, she’s maintaining a nice alignment. The bending is happening in the knee and hip
as opposed to the spine. That’s much safer on the spine. The loading through trabeculae
and the whole vertebral body is much more even. Exercises that increase your chance of spinal
fracture. Therefore, all different, all exercises that bring you into that forward flexed position.
Flexion and rotation, as seen in the middle photograph, is even more risky in that you’re
combining the two motions. If you think about it, we think, “Ooh exercises,” but you know,
oftentimes I’ll see women carrying heavy purses and they go to sit down and they’ll rotate
and drop their purse to the side. That too is a very compressive load in a way that puts
your spine at risk. So those are things to consider. Looking at
how to move well, how to move safety, and not just through formal exercises, but through
exercises that have become more popular like yoga and pilates. Yoga and pilate moves need
to be practiced with caution and should be practiced under the supervision of instructors
who are well trained in the precautions that need to be carried out for individuals with
osteoporosis and low-bone density. You do not want to be doing any of the poses that
you see here. If you have an instructor who wants more information, or for yourself, we
did do a booklet, and I worked with an excellent yoga instructor, Jayelle Lindsay. She and
I put together a booklet specifically on safe yoga practice for osteoporosis. You’ll see
reference to that at the end of this tutorial. Best to keep it neutral. So flexion is obviously
contraindicated, but extremes of extension are also not recommended. So with all activities
of daily living, with strength training exercises, aerobic exercises, yoga, pilates, extremes
for your spine are not recommended. So whether you’re grooming your dog, going into the fridge,
picking loads up off the floor, or embarking in an exercise program, you do need to move
carefully and safely. I’m proud to say that MelioGuide does offer
you excellent exercise programs that do not put your spine at risk. So I hope this has
been a helpful tutorial. That has been all for this session. I’ll see you next time on

9 thoughts on “Compression Fracture: Movements that Increase Risk Fracture”

  1. Thank you for the video, I have a T8 compression fracture. A PT gave me an extreme extension exercice and I got severe pain afterwards. My fracture is 8 weeks old.

  2. I would like to ask your advice is there anything that can fix the vertebrae as in 5.38 in your video,as my disc has collapsed in on the vertebrae identical to the image in your vertebrae is L2

  3. No mention pain management. I was extremely active and ocd. My bones are deteriorating and now taking prolix injections every 6-month. My compress fracture was ignored by (some) brilliant doctor. Three years with increased pain and now fracture she sends me to pain management 😕 now let see where I go from here. Pain management has quickly ordered mri and a back brace. Insurance plays big part

  4. I wish that you had spent as much time on exercises that were GOOD for the weakened spine as you did on those that were bad.

  5. I developed compression fracture L3, Dr recommend KYPHOPLASTY had procedure Feb 27,2019, I woke up in recovery EXCRUCIATING PAIN, WAS IN TEARS, I WAS given 4 very strong IV Pain meds, did nothing, I was sent home, I only can sleep sitting up on the couch unable to do anything, but sit on couch with legs elevated, and my Pain meds do not even touch the pain, saw Dr today April 11, 2019' there now Compression fractures L4&L5, I can not tell you how upset I was. I am being fitted for brace to wear 6 to 8 months, I have no quality of life, wish I never had it done was active could do what ever I wanted, can not even walk can stand in one place 15 Seconds if any longer I would fall.

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