OSTEOPOROSIS AND PILATES
WHAT IS OSTEOPOROSIS?
Osteoporosis literally means porous bone, and it's precursor, Osteopenia, means thinning bone. The National Osteoporosis Foundation (NOF) states that osteoporosis is a debilitating disease that can be prevented and treated. It is a disease characterized by the deterioration of bone tissue affecting both the structure and strength of the bones - of which there are 206 in the human body! Through Osteoporosis, bones become weak and fragile and are therefore at greater risk of fracture. Areas that are most vulnerable are the hips, vertebral column, ribs, and wrists. Frequently referred to as the "silent disease", osteoporosis has no symptoms and oftentimes individuals don't know they have it until they fracture something during a fall.
HOW IS IT IDENTIFIED?
If you're a post-menopausal woman, many of you will already be familiar with a bone mineral density test or BMD. This is a test or scan that measures the BMD in both the lumbar spine and one of your hip joints; it is most commonly executed by means of a low radiation X-ray (DEXA). It is interesting to note that the device cannot accurately measure the BMD of the thoracic spine because of the obstacle of the ribs and sternum. Therefore it is often assumed that you probably have low BMD in the thoracic spine if your test results show that you have low BMD in the low back and hip.
The DEXA determines your fracture threshold by comparing your BMD to that of an individual with a "normal" BMD. An important fact: the most popular site for fractures of the spine is T6 -T8 (this is the area between your shoulder blades). Often times you will notice this area taking on a convexity in certain individuals. So what do we do with this information? Read on.......
WHO SAID STRESS WAS A BAD THING?
Stress is required for strong bones - physical stress that is! Weightbearing activity and resistance exercise (such as say, um....Pilates!) place mechanical stresses on the bone which in turn stimulate bone growth. Because bone is a living tissue, there must be a demand placed on the tissue in order to elicit a response. Most medical authorities state that once that vital window of time is closed (the critical growth period), there is an inability to increase bone mass without medication, however; there are some studies that reveal otherwise. Sherri Betz, a Physiotherapist and Pilates instructor in California, states that as much as 20% of bone can be built in one year's time through modification in diet, coupled with bone building exercises which includes Pilates (her website is noted at the bottom of the page; please take a look).
The most important thing to remember, and everyone can agree on this, is that it is important to at least maintain the bone mass you have and this can be achieved through specific exercises and proper nutrition. For your information, a pilates instructor is not qualified to make claims regarding one's condition, or offer medical advice - such matters should be discussed with a Doctor and/or Nutrionist.
CONTRAINDICATIONS TO EXERCISING:
If you are working with osteoporosis, it is important to have an awareness of which exercises are contraindicated (should be avoided), especially if you're at an advanced stage of bone loss. This involves any exercises that place the spine in flexion (forward bending). When you bend forward the weight of the spine moves forward onto the front of the vertebrae where the bone is softer and less supportive, this may put an individual at risk for a compression fracture if the bone in that area has been weakened by the disease.
The same is true of any lateral flexion (side bending) and twisting; the safety of the individual vertebrae is compromised. This movement would not pose a threat to an individual with healthy bone mass but could be detrimental for somone at an advanced stage of osteoporosis. So therefore it is advised that individuals with osteoporosis avoid these movements. Some health professionals suggest that these specific planes of movement be closely monitored in the osteopenic population as well (perhaps they should reduce their range of motion when twisting and side bending). It is unfortunate that many fitness professionals are unaware of these contraindications, especially those working in generic fitness environments where crunches are part of the everyday routine.
Be careful if you are Osteopenic; you are still at risk for fracture - although some people with osteoporosis may never experience a fracture in their lifetime. The problem is that we don't know how much we can stress the bone before fracture. According to Dr. Susan Brown, a medical anthropologist and clinical nutritionist, there are other factors that determine the health of the bone which include the actual quality of the bone and the trabecular architecture. A BMD scan does not determine the quality of the bone, just its density. We are still learning more about what all of this means.
In my Osteoprevention class, alignment is key. We look at our postural habits and make subtle changes so that the load on the spine is of equal tension. Poor postural habits result in muscle imbalances which lead to uneven demands placed on the bones (remember muscles pull on the bones in order to move them). Attention is also focused on using the hip joint optimally which includes proper bending or hinging forward at the hip while maintaining a long and neutral spine. All flexion is avoided and you'll be surprised how challenging a workout can be without any flexion (so no "series of five"/"stomach series"/"medley" with the head up folks). Please check out this article: http://www.ny1.com/Default.aspx?SecID=1000&ArID=83695 ("Exercise Can Help Ease Osteoporosis, But Doctors Say Use Caution").
Strengthening of the legs is important as you will rely more on the quadriceps for support when bending at the knees to pick something up (instead of rounding at the spine). Range of motion exercises are explored and a balance between mobility and stability of the joints is strived for. Extension exercises are certainly a highlight as they take stress away from the anterior spine (where the bone is softer) and place it on the posterior part of the vertebrae where the bone is stronger. Extension exercises also help counteract hours at the computer as well as the forces that be - oh gravity - we mustn't let it get the most of us!
Some helpful websites include the following:
