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 MelioGuide.