♪ Bob and Brad, the two most famous ♪
♪ Physical therapists on the internet ♪
- Hello, I'm Sarah Meeks,
and this is the second video
in a series on the management of osteoporosis,
which is my specialty area.
So today, what I'm going to do
is work with these skeletal models here
so that you understand what osteoporosis is,
where it occurs,
and also some of the problems with it
and what we can do about it.
So I'm going to begin with the first model here.
And when you look at the model of the spine from the front
just imagine that this is your backbone.
You will notice that it is more or less
straight up and down.
If you look at it from the back, it is straight up and down.
But if you look at it from the side, it has curves.
And this is the important part of the Meeks Method.
So the curve begins down here.
This is called the tailbone,
or the coccyx is the other word for this,
and I want you to notice that it is curved under.
If you go up the spine,
the next bone is called the sacrum,
which goes, it also has a curve in that.
Then you have, this is called the lumbar spine
or the lower back,
and the curve shifts into what is called a lordosis.
Then as you go up the spine,
the curve goes again the other way
and this is called a kyphosis.
Now, some people get concerned about the word
and confused about the word kyphosis.
We should have a kyphosis in our spine
because in front here, you have your heart and your lungs,
and this is curved to help protect those vital organs.
And then as you go further up,
you will see that the curve changes up here
in the cervical spine back into another lordosis.
In the Meeks Method,
I always am concerned that we do exercise
with keeping the curves as they are.
I do not do pelvic tilts
because when people do pelvic tilts,
which is a tilt of the pelvis,
which can cause movement in the lumbar spine,
which may end up with a fracture
in people with osteoporosis.
So I do not do pelvic tilts.
I do not have people flatten out the lumbar spine.
I want them to do the exercises
with the curve intact and the same thing for the neck.
I do not flatten the neck.
I want to keep a natural curve in the neck
as we're doing the exercises
so that people are strengthening muscles
in what I call optimal alignment,
optimal spinal alignment.
My basic and my most common area of fracture
with osteoporosis is the spine itself.
We also have problems with the hip,
that's the next big one,
but I want to strengthen the muscles that support the spine
with the spine in alignment.
Now, just for your information,
the common test that's done for osteoporosis
is called a DEXA scan.
And probably some of you watching this video
have had a DEXA scan,
or at least you know what it is.
It measures the density of the bone in a certain area.
And the area they usually test is the lumbar spine.
And there are certain numbers that will tell you
whether the person has osteoporosis or osteopenia
or normal bone, or whether they've had fractures,
and so on.
However, most of the problems with osteoporosis
occur up here in what's called the thoracic spine,
but the DEXA scan does not scan this area.
And that's one of the problems with the diagnoses.
And then in the neck,
I want you to know that the bones in the neck,
in the cervical spine up here,
even though they are the smallest,
you notice that the bones get larger as we go down the back,
that these are the most dense bones in the spine.
And I was kind of wondering about that
but then eventually figured it out,
because I always thought
with the force of gravity coming down and so on,
most of the density would be in the lower spine,
but that is not so.
So why is the bone more dense up here in the neck?
Well, there are a couple of theories about this.
One is that as human beings, as we go through our life,
we move our head a lot.
You know, we bend our head to one side,
or we look down or we look up,
or we nod our head or we turn it, you know,
a 'no' signal or something like that,
but we move our head a lot.
And the force of the muscles and the movement
is going to contribute to the strength of the bones
in the neck.
It turns out that the bones down here
are the least dense as you go down.
So it is not just the weight on the bone.
It has to do with the kind of movement we do,
and so on.
And most of the issues, as I said, occur in this area.
Now, if we look at my other model over here,
you'll notice that they're different colors.
So the green is the lumbar,
and down here, that looks like orange.
That's the sacrum.
And they've got the little tailbone there, a little darker.
But the area that's most at risk is this blue area,
in the thoracic area.
You can think of it as
between your shoulder blades and down to your waistline.
This is the area where most fractures occur.
And also the thing that you need to know about that is that
up to 80% of compression fractures are silent.
What that means is that the person doesn't feel it.
They don't have pain.
And, but on the other hand, when they have the fracture
the curves in the spine are going to change
because of the fracture.
Fracture predicts fracture.
If you have one, you're at risk for more.
So I wanna take a look at this model here from the side.
Also, that when you have a fracture,
then what happens is you start to get
what's called a hyperkyphotic curve in the spine.
This is going to affect heart rate and breathing
because these organs are right in front of
that area of the spine.
So I think that's an important thing for people to know.
There are tests for osteoporosis in this area of the spine.
One is called a lateral vertebral assessment,
where they look at the spine from the side
and they can see compression in the vertebral bodies.
Now I've met therapists,
physical therapists with many, many decades of experience
who were thinking that the area of the body most at risk
for osteoporosis was the backside of the backbone.
But it is not.
These are very, these are primarily called,
it's called cortical bone, which is a stronger bone.
And these are made primarily of trabecular bone.
The inner surface or the inner part of the bone
is more fragile, and it's like a maze in there.
The bones, you have vertical and horizontal bones.
And then also you have the disc spaces,
that's what these little things are here,
that also help protect the spine.
So the other area that I want to talk about
a little bit is the hip.
And when we talk about the hip,
a lot of people think their hip is up here
on the top of the pelvis or around waist level.
But the hip joint itself is actually probably five inches,
it depends upon the height of the person and so on,
below the top of the pelvis,
and the area at risk for the hip joint
is called the neck, here, of the femur.
This is the femur bone, that's your primary thigh bone.
And the fractures mostly occur in the neck of the femur
and also in an area called the intertrochanteric area.
This is called a trochanter, this big knob here,
the greater trochanter.
And so that's where most of the fractures occur in the hip.
Now we do have exercise protocols for fractured hips.
We have surgical procedures that work very well.
Some people have to have what's called
a total hip replacement
depending upon where the fracture's occurring and so on.
But it's important to know this because the,
some people we, you know, we talk about the hips.
We're talking about up here,
but we're really talking about here.
Now, there's a big dilemma in management of osteoporosis.
The two forces that you need on the skeleton
to build strong bone are muscle contraction
and weightbearing force.
Those are the two primary forces to help build bone.
There are two areas in the body
which have no muscle attachments.
So if we say that muscle contraction is so important,
and we have areas where there are no muscles attached,
we have a problem.
The two areas are the thoracic spine,
the mid to lower thoracic spine.
There are no muscles attached to the bones in the front.
There are muscles attached in the front
in the lower spine and in the cervical spine,
but nothing here.
This is the area, where there are no muscle attachments,
where most fractures occur.
They occur below the level of what's called T6.
So this is the first thoracic 2, 3, 4, 5, 6, thoracic
down to where the spine changes into the lumbar spine.
That's where most fractures occur
and where no muscles are attached.
The second area is the neck of the femur.
This is where most fractures occur in the hip
and there are no muscles attached to the neck of the femur.
There are muscles all around the hip
and the pelvis and so on, but nothing right here.
So if we say muscle contraction is so important
and we have no muscles attached, what are we going to do?
Well, my, I always say I have no answers,
I just have ideas, but my answer, in quotes, is alignment.
Making sure that we have the spine in alignment
will help to guarantee or at least improve
weightbearing forces.
Also what I would like to tell you,
I've traveled around the world.
And I was over in Italy at a convention,
attended a seminar
with one of the leading researchers on osteoporosis.
He gave a keynote address and after he finished
I went up and asked him a question.
I said,
"Well, we know that muscle contraction is necessary
to build strong bones.
It's one of the most important forces on the bones
besides weightbearing.
And so we know that
most fractures occur in the thoracic spine.
And we also know there are no muscles attached here.
But we also, and the research shows,
that when we strengthen the muscles on the back,
called the erector spinae, or the back extensors,
that can minimize the risk of fracture
on the other side of the spine.
So how does that happen
if you don't have the muscles attached?"
So this is what he said.
He said, "Well, we really don't know for sure."
Now this is one very, very top researcher in osteoporosis,
and he's admitting that we don't know for sure.
But he says that our bones react to compression.
They also react to tensile force.
A tensile force is a lengthening force.
And so if you contract these muscles,
you're going to get a lengthening force
in the bones on the front of the backbone,
and that can affect the fracture risk
with that kind of a force.
I thought that was a pretty good answer.
So that's the answer that I usually give.
Our bones react to forces of compression.
They react to forces of lengthening, tensile force,
and they also react to shear forces.
Shear forces are sliding, gliding forces
and twisting forces on the bones.
The bones are weakest in shear,
strongest in compression,
and the lengthening is somewhere in between
the two of those.
So the first exercise that I usually give people,
there's a couple of them.
One is, and we're going to do this in the next video.
It's called the realignment routine, is lying on the back.
When you lie on the back, the force is underneath
on what are called the spinous processes,
so that you get a lengthening force
on the front of the backbone.
So that's one way.
And I encourage people to lie on
the firmest surface they can.
They don't have to get down to the floor.
I've started this program in recliner chairs, in ICU beds,
just anywhere I connect with a patient
I can get this program started,
but we do like to have them on the firmest surface,
eventually, that they can tolerate,
because we'll get more of that lengthening force.
Now, a new exercise that I have just designed
that people seem to like a lot
is called the Fontanel Feather.
Now the fontanel is located
on the top of your head, near the back.
It's where the, the soft spot that you had as a baby.
So I have people place their hand on that area,
bring their feet underneath their hips,
now that most people know where their hips are,
and take a breath in and push the feather
of my hand off from the top of my head.
And when I do that,
I can feel a lengthening force throughout my body.
So that's an easy exercise
that people can start with, the Fontanel Feather.
So that's a little bit of an anatomy lesson.
That's just a start.
And the next video will include more details
with a routine that I usually start people
out with called the Realignment Routine.
It begins with lying on the back
and then learning the isometric exercises
that I talked about a little bit earlier in the first video.
And isometric exercise,
strengthening the muscles that support the spine
and the body against the force of gravity.
So thank you for coming.
Thank you for listening.
And I'll look forward
to seeing you again in the third video.
(mellow, jazzy music)