Hi,
I am seeing a 63 year old lady at laban health regularly for shiatsu treatment who has recently been diagnosed as showing signs of osteoporosis in her spine following a bone density scan. She has been recommended by the hospital consultant to have injections to slow down her bone production which has the effect of slowing down the bone loss too. She is reluctant to have these and was asking me to advise her on some specific bone strengthening exercises. I would appreciate any advice from the physio's and or osteo's about exercises and whether exercise alone can, in someone of her age, effectively manage osteoporosis. She would be willing to have a physio appointment and already attends the pilates studio, I said I would enquire on her behalf first. I am seeing her again next Tuesday.
Perhaps if anyone responds they can respond to all so we can generate a discussion and exchange of ideas from this. I have directed the email primarily at the physio's and osteo's initially but welcome any suggestions from our other therapists,
yours gratefully,
Deborah (Shiatsu Practitioner)
Dear Deborah,
A combination Of exercise and diet can help. There is some precautions and contraindications to exercise but it is very beneficial for this type Of patients. Would be happy to discuss this further, and help this lady with setting a home exercise program.
Best wishes
Ana (Physiotherapist)
Dear Deborah,
Tai Chi is a low impact, bone and muscle strengthening exercise, which also improves balance: falls being one of the most significant risks for the elderly, especially those with osteoporosis. Joining a local class would be her best bet (not too difficult to track down: http://www.taichifinder.co.uk/ is a good place to start). However I would be willing to show her a simple weight shift and stepping excercise, commonly used in warm ups before going on to do form work, if she wants to get in touch.
Kevin Grey (Acupuncturist and Tui Na Therapist)
Dear Deborah,
A very interesting case!
There seems to be a vast amount of evidence indicating extension-based exercises in order to reduce the incidence of Osteoporotic wedge fractures. These commonly occur at Thoracic spine levels T7, T8 and T6 and fracture prevalence [commonly] occurs in that order.
Weight-bearing exercises are encouraged to stimulate bone growth, swimming too because of the spinal extension to keep afloat. Advice to take care in day to day trivial things such as high steps and stairs, as often the impact from a steep drop can cause a wedge fracture.
A colleague and I wrote an unpublished paper as undergraduates that I have attached, and it has been found to be useful as a handout to patients. Not much in the literature has changed since osteoporosis was recognised as a condition; there is a seminal paper by Sinaki and Mikkelsen (1984) advocating extension-based exercises, including in Pilates, be adhered to. There fracture rates at [five-year] follow-up were significantly reduced compared to controls using flexion and flexion and extension exercise groups. We also understand direct manipulative mobilisations to the vertebrae should be contraindicated, this includes those who do not have a definite diagnoses of osteoporosis but may well be osteopenic.
I hope this is helpful and contributory..... Case study anybody?
Best,
Darren (Physiotherapist)
