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Back Extensor Strengthening

SaraMeeks
  • By SaraMeeks
  • Posted October 27, 2008 at 8:33 pm · 36 replies
  • In Exercise
  • Shared with the public
1 Recommendation

I thought that this group might be interested to know that more and more research is showing the importance of strengthening the back extensor muscles to minimize the risk of compression fractures in the spine. A recent retrospective study reported from Mayo Clinic showed that strengthening of the back extensors alone was more effective at reducing fracture risk (after at least one fracture) than either vertebroplasty alone or vertebroplasty plus back extensor strengthening.
There are no specific exercises in the gym that target this muscle group. So.....it's important to seek out a therapist with a program that does so. And then do the exercises.

Explore topics in this discussion:

Exercise Cancer Arthritis Falls Back pain Fractures Coumadin Physical therapy Reclast Osteopenia Pain Yoga and Pilates Lung cancer Osteoporosis Warfarin Cortisol Stress

36 replies

SaraMeeks

Susan:

You are wise to discontinue that exercise. One possible explanation for fractures occurring with straight leg raising is the shearing force exerted by the psoas muscle on the spine. But I'm not sure anyone really knows why.

Let me know how you make out with the Level 3 therapist.

Sara Meeks

SusanRae

Thank you for the post, Sara.

I didn't think that straight leg raises could cause compression fractures to my back. I thought since my back stayed straight . . . . My PT gave me these exercises to strenghten my legs, and I added resistence bands to make it more challenging. He said these exercises were all safe for OP. I will stop this until I can get with a PT trained in the Sara Meeks method.

I got your list of OP trained PTs and just sent an email to a level 3 PT to see about setting up an appointment. Having had a few low impact fractures, I don't want to take any chances.

Thanks, again. Susan

Char42

Hey SaraMeeks that authority was a compliment, I am not a authority. I only do what works for me and rough exercise works for me. I am only more careful because of Warfarin and injury which can cause bleeding.
You said, "These silent fractures occur within the bone and would not be detectable by a bone scan"
Any fractures would have been seen with my bone scan as it was with contrast. I have my Orthopedic Doc's permission to carry on with any exercise I am comfortable. He did not push Bisphosphonates.
My apologies if I upset you, I am not sensitive, comes with working Psych for many years.

SaraMeeks

P.S. I would even entertain a detailed discussion on toe touching, abdominal crunches and why flexion is such a risk.........a separate discussion than strengthening of the back extensors.

SaraMeeks

Thanks Sandi:
I'm not signing off from the site--just from this discussion. I think that the subject has gone far enough and now other issues are creeping in. Perhaps subjects for other discussions?
I am continuing to enjoy the discussions and the site in general and do not plan to leave.
I've had less of a presence of late as I've been pretty busy with traveling and teaching; however, I join in when I can and when I think I have something to contribute.
Thanks for your support and also thanks to others who have given me notes of support also.
Sara Meeks

sdivas

In my personal opinion, Sara Meeks is an expert and authority on physical therapy safe movements for osteoporosis. A person with osteoporosis that is looking for a physical therapist has two easy questions: One: Do you visit and use the NOF website? Two: Are you familiar with Sara Meeks? If the answer is No to either question, please move on and keep looking for another PT. I think sometimes we forget this is an unique osteoporosis site .... not only a discussion, but a community under the NOF banner. No other osteoporosis discussion group (to my knowledge) has interaction with professionals in their respective fields. It's a gift to all of the community members. Sara, I hope you will reconsider. The information you have provided is needed and is valuable. As physically active as I am, with ballet barre, Pilates Reformer, Yoga, and walking, and instructors that have knowledge of bone loss, I have read and printed all of your posts and made some changes .... because although I am 62 and fracture free, I intend to remain fracture free. If I am given information about movement that will help me to remain fracture free, I will make the changes. Fractures are painful (so I've been told) and touching my toes just because I can is not worth the risk. Please know that the information you provide on this community is appreciated. Sandi

SaraMeeks

As a short P.S.
Although I began this conversation regarding strengthening of the back extensors and the role of this muscle group in minimizing compression fracture risk, I will no longer be replying to this thread as it is beginning to take other directions.
If anyone wants to contact me privately regarding strengthening of the back extensors or other similar topics, please use the "friends" links for this discussion group.
The Very Best To All Of You
In Good Bone Health.
Sara Meeks

SaraMeeks

Thanks Woody for the follow-up.
Without straying too much from the conversation on back extensor strengthening, I would like to say that, in my patient population, I have found that the hip flexors (iliopsoas and rectus femoris) and external rotators are much more of a problem than the hamstrings in terms of restriction. In my Patterns of Postural Change, the hamstrings are involved but come in later in the pattern. AND, I have found the hamstrings to be much more involved at insertion behind the knee than at their origin........this, combined with restriction of the gastrocnemius at origin also affects back alignment. However, the restriction in the hip flexors is much deepeer and more pronounced in the end and I postulate that it begins early in life when we begin to sit too much.
I am speaking here of my own clinical experience and observations over the years.
Let's hear it for non-machine workouts!! Free weights add components of coordination and balance not possible on machines.

SequoiaHealth

Hi All:
Sara is correct. Extensor strengthening is very important. In the clients I work with we also add a good full body functional exercise program including balance, flexibility, stamina and weight bearing strengthening. Modified Yoga is good as well. Make sure your legs are strong. When lifting, people with weak legs overuse their backs placing undue strain on the bones and joints causing pain and arthritis.

Much of back pain can be traced to leg tightness, especially hamstrings. Make sure to stretch adequately after EVERY exercise session. Tight legs contribute to abnormal hip and lower back function which will affect the upper spine as well. Tight muscles overload the bones and joints of the spine.

We recommend non-machine based workouts. They provide better balance and body awareness. Great substitutes are fitness balls and dumbbells or medicine balls. (or 5 pound bag of sugar for that matter).

For the total package, "The Big 5 for Healthy Bone” are also needed:

1. A diet that contains 50% fruits and vegetables. Fruits and veggies contain greater amounts of water and minerals with generally lesser amounts of animal protein.
2. Adequate water intake based on body weight. Water is very important in helping the kidneys regulate pH and detoxify the body.
3. Stress reduction activities to help lower cortisol, homocysteine and total body inflammation to reduce calcium loss.
4. Vitamin D3 levels in the 50–80 ng/mL (or 125–200 nM/L) year around confirmed by 25-hydroxyvitamin D testing.
5. Sufficient weight bearing exercise that includes balance training to reduce falls and stimulate muscle growth which is essential for bone strengthening determined by regular full body strength testing.

Hope this helps.

Woody McMahon
Reston/Herndon Osteoporosis Support Group Leader

SaraMeeks

Dear Char42:
I am not certain that I would classify myself as an "authority" or "expert" in this field; however, I have spent that past 25 or 26 years doing almost nothing but a physical therapy practice focusing on the management of osteoporosis/osteopenia and other bone-related and back-related pathologies.
There are always people who seem to be able to do whatever they want and thrive on doing so and you are perhaps one of them. As I never want to tell anyone that they absolutely can't do something, I endeavor to educate as much as possible, let people know the risks and then they make their own decisions and live their own lives.
There are people with osteopenia who sustain compression fractures with minimal trauma and there are people with osteoporosis who never fracture. Part of it has to do with quality of bone which cannot be measured non-invasively. As an aside, there are also people who smoke all their lives and never get lung cancer; however, the statistics are not in their favor. And, with 70-80% of compression fractures being silent and undetectable by most testing means, the odds are not in yours either. These silent fractures occur within the bone and would not be detectable by a bone scan or X-ray as the damage is internal--then one day, someone bends over to tie a shoe and has a "full-blown" compression fracture and sometimes more than one at a time.
I would like everyone to know that it is not my intent to scare people......only to educate giving the best of what I know of the research literature and my long years of clinical practice.
As an aside, my last post was meant to answer Char42's post and not Iola's. It is the toe-touching that I was concerned about--and still am. One more point on that--many people need to go "the other way" and stretch as far away from the toes as possible. Please take a look at my website www.sarameekspt.com for details on The Patterns of Postural Change and you'll understand why I say that.
For Iola, as far as traction is concerned--I'd rather see people hang from the feet than from the arms. I'm not sure the shoulders of a lot of people could take the weight of the body well to get a good spinal stretch. And, even hanging from the feet, it is not necessary to hang completely upside down to traction the spine.

Char42

Have SaraMeeks, I am sure you are a authority, I have had osteopenia/osteoporosis going on 17 years without a fracture. Guess I am lucky, after many falls over the years speed skating I had a bone scan 2007 with contrast. It was negative for fractures, my activities have not changed much except for the speed skating. There is a little more common sense in my activities because of Coumadin for blood clots. Today I already biked this area, walked and oops did my toe touching.

SaraMeeks

Hello All!
Looks like I generated some discussion here on the subject of back-extensor strengthening and a few other subjects have been added.
In the management of osteoporosis the "bottom line" is prevention of the next fracture, whether it's the 1st, 10th, 22nd or 40th or beyond. Flexion exercises are known to cause compression fractures--these exercises include abdominal crunches, sit-ups, toe-touches, knee-to-chest, straight leg raising etc. Unfortunately, these types of exercises frequently "feel good" and, as people are used to doing them, they keep on doing them. Specifically to Iola, you could be sustaining silent fractures which may, one day, result in more, this time clinical, fractures. Up to 70-80% of compression fractures are silent--that means people don't feel them--and they can lead to more devastating, life-threatening situations.
The one thing, so far, that's been shown to minimize the risk of fracture is extensor muscle strengthening.
There are many ways to safely stretch the hamstrings and I have found, as a clinician, that it is also important to stretch the hip flexors. For safety in movement, to prevent fracture and live a long and healthy life, it is important to get guidance from someone trained in this field. You should not "self-select" exercise nor should you go to the gym or any class without knowing who is teaching you what to do. You do so at your own risk.
My entire program focuses on strengthening the back extensors, along with other aspects of care to minimize risk of injury. You do what "feels good" and what you are used to doing at a great risk.
If people want more details on my program please log on to my website www.sarameekspt.com and contact me through that website.

Char42

Hey MotherGoose, I like toe touching keeps me limber and I have suffered no ill effects. I do more risky activities than toe touching several times a week. Such as sitting on a Gator. LOL

MotherGoose

Please --- no toe touches! This is way too much anterior pressure on the vertebrae. Same as with crunches and other bending from the waist.
This manner of stretching hamstrings has been out of favor for a long time. Better to stand or to lie on one's back.
Lucy Buckley PT aka Mother Goose

iola

Hi Sarsmeeks, I hear so much about stretching from other people on here. This mean puting U Arms above u head and stretch? Befor i know i had Osteo, when my back would hirt i hang on to the top of a Door fram stretching my back & it would help now i afraid of haveing a fracture again so I stop. Is this right ? Thanks for the Decompression Exercise its help the pain i am so gratefull to U. U are God send on here. Thanks again.

Char42

To strengthen my back I lay back on a Pilate ball at least twice a day for 60 seconds. Lift weights every other day, bike (using common sense no curb jumping), walk, stepper every day. Balance exercises MWF including straight line walking. Toe touching twice a week and other stuff as I think about it. Sometimes I am on my bike most of the day and so less amounts of the listed exercises. No sit ups or ab crunches.

borobelle

Hi Sdivas,
Thanks so much for your response. I'll contact Sara and Sherri.

borobelle

Dear Lynn,
Thank you so much for the great information. I am not familiar with anyone (doctors, therapists, or exercise trainers) in my area who specialize in osteo, but I'll certainly continue to seek them out. My PT did have modified crunches in my program, but we've eliminated those. Thanks so much for the work you are doing!!!

sdivas

Hello borobelle, in answer to you question, yes, there are yoga and pilates osteoporosis instruction. Please check www.sarameekspt.com (Sara Meeks) and www.therapilates.com (Sherri Betz); both community members. Both Sara & Sherri have books and videos. Sandi

Lynn_Smit

hi borobelle
sorry i had to split the 2 answers, but work was waiting. their is certain yoga and pilates exercises that is a big no - no for any form of osteo. remember the golden rules any exercise training - do not bend over without a straight back and make sure you bend from the hip. do not do any twisting exercises where you move from side to side twisting your vertebrae. do not do any form of crunches where the mid section have to crunch like the normal tummy exercises. stretching is good to work on the flexibility and functional mobility. if you can meet a PT that knows about osteo or is qualified as a Osteo Personal Trainer or has done a course in OsteoPilates - you will do good. take it slow and remember to warm up and cool down stretches after each training session. enjoy!!
sunshine greetings
lynn

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