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Exercise - Toe Touches/Ab Crunches/Forward Flexion

sdivas
1 Recommendation

When I was diagnosed with osteoporosis (2000), I wasn't given any guidelines. I was able to touch my toes. I was able to do ab crunches. I would twist from side to side. I didn't know about compression fractures. My information was very limited. Why shouldn't I continue to move the way I was able to move? There may be community members that also have not been given any guidelines and don't understand why it is not safe to touch toes, ab crunch or twist. PT's, please share your knowledge and educate the community about why flexion is a risk. Thank you. Sandi

Explore topics in this discussion:

Exercise Falls Back pain Fractures Reclast Osteopenia Pain Memory Osteoporosis Cortisol Stress

14 replies

sdivas

Bumping

millie123

Really good discussion. Mother Goose, you are almost poetic here.

sdivas

bumping

54

With a T score of -2.54 (with scores of -2.6 and -2.7 in lumbar vertebrae) I am not doing crunches--but what about the hours of weeding, digging, and pulling I do each week in the grass and garden? I cannot do all these activities in a squat or on my knees; sometimes I just have to bend and pull. Am I getting risking my back for the sake of my landscape?

Also, a recent chest x-ray showed (according to the radiologist) "minor anterior wedging." Is such a diagnosis indicative of fractures?

A little confused and shell-shocked by my bone loss,

Thanks for everyone's help,
54

ValerieEvelyn

I am 70 and have always enjoyed gentle jogging/power walking which I thought I may have to give up. Now I know this is not the case so shall continue to enjoy this along with yoga and light weight lifting. Is there anyone else on the site from the U.K.? Good luck everyone. Valerie.

SequoiaHealth

Hi Jeffer:
Your golf game is never going to miss toe touches, abdominal crunches or sit-ups. If you really want to get physically fit for golf, sit-ups, toe touches and ab crunches are not going to help you. Also they do not keep your waist in check either; only your mouth can do that. Remember, spot reducing won't work.

Any Core (abdominal and back muscles) strength work for golf should be done in the “playing position” which means standing. Golf is a standing game so strengthening for it wants to be in the "playing position" 90% of the time. This is because of muscle memory. Sitting or floor exercises, unless they are stretches, don't translate well to standing sports.

The other golf secret that even Tiger learned later on was that good flexibility is more important than strength. Your body must be flexible enough to utilize the work the club and ball are designed to do which is 90% anyway. I work with several golfers one of which has reduced his handicap from a 21 to a 4 in five years.

As for your osteoporosis, make sure to concentrate on lifestyle changes to help your exercises and activity work better for you.

Woody McMahon
NOVA Osteoporosis Support Group Leader

Jeffer

Oh no, I was not aware of the need to change exercise habits because of my newly diagnosed osteoporosis and a risk of compression fractures. My t-score is -4.1 for the spine (hip is osteopenia) so I guess I need to pay attention to this. I currently do sit-ups, ab crunches and touch my toes to keep my waist in check and I play a fair amount of golf (which involves a lot of twisting). I am definitely not giving up golf, but I suppose I could avoid sit-ups/crunches, etc. Thanks for posting.

borobelle

I've appreciated the responses on exercise. I had never been told to limit crunches, toe bends, twists although it makes perfect sense. I am involved in PT now. I've been doing an exercise with a wide resistance band around my lower thighs to strengthen my hips. (I've been working on building core strength). I am concerned that this puts to much strain on my spine. Can anyone weigh in on this? If anyone has exercise suggestions for safely building core strength they would be appreciated.

Gatekeeper

You can find the FRAX tool at http://www.shef.ac.uk/FRAX/ and go to Calculation tool at the top.

Now that's cool. I came up with a 10% chance. Though I didn't know the make of the Dexa machine. I had the model called Discovery which I think might be the holosomething?

raindancer

Thank you Lucy and Woody, these are both wonderful and helpful posts.
I am trying to do most of the above mentioned but I do have 2 questions. I do some light to moderate weight lifting and there are some of them that can be done sitting or standing. I know from years back that I did some while lying down as well. Do you think they would be more appropriate for me now as I think the floor would provide better suppport than a chair or my own body [spine] . I am able to get up or down from the floor with no big problem at this point. I also do bent knee pushups...are they safe as long as I keep my back straight?

I have no idea what my Vit D score was to start with but after 8 months on 2500 units of Vit D daily, I requested a test..my level was 41. My primary care Dr [the one who wants me to take ReClast was really surprised and her words were "Wow, that that's really good, we rarely ever see anyone with that high a D level around here" [I live in Upstate NY]....don't tell me to get another Dr. ...lol...she really is a good Dr and always willing to let me try out some of my own ideas. I take several vitamin and herbal supplements and my blood work is right where it should be except for the D and I will keep trying to raise that one.
Again thank you both for the really helpful posts.
Paula

SequoiaHealth

Hi All:

These three movements exert extreme pressures on the vertebral bodies of the spine. Higher pressures increase the risk of compression fracture. Again, it is a relative risk thing again.

As for activity, the diagnosis of osteoporosis is supposed to be based on multiple risk factors. Generally it is made on DEXA scores alone which gives most patients an unrealistic picture of their condition. Even with a diagnosis of osteoporosis/ osteopenia no one really knows who will fracture and who won’t. DEXA scores cannot accurately predict that occurrence. The numbers are all about relative risk. That is why the FRAX was developed to give people a better sense of fracture risk which is really what you want to know anyway. (see below)

IN MY OPINION, the absolute wrong approach is to stop all activity or “stop the fun.” Again, this will depend on current activity levels, FRAX scores, etc. It is better to evaluate your true risk then embark on a balanced program to improve bone quality, not just bone density. Do as much as you can safely.

Exercise is one of 5 components essential for high bone quality. I have listed the others below. With exercise, you can easily modify your program to eliminate toe touching, crunches and twisting. My clients never do abdominal crunches because there are many better exercises to work the CORE; we do modified or restricted twists and if we bend, it is hinged more from the hips.

Sara Meeks has good information on this on her website http://www.sarameekspt.com

So the bottom line is you can very active and never have to worry about these three movements.

You can find the FRAX tool at http://www.shef.ac.uk/FRAX/ and go to Calculation tool at the top.

I call the “Big 5 for Bone Health” lifestyle changes. These are:

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 for maximum hydration. Water is very important in helping the kidneys regulate pH and detoxify the body.
3. Daily stress reduction activities. This helps lower cortisol and homocysteine levels reducing calcium loss.
4. Year round vitamin D3 levels in the 50-80 ng/mL (or 125-200 nM/L). This should be confirmed by 25-hydroxyvitamin D testing.
5. Sufficient weight bearing exercise to stimulate balance and 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

MotherGoose

First of all -- the round part of the vertebra -- called the "body" is not "solid" bone, but made of the more lightweight trabecular bone one might compare to a round piece of Rice Krispy candy bar that is then coated with a hard candy coat of cortical bone (the hard kind like our shin bone) for protection. The lighter weight bone (trabecular) is more available to our entire system for its daily calcium requirements for nerve conduction, heart function, clotting, etc. Also -- if we only had cortical bone, our skeleton would weigh so much we'd never get anything done, or escape the saber-toothed beasts, etc. The engineering of our skeletons is a marvel! BUT -- as the density of the vertebral bodies gets scantier with bone loss, they are less able to support the stresses put upon them.
Quite apart from bone loss, the forces on our back are the greatest in sitting and with back bent forward.
These forces are the least when lying down on our backs. Gravity is then eliminated. That is why the simple act of lying down can relieve back pain that comes on with a period of being on our feet, such as vacuuming. (I certainly do not recommend bed rest as a means of dealing with bone loss! Bone needs the stimulation of gravity and of muscles pulling on the bones to continue its on-going bone remodeling -- replacing older bone with newer bone).
As for forward bending, the forces on our vertebral bodies anteriorally -- towards the belly -- are 4X what the forces are when we extend our backs-- standing or arching our backs. Forces of 4X on a relatively fragile bone? That is why we PTs shudder when we see someone at risk for bone loss bending over to pick up something or to tie their shoes. Twisting on fixed feet is also risky behavior. AND the worst thing is that most vertebral fractures are silent -- you do not feel the collapse all at once -- maybe not at all. It "just happens" -- over time 2/3 of the time. Along with poor posture, this vertebral deformity is the reason for the marked height loss that is so evident to us -- whether we are those losing the height or the observors. Just because you did not get hit by a car as you jaywalked does not mean you did nothing risky. Same as with vertebral fractures. You cannot actually see inside what you are doing when you touch your toes, but keep it up and you will see the external results and suffer the consequenses eventually. Vertebral compression fractures (VCF) squash and deform the bodies -- when they heal they do not return to their previous shape, as would another bone such as the shin bone. That is the shape you are stuck with. Like having a house collapse with the first floor down in the basement. The fractures further throw your body weight forward and compromise your balance to place you at risk for falls and possibly more bone-loss-related fractures such as the forearm and hip. That is why we PTs get excited about PROPER exercise and with GOOD posture and with SOUND body mechanics! We understand movement and how the different parts/systems of our body support our life style. We have addressed all the aforementioned many times on these pages and you'll find earlier entries if you go looking. Also remember the NOF site has MUCH good information to help you. You may also call NOF at (800) 231-4222 to speak with a health educator. Also for an email message, use request@nof.org.
Lucy Buckley PT aka Mother Goose

Caff55

Hi

Prior to diagnosis I was mountain-biking, rockclimbing and mountaineering. My general practioner suggested it was time to stop the fun. Thought about it for a week or two and one lovely day just couldn't resist dusting of the MTB and nearly a year on still at it. Since then fell off banged my head on a branch (helmet of course) sending a shockwave down the top of my spine and survived.
Since diagnosis I've also started weight training and pull up to 45 kg depending on the apparatus.
This is not a recommendation just a way of saying you have to weigh up the odds and decide whether or not you want to accept the risks of continuing with a lifestyle you enjoy.
If bones are going to break they'll probably break anyway. Anything from a minor fall to reaching a high shelf!

rainie

Hi Sandi,

I was in the same condition as you, i.e. touching my toes, twisting, etc. and now I'm afraid to. I look forward to any responses, also. Thanks for asking the question. I'm looking into a consult w/ a PT who may specialize in osteoporosis.

Best,
Raine

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