John Hopkins Report on Back Pain & Osteoporos

kkiser
0 Recommendations

I wondered what you all think of a special report by John Hopkins regarding exercises to strengthen the back? Available at: http://www.johnshopkinshealthalerts.com/reports/back_pain_osteoporosis/1879 -1.html?ET=johnshopkins:e4540:166911a:&st=email&st=email&s=RBH_080222_013.

I've been doing Pilates for 2 years and recently adapted my moves to remove bending over to stretch, twisting at the waist & neck, lifting my head off the mat, and roll-ups. This special report has modified toe-touch, modified toe-touch with rotation and abdominal curls as recommended exercises. Are these acceptable as safe movements as long as you watch your alignment?
Karen

12 replies

MotherGoose

I have not seen this report yet.
I did sign up for their online Report, but it has not come into my mailbox yet. Shall comment further when I get a chance to see it.
Good for you to question this.
Lucy Buckley PT

MotherGoose

It would be great if Suzi -- this support group's yoga-for-those-with-bone-loss knowledgeable teacher -- would comment on the rather sparse info about yoga on the Johns Hopkins Report website. And here as well!
I found their yoga info to be lacking in caveats and cautionary language.
I could not find what Karen was commenting on.
Many alerts are listed on this broad subject (lumping together back pain and osteoporosis is rather unwieldy in my opinion).
Cutting and pasting did not work for me.
Lucy Buckley PT

MotherGoose

I'm sorry, Karen, not to answer your question about the "acceptability"of "modified curls and twists and bends.
You are smart to be concerned. Just because it comes from a prestigious institution does not mean it is 100% correct. Two years ago the members of my OP discussion group challenged a equally prestigious health letter that was selling wall charts for those with bone loss. They received ads in the mails and were shocked to see abdominal curls and other no-no's on the chart of exercises for osteoporosis. Oftentimes, people with SOME knowledge do not realize how much they do NOT know, but since they do not know that, nothing stops them from advising others.
Lucy Buckley PT

sdivas

Hi Karen, I've taken Pilates mat, but over the last few years have chosen Pilates Reformer. I take private instruction; as well as a Reformer class with 4 other women. I have a few questions for you to consider. Does your instructor know that you have bone loss? Are you taking mat Pilates from a gym or Pilates studio? What are the Pilates instructor's qualifications? I would suggest checking at your library for the following books: OsteoPilates by Karena Thek Lineback and The Osteoporosis Exercise Book by Sherri R. Betz PT (www.therapilates.com) The books may be easy since you've taken Pilates for 2 yrs, but still provide guidelines for those of us with bone loss. I can tell you that physical therapists err on the side of safety; as they must. A good Pilates video that visually focuses on breathing and specific Pilates moves: Pilates for Over 50 with Liz Chandler. www.realpeoplepilates.co.uk Personally, I do not engage in any movement that rounds my spine. Crunching and bringing shoulders up and down is flexing the spine. It isn't necessary to do crunches or sit ups to strengthen the abdominals. It isn't necessary to lift the head off the mat for hundreds. Alignment, breathing correctly, working the core muscles correctly and effectively are all important. I've invited several Pilates (osteo related) instructors to join the community. Hopefully, we will have more input on Pilates and osteoporosis. Sandi

windblown

Hi Karen and all: I wouldn't consider any of those exercises safe!!! I get that newsletter, and was really blown away by the suggestions. One thing you have to remember is to question everyone that suggests certain types of high risk exercises, regardless of where they come from. You would think that John Hopkins would be better informed, but it doesn't surprise me in the least.

I personally couldn't do "any" of those exercises without killing myself, let alone risking fxing something. I've had 6 vert fx's and 7 spinal fusion etc, and I just can't do those types of exercises. I have hardware (rods/screws) at L3-L5 and I can't bend from the waist because of that. Hardware doesn't articulate like the spine does, so I'm stuck with certain types of exercises. If a PT ask me to do any of those exercises, especially the one where you bend forward from the waist, placing your head on your knees and looking between them, and then pulling from the back of your thighs to force further movement, I would be in big trouble, plus I physically can't do it anyway.

I think that a lot of people would attempt these exercises if they didn't have severe back pain, and that's what's frightening to me. I realize that if you don't have bad back pain or severe problems with the spine that prevent these movements you might try them. I know people who have t-scores as low as mine that do similar things (-3.6 spine) and I just can't get them to understand the risk of compression fx's and micro fx's.

In my case I can't physical do these exercises anyway, so I wouldn't even try, but there are some who will, especially with the JH tag on them. I would love to know who authored these exercises, but I suppose it wouldn't change anything anyway.

You would be surprised at how many people I have talked with that have never been given any advice on what not to do to prevent fx's so they go ahead and do some incredible things. If anyone is familiar with crow pose in yoga this is one example I've heard from a lady who had a -4 t-score and she continues to do this (semi head stand with knees on your elbows), it's hard to describe but you could look it up, it's a very advanced pose, which is just an example of some things I've heard and couldn't believe.

Of all the exercises listed in that newsletter I've actually done one of them, and that's the modified hip drop, but I'll never do it again. I did that one time and was in bed for a whole week.

I realize that back pain and osteo don't necessarily go hand in hand unless you've fractured already, but you need to be careful. My life is totally messed up from my many surgeries, and whether or not is was related to osteo I guess I'll never know, but I've had hardware just "fall" out of my bone and the screw went clean through my sciatic, so it wouldn't be difficult to blame it on my 51% bone loss, you just don't normally have 6 fusions disentegrate one after the other.

Just make sure you question everything you read, and use common sense when doing any type of exercise.

Good Luck and stick to the advice that has some logic behind it!!!

MotherGoose

Egad! I finally manged to get to see their exercises.
Definitely not for those with bone loss of any degree.
Maybe for some other types of back problems and younger bodies at that. MAYBE!!
To those who are reading these messages DO NOT TRY THESE!
Dr. Sinaki at Mayo has devoted many years of research ( > 25 years) to exercise, vertebral fxs and osteoporosis. Her 1984 study of PM women with bone loss studied the resulting VFs of these women divided into 4 groups -- those doing a flexion program; those doing an extension program; those doing a program of both flexion and extension; and those doing no exercise at all. After 2 years -- the most fractures were in the flexion group; next most was the flexion and extension group; then the no exercise group; and the least numer of VFs in the extension group.
In other words, it is safer to do nothing than do the wrong thing!!!
Her research over all these following years has continued to reinforce these findings.
Lucy Buckley PT

ileend

I have severe osteo. Thank God so far no breaks nor back pain. My gp tells me that kayaking is good for the back because it uses the arms and shoulders, not the back. I am an active person, liking to walk, hike and bicycle as well as kayak. I do modified palates with an instructor. Any ideas on kayaking safety? Thanks, Ileen

windblown

Hi Lucy: I agree with you that if you were younger, or didn't have a back problem and no osteo you could does these exercises.

Thanks for the mention of the study at Mayo, I want to read that and pass it around. What I'm wondering and have done for a long time, is what do you do when you have to have a series of flex/exten x-rays, or when a ortho surgeon ask's you to touch your toes to check range of motion, do you comply?

I guess there are always going to be times where we are asked to do something we disagree with, because it will cause great pain, but I have always wondered how others deal with it.

Thank for your input...

kkiser

Thank you for your input. I have read Osteopilates, which is why I modified what I was doing. John Hopkins is very prestigious, so I thought maybe I could modify again using their exercises. I don't want to risk fracture, but I know we need to be flexible, have balance, and a strong core as we age; to be active & independent.

Kareb

SuzaFrancina

Hi Lucy Buckley PT, Hi Everyone, I do plan to comment this week on the recent John Hopkins Report on Back Pain and Osteoporosis, both here in the comment section and in a seperate article. This is not their first report--to the best of my recollection there have been others.

Meanwhile, I want to mention that the best book I know of that addresses back and neck problems and osteoporosis is "Back Care Basics: A Doctor's Gentle Yoga Program for Back and Neck Pain Relief," by Mary Schatz, M.D. I began using this book in 1992, when it was first published, to create safe yoga programs for students with osteoporosis and back and neck pain.

I cite Dr. Schatz book as well as her articles for Yoga Journal on osteoporosis, in all three of my own book on yoga for older students and yoga for menopause.


If you are currently attending a yoga class, I guarantee both you and your teacher will benefit from this book.

I teach today but I'll be back soon!

Suza Francina RYT
Certified Iyengar Yoga Instructor
www.suzafrancina.com

MotherGoose

When asked to touch your toes by a healthcare person, tell them that motion is contraindicated and requst that the flexibility of your hamstrings and lumbar musculature can be tested in another manner.
Lucy Buckley PT

MotherGoose

Kayaking is great fun and extremely popular these days. I was fortunate to kayak long years ago
and now miss what I can no longer manage. It is great exercise in general, BUT picturing those with bone loss getting in and out of the kayak gives me shudders.
Mighty tough to keep a straight back and not bend at the waist, AND not fall onto the water, too!
Maybe possible to get in on land and get pushed/ slid down onto the water?
Then to keep a straight back while paddling without much rotation.
I cannot, in good conscience, advise those with bone loss to kayak -- or canoe.
And remember -- microfractures are silent, but accumulative in their damage to the vertebrae.
Lucy Buckley PT

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