Johns Hopkins 6 Core Exercises Not Advised

3 Recommendations

It has come to my attention that these exercises, advised to "build bone strength" are -- in general -- and some specifically -- NOT SAFE for those with bone loss. It is very disappointing that an institution as esteemed as Johns Hopkins should be promoting such aggressive routines and presuming that all those with bone loss can follow them without fear. First of all, these are called core exercises which is ill-defined. Core strengthening involves only a certain group of our trunk muscles. Their exercises do nothing for our core AND core does not much for our bones, per se.
They recommend progressing weights weekly by several pounds. Such a strain is a good way to fracture spinal vertebrae.
Please, people, do not swallow all you read. One would certainly think such a prestigious medically-related institution as the Johns Hopkins Health Alerts would provide better information -- safer and more effective. My local discussion group discovered a couple years ago similar bad information being promoted and sold by the Harvard Health Newletter.
So -- one never knows, BUT, please remember the
basic warnings:
1. No bending from the waist -- keep you back straight and bend at the hips and knees. This is called "hip hingeing".
2. No twisting of the spine with feet fixed on the ground.
3. No toe touching and no crunches or similar stresses on the spine.
Furthermore, this JH protocol did not mention posture or safe body movement -- the heart of ALL exercise regardless of diagnosis.
Be very cautious about taking on anything that does not include the precautions/information I noted above.
Regardless of your age -- if you have any clue about having bone loss, you cannot play with fire and invite compression fractures of your spine.
Lucy Buckley PT aka Mother Goose

26 replies

After reading and analyzing the exercises recently promoted by Johns Hopkins for osteoporosis, I totally agree with Mother Goose and would not recommend these exercises for osteoporosis. Although they are promoted as core exercises, they do NOT work out the core, the directions are poorly written and many of the positions suggested would put people with osteoporosis at risk for injury.

what about yoga stretches, and, bike riding?

Thank you, Mother Goose for the exercize info.

What do you think about Yoga and the side stretches
and salute to the sun

JoanL thanks again

alanmoca -- 6/22/08

I am not the expert on yoga -- Sara Meeks is -- but there are positions -- think forward bend, also lateral bends and twisting, that are contraindicated for those with bone loss. Too much compression of those fragile vertebral bodies.
As for bike riding -- this is fine for aerobic exercise and one's cardiovascular systems, but not much for building bone. Bike riding is not weight-bearing and without added resistance it is not resistive exercise. Good for flexibility of the knees, I suppose. Also the bent-over posture is a no-no for those with bone loss.
Lucy Buckley PT aka Mother Goose

In general, Yoga, Pilates, and bike riding, along with Tennis, Bowling, and Golf all contain movements that would be contraindicated for someone with osteoporosis. These movements are forward bending, side bending and rotation of the spine--some of these activities combine all 3 at the same time, adding to the risk. Bike riding, as Mother Goose said, is non-weight-bearing. Cyclists and swimmers have the lowest bone density of any athletes primarily because of lack of weight bearing on the bones.
Yoga and Pilates (as well as other activities) can be done more safely; however, instruction by someone trained in osteoporosis knowledge and management is necessary for safety.
Take a look at www.therapilates.com for info on Pilates; www.sarameekspt.com for info on P.T. and Yoga.
We know that exercise and movement are good for the bones but, once you have bone loss, there are other considerations.

Mother Goose & Sara,
This is good info. My Dr. says yoga would be good for me, but I didn't realize that I was limited as to which way to stretch and so forth. The class I started is for anyone who wants to join at my gym, so the excersizes are not specifically for OSP people like myself. I find it challenging to move in some of the positions in the class and it may be because my body is telling me not to. The osteoporosis is worst in my hips, so I better re-evaluate whether this class will do more harm than good.

Vjeanne:
Hope you have checked out what Sara has to say on her website --- www.sarameekspt.com.
Lucy Buckley PT aka Mother Goose

Thank you for the advice ladies. This is all pretty new for me so I'm a little overwhelmed by all the info. I really don't know where that fine line is when it is ok or not to do certian things. I am 50 years of age and my t-score on my hips is 2.61. I have always been a healthy active person, but I do have a tendendancy to push myself in exersize routines. I also have a bad case of scoliosis (43deg angle), but my t-score on my spine is not as bad 1.39. My husband gives me grief when I carry the groceries, but yet I feel strong. It's difficult to accept. I want to be as positive as possible, but I don't want to hurt myself.

Vjeanne:
Yes, this is probably overwhelming at this point -- just like any new venture might be.
As you understand the rationale for the do's and the don'ts, you'll be able to sort things out on your own better.
Since the spine's vertebral bodies (the round bony parts that have the discs between them) are compressed by bending forward forces -- and by twisting and side-bending as well -- we should try to avoid activities -- work, vacuuming, making beds, certain yoga positions, certain exercises such as crunches and toe touches -- that bend us at the waist.
It is possible to carry out our daily routines with a straight back -- bending at knees and hips, such as squatting and hip hingeing -- with greater safety. Crunches cannot be done safely for anyone with a bad back regardless of the problem, however. We need to be selective with the exercises we do -- there is more than one way to skin a cat, remember. Some of the older exercises -- which some folks love to cling to -- have fallen into disrepute as research has realized the exercises may not be doing what we had thought -- or they are too difficult to do properly and when done wrong, can be harmful. That is why PTs can be helpful in sorting out the WHO, the WHY, the WHAT, and the WHEN of exercise. One size does NOT fit all!
Do not panic -- after all, you know more this week than you did last week -- and less than you'll know as time goes by. We cannot change yesterday, but we can change tomorrow -- sort of.
Good Luck!
Lucy Buckley PT aka Mother Goose
PS. Scoliosis is a risk factor for osteoporosis. So be good to your back! No need to be lugging heavy groceries!

Well said, Lucy. We know more today, less than tomorrow--I like that. Also, one size definitely does NOT fit all!
This is a message that seems hard to get out there. I've given some places to start but, if you know you have osteoporosis, you have to seek out exercise instructors that are skilled and knowledgeable about the management of this condition. Any exercise instructor will probably tell you they know what to do but that doesn't mean that they DO know. The consumer needs to ask questions and find out a lot for themselves. The National Osteoporosis Foundation has good information which includes contra-indicated movements.

I switched to yoga from pilates, thinking it was better for me. I have been trying to follow the safe movement guidelines. I have been avoiding moves like the "tailor" position where you sit with legs bent outward, the shoulder stand, due to right angles of the neck, and the rollover. Am I correct in thinking that these are dangerous? (I have osteoporosis in the hip & osteopenia in the spine.)

Pay attention to what Sara Meeks has to say -- she is a PT with GeriatricSpecialty Certification AND yoga training/experience related to osteoporosis modifications.
Lucy Buckley PT aka Mother Goose

Hi Lucy and Ladies: Thanks for all this info. I had the same reaction when I read that newsletter, I actually couldn't believe it!

I've had 7 spinal fusions and occasionally a ortho/neuro surgeon, or some other type of bone Dr will ask me to:

Touch my toes

Bend backwards

Bend sideways from the waist-to the right and left (to see how far you can reach down your leg)

Twist from the waist (right and left)


What do you say to these professionals? I should also mention that all of these Drs knew I had 7 fusions, low t-score, DDD, grade 1 spondy, and severe stenosis among other problems.

When I refused to do these, for a *range of motion* eval, one Dr got very indignant and said I could also leave the office and not be examined.

I want to add, that when I went to a PT, she specifically said she would not have me do *any* range of motion tests for my lower back, because it was too dangerous. She did check my neck for range of motion but not my low back, where I had the surgeries/frax.


What do you think, and what does a patient say to these Drs who want you to do this *before* they will do an x-ray, to check for a frax? I was seeing this Dr so he could x-ray my spine to check on my hardware (screws and rods). I've had hardware fail after surgery, and one of the screws went through my sciatic nerve, and the fusion disintegrated. After this was discovered I had to have all of the titanium removed. In 2003 I had to have a TLIF and they put the hardware back in, and so far it's still in place.

Thanks for all your help...

Hi all,

My input is that all the things we shouldnt do ie bending twisting etc mean we should hire a servant to - make beds, hang washing, some personal grooming, etc not an option for most of us - husbands can help but they are men and dont seem to realise we need these things done when we ask .. not when THEY get around to it! Its very frustrating. Also I challenged my hydro therapy people re some of the exercises AND whether a back brace (soft one) would help me (T7 and 8 vertebroplasty April 08.... still in much pain).. they seem to think some twisting is ok and said the brace would make my muscles worse.... Its awkward challenging the medical profession but hey its our body!!! Sara M is brilliant so I agree - trust her input. Regards Aida

Yes, this diagnosis and world are very challenging given our daily lives.
One can learn better body mechanics to hang wash, make beds, do dishes, lift bags of groceries etc but it does take commitment and practice. Working with a therapist can help as then you have someone watching you move who can make suggestions. There are all sorts of ways to modify movement for safety.
Some twisting is NOT ok with osteoporosis. Typically, when one rotates the spine, one is also flexing it and the two forces are additive. Bone responds least well to twisting (shear) forces.
The Spinomed III brace is the first brace I have ever seen (46 years experience now) that actually STRENGTHENS the body part it is designed to protect--the back. The hydrotherapy people are right in that MOST braces weaken the back; however, this one is different. You really need to look into this.
Also, for body mechanics, log onto www.nof.org -- I believe they have information on better body mechanics. There is a chapter in my book WALK TALL! on body mechanics. Seek out a therapist who is knowledgeable about osteoporosis management.
Your life may depend upon this--taking care of your back. Compression fractures affect the heart, lungs and other internal organs and may cause compromised function there.
Hope this is helpful. Contact me privately through my website for specific details on your particular issues.
www.sarameekspt.com

Reply to Aida:
No, one does not have to have servants. Yes, would-be helpers can be maddening. BUT -- it is HOW we do these problematic chores, not the chores themselves. That is why we stress having a good PT or OT help you learn HOW. Hip hinging -- bending from the hips and the knees -- rather than from the waist is KEY. It IS hard to figure this all out without the background in anatomy, pathology, and kinesiology that we have in PT. You would not try to learn how to play the piano wthout instruction, would you? Well, it might be possible on your own, but a few wrong notes on the piano have no consquences for your back and some ill-advised movements of your trunk do!
Lucy Buckley PT aka Mother Goose

Lucy,
Thanks for the heads up. And yes, there is so much out there to read, I tend to listen to my body more than believe everyting I read or hear.

Dear Vienne and others:
"Listening to your body" sounds wonderful but could actually be very dangerous if you have osteoporosis. Osteoporosis has long been called the "silent disease" because so many people don't know they have it until they sustain a devastating, and potentially life-threatening fracture. Up to 80% of compression fractures are silent and I personally have seen many people who had fractures, had lost inches of body height and had not experienced any pain or other symptoms to alert them,
One of the problems is that people tend to do movement in "habitual" patterns so they get used to certain movements that "feel good." These "feel-good" movements could get one into real trouble.
It is important, if you have osteoporosis, or even if you don't and just want to learn to move better, that you learn good body mechanics and the risks involved with certain movements.
I don't believe EVERYTHING I see and hear either but, knowing the anatomy of movement as I do, I certainly believe that and, as I have severe osteoporosis also, I continually monitor my movement and avoid certain ones that I know can be problematic.
It's the sensible thing to do. Even at that, I know that one day I may "forget" and sustain an injury. It's a risk I take in life as there are no easy answers.
Soooooooooooo, listening to the body can be helpful but knowledge is power!

Thank-you, Sara, for responding to "Vienne and others.
I, too, have been concerned about this attitude of "listening to my body". Osteoporosis IS called the "silent disease" with good cause. Do not play without the helmet of common sense.
Lucy Buckley PT aka Mother Goose

I visited Orthopedic Surgeon last week for possible gangelions in L wrist - so I also discussed my recent osteoporosis fracture etc - still painful 4 months later and promised - painfree situo - has not occurred yet, even with physio and 9 hydro ther sessions. After warnings on this web site from Sara M and others I was not surprised when Orthop. eventually asked me to :
- turn from waist side to side
- bend sideways ; AND
- to touch my toes. I protested at this - but he mentioned "walking a tightrope" when fractured and osteoporotic!!. He thinks there is some arthritis/osteo arthritis which may be exascerbating my pain and sent me for a bonescan ...
Radiologist discussed the scan afterwards with me - (they dont usually) and said "definitely things of significance going on in thorasic spine" (great! - and scarey!) but he didnt enlighten me further..just told me results would go to my Dr. I expected to take report with me. My appointment is almost a week away - SO to put me out of suspense I went back next day to Scan clinic and "demanded" to at least read my report - even if I could only understand some of it.The good news - no new fracture (luckily) - but mention was made of T8 and a new one - T3; as well as osteo-arthritis.. At least I can sleep a bit easier while I wait.
Am taking info about the spine III brace to specialist. (from website on net). I requested company advise if supplier in Australia. Dont think available here .
Regards Aida

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