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New study on exercise and fractures

SantaFe
3 Recommendations

Dr. Susan Brown has just written about a new study from Mayo Clinic that shows a specific back extensor exercise with a weighted backpack that lowered fractures and improved BMD (compared to non-exercisers) But it looks like the participants did not have osteoporosis---so could the PTs let us know if this specific exercise would be safe for osteopenia in the spine? There is a photograph and explanation of how to do it.
http://www.betterbones.com/blog/default.aspx

Thanks for your information and help.
Santa Fe

Explore topics in this discussion:

Osteopenia Exercise Herniated disc Scoliosis Pain Fractures Osteoporosis Physical therapy Stress

32 replies

thebonz

This exercise was recommended to my by a physical therapist about 2 years ago. However she told me to use 10 lbs weights in a back pack. I have been doing this exercise about 3 times weekly but I have seen no improvement in my bone density. I think I will try it with 15 lb weight and 5 times weekly and see if that helps. But evidently since recommended by a pt it should be ok for ostepororsis of the spine. I have a-3.8 t score and haven't had any problems doing it.

sdivas

I do back extensions, but not with weights on my back. My concern is without an instructor, the weight may not be evenly distributed; also I would be concerned about the body in proper alignment. After years of Pilate reformer as well as ballet, I continue to have corrections in class. One side of the body may compensate for the other side of the body ... and the exercise ends up doing more harm than good. But I'm not a PT or fitness professional. I'll also be interested to know if the exercise is safe and wise for people with osteoporosis ... of course, may be different advise for a person that has fractured in the past.

SantaFe

Bonz:
Thanks for the details. I am a little shocked with your numbers that you could do that much weight. That took guts.
Was your PT knowledgable in osteo? Because if so, then that is encouraging if we can do this exercise safely. Those of us with herniated discs have a hard time finding weight lifting exercises that stress the spine but don't exasperate the sciatic pain. This exercise would work for me---it's standing upright and lifting weights (even light ones) that makes my discs cranky.
Be careful with the new added weights, but hope it works!
Santa Fe

SantaFe

Sandi,
You bring up an important point about balanced weight distribution. After reading your concern, I thought maybe a snug weighted vest with weights just in the back part evenly distributed might solve that. My husband is a Pilates reformer fanatic also. He works with a personal trainer for his scoliosis and could be a "spotter" for my alignment---before osteo, I did a lot of Yoga so I know what you are saying about needing someone to keep an eye on your form. But doesn't this simple exercise look pretty easy to check for alignment, as you have the floor support to feel where body parts are and are only moving in one direction a little bit? It is similar to the Cobra Pose without arm support.
Thanks again for your advice and info.
warmly, Santa Fe

Caleigh

SantaFe: This is very interesting. I will certainly talk to my PT about it. It looks like a really simple exercise to do. I do have concerns about the ultimate goal of 50 lbs mentioned in the article. That seems really heavy. It is really encouraging to know that exercise can help us in so many ways. Thanks again.

Caleigh

SantaFe: This is very interesting. I will certainly talk to my PT about it. It looks like a really simple exercise to do. I do have concerns about the ultimate goal of 50 lbs mentioned in the article. That seems really heavy. It is really encouraging to know that exercise can help us in so many ways. Thanks again.

Caleigh

SantaFe: This is very interesting. I will certainly talk to my PT about it. It looks like a really simple exercise to do. I do have concerns about the ultimate goal of 50 lbs mentioned in the article. That seems really heavy. It is really encouraging to know that exercise can help us in so many ways. Thanks again.

Caleigh

SantaFe: This is very interesting. I will certainly talk to my PT about it. It looks like a really simple exercise to do. I do have concerns about the ultimate goal of 50 lbs mentioned in the article. That seems really heavy. It is really encouraging to know that exercise can help us in so many ways. Thanks again.

SaraMeeks

This study was published in 2001 and is a very important study regarding the reduction of compression fractures, showing that these exercises do reduce the risk. Although the study was done in "healthy, menopausal women," I think there is carry-over into people with osteoporosis/osteopenia.
However, these exercises can be difficult to do correctly and one should seek out a therapist to help you get it right. Many people cannot do this with weight especially the amounts some people have said they use. Lifting body weight can be enough for some. Also, it is possible to vary such an exercise with the positioning of the arms--arms at sides is easiest and then there are positions of clasping hands behind back, W, T, Push-Up position and arms alongside the head--increasing in difficulty as you bring the arms up along the body as you are now lifting more weight.
I teach these exercises by combining pelvic stabilization (to reduce lower back strain and injury,) squeezing the shoulder blades together and doing an exercise called the Head Lift first--then lift the body. Much harder this way.
Some people actually need to begin with strengthening the back extensors while lying on the back. This is what my Re-Alignment Routine does. Anyone interested in receiving a copy of that document (and many have alread) could send me an email sara@sarameespt.com and I'll send a copy.
Bottom LIne--The back extensors are what I call the "forgotten muscle" of most exercise programs and it is essential to strengthen them for better body alignment and minimization of fracture risk.
Have Fun!

SantaFe

Sara,
I am so happy to know this exercise can be done safely with osteo!
I am sending you an email for more info on your books and specific program.
Thanks Again,
Santa Fe

SantaFe

Sandi,
Thanks for all the really helpful tips. I have watched my husband's progress with Pilates and been truly amazed at his improvement (his Pilates teacher sold him one of those foam rollers also).

I did ask if they had someone who specializes in osteo, but what they told me was they had someone who WORKS with osteo clients. After all the warnings on this discussion group from the PTs, I didn't feel confident enough. Also I have that pesky disc problem, so a lot of the Pilates work is out for me. I do special exercises everyday that I worked with an excellent PT years ago for my discs, but they don't really build bone like that exercise above does.

I think that I should pursue finding the right osteo specialist more aggressively now, and will ask to speak to the instructor who WORKS with osteo clients. Because my husband has had some amazing results with his scoliosis at that Pilates studio.
So glad you are able to do such an aggressive Pilates routine with osteoporosis (especially that foam roller with weights) or are you still in osteopenia?
Warmly,
Santa Fe

SantaFe

Caleigh,

Please let us know what your PT thinks of this. Could you ask what she/he thinks of the amount of safe weight to use? I also think 50# is too much.

Thebonz's PT recommended 10# but there wasn't any success, so maybe increased to 5 days a week and SLOWLY build up to 15 or 20# would at least give some added bone without too much danger.
Also Sara's suggestions of making it a more demanding exercise with different positions sounds promising too.
Warmly,
Santa Fe

SaraMeeks

If anyone would like to find a Pilates instructor who is knowledgeable regarding osteoporosis, Sherri Betz PT is the best person I know to contact. She has a website www.therapilates.com and has a book and DVD's for reference.
I also have lists of people who have taken both mine and her training, also Yoga, if anyone is interested.

karenatheklineback

It looks like the exercise is a good one and I agree with Sara Meeks that it may be difficult to do correctly.

When I first read backpack, I immediately think of something on the low back, but it looks like the weight is centered between the shoulder blades. Those of you who are looking for an increase in bone density as a result of this exercise will more than likely be disappointed. The study reads that bone density did not increase but that fracture risk did significantly decrease: further evidence that a strong musculature protects bones. When I teach this type of exercise this is what I recommend:
1. Rest the forehead on the backs of the hands
2. Pull the stomach/belly button away from the floor
3. When you lift the head; keep the hands glued to the forehead and keep the stomach pulling away from the mat (even if you aren't 100% successful)

It is very important not to 'dump' into the low back. Focus on the upper body moving and the low back extensors will automatically engage without ever changing the shape of the low back. If you do 'dump' into the low back you are looking for an injury which is why sdivas and Sara Meeks recommend beginning with someone to watch you. If you are reading this from the Artic Circle then there are fantastic resources listed above that you can take advantage of. I also just released safe exercises for osteoporosis with Pilates for Healthy Bodies and the book OsteoPilates.
Good luck everyone, but overall it looks like the jury has come back with a very positive response on the initial question on whether this exercise is a keeper. It is!
Karena

SantaFe

Sara and Karen,

Thank you so much for your generosity in time and consideration of this exercise. We are so fortunate to have your input.

Karen---thanks for the clear specificity on how you do the exercise--especially the low back dumping warning---I noticed the tendency for that when I first started the exercise. Am heading off to check out your web site.
Many thanks to you both,
Santa Fe

SaraMeeks

Thanks, Karen, for putting it so well--no "dumping" into the lower back. I do it a bit different but the idea is to use the entire back in an exercise such as this. The erector spinae (back extensors) runs from the tailbone up to the base of the skull in a vertical line of pull and it works in several ways. It "recruits" as it works -- that it, if you begin the contraction in the lower back and raise the body, the muscle will recruit up the spine. Part of it is also a tonic, postural muscle that is under constant fire in a healthy individual.
It is really important for anyone wanting to do these exercises correctly to consult with a therapist/exercise professional who can observe and make sure you are doing it right. No sense wasting effort doing it wrong.

SuzaFrancina

Thank you, Santa Fe, for posting the link to Dr. Susan Brown's article, "Stronger back muscles can lower future fracture risk."

I agree with the comments made by Sara and Karen.

This is a classic back-strengthening exercise taught in "Yoga Basics" classes. It is often refered to as the "Cobra Pose."

If one of my students came to me asking about practicing this pose with a weighted backpack, especially sice I myself have not yet tried it, I would recommend first practicing without added weight.

For most people, there is plenty of back-strengthening involved lifing their own body weight. As Sara Meeks points out, this exercise/pose can also be done with arms out to the sides, in line with the shoulders, and other more advanced arm positions that require more effort.

People who are new to this exercise almost always attempt to lift their head first and arch their necks back. To help prevent "dumping" in the lower back, keep the head (chin) looking slightly down, rather than up.

To help protect the lower back, learn to press down through the legs and feet so that they stay firmly planted on the floor. A teacher can show you various techniques for learning this, including holding the ankles and feet firmly down.

Suza Francina
Certified Iyengar Yoga Instructor
www.SuzaFrancina.com

SuzaFrancina

A clarification:
When I say "teacher" that includes physical therapists/exercise professionals.

Now I'm going to email sara@sarameespt.com for a copy of her Re-Alignment Routine document.

SuzaFrancina

Whoops! The "k" was missing from the above e-mail address. The correct e-mail for Sara Meeks is sara@sarameekspt.com

jacquelinenh

Thanks for all the informative commentary. Looking at the photo on Dr. Brown's post http://www.betterbones.com/blog/default.aspx
and reading the study, I can't figure out how the backpack gets weighted. Can I just stick some handweights in the pack or should I buy some large zip lock bags and fill with sand -- a pillow shape that is more evenly distributes the weight? I am trying the exercise now without the backpack -- thanks for the positioning tips!

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