Rehabilitation and the Aging Osteoporotic Spine
Osteoporosis is a common bone-thinning disease involving the loss of bone density, mass, and structural form in the major supporting bones of our skeleton (femur, pelvis, and spine). As bone density and mass becomes flushed out by osteoporosis, the bones become brittle and the risk of fracture and additional functional deficit increases significantly. This affliction of the aging spine is more common in females than males, and it is estimated that one out of every two women and one in four men over 50 will have an osteoporosis fracture in their lifetime.1 The loss of bone density and the potential fractures associated with osteoporosis can have a major effect on how we are able to perform once easy daily tasks. Everyday activities such as getting up from a chair, walking, and even turning in bed can become extremely painful and debilitating.
Along with appropriate medications and changes in nutrition, physical therapy is a common, early treatment choice for those diagnosed in the early stages of osteoporosis. Once physical therapy has been advised by your physician, your physical therapist will perform a detailed, one-on-one initial evaluation to help gather the information needed to develop an individualized treatment plan for the patient with osteoporosis. Educating the patient in positions of comfort, safe lifting techniques, and methods to relieve and prevent excessive pressure on the spine are important topics the physical therapist will address. Your therapist will help teach you appropriate stretching and strengthening exercises, designed to improve your posture and help reduce your risk of falling. Initiation of weight bearing exercise, designed to enhance the body’s natural ability to produce more bone, are essential. As the name suggests, these exercises must involve weight bearing activities, such as walking, repeated step climbing, low-level aerobics, or standing balance and weight shifting. Those who are dedicated and compliant with their medications, changes in diet, and home exercise program can expect beneficial results in helping to keep their bones healthy and prevent the progression of osteoporosis.
Unfortunately, conservative measures are not always effective in slowing the progressive nature of osteoporosis. Once the bones become too brittle, fractures, spinal compression fractures in particular, are probable. At this point, the pain associated with the compression fractures can become so debilitating that surgery may be the only option. Your physician may suggest a Vertebroplasty or Kyphoplasty to treat the compression fractures in your spine. Proper preparation for surgery can ease your recovery, and the physical therapist can play an important role in your preparation. Education in proper ways to move during daily activities such as getting into and out of bed, lying to sitting and sitting to standing will help to prevent excessive force from being placed on the compression fractures and eventual surgical sites. Learning how to maintain proper posture and co-contract the surrounding trunk musculature will help reduce the energy required to perform routine activities. Maintaining good posture during transfers and activities of daily living will significantly reduce post-surgical pain. Maximizing lower extremity flexibility and trunk strength prior to surgery will also make it easier to restore these levels after the procedure. Education in the proper use of an appropriate assistive device such as a walker, lofstrand crutches, or a cane, is often easier prior to the surgery and will allow for early weight bearing activity after surgery. In addition to helping you to prepare for surgery, physical therapy can be effective in pre-surgical pain management through the use of pain relieving modalities such as moist hot packs, ultrasound, low level laser therapy, or electrical stimulation.
Once your procedure has been performed and your condition has begun to stabilize, your physician may recommend additional outpatient physical therapy in an effort to help optimize your recovery. Goals of physical therapy at this stage focus on post-surgical pain relief, progressive strengthening and stabilization exercise, advanced education in proper methods of lifting, carrying, and bending activity. Post-surgical out patient physical therapy typically lasts for 6-8 weeks.
While osteoporosis can be a debilitating and progressive disease, it is important to remember that you do have options in helping to reduce the associated pain, slow its progression, and maintain a healthy active lifestyle. Physical therapy is a conservative option that has beneficial results whether you have recently been diagnosed with osteoporosis, are preparing for surgical intervention, or are recovering from surgery.
References:
The National Institutes of Health (NIH), Osteosis and related Bone Diseases ~ National Resource Center, Osteoporosis Overview;