Pilates for Osteoporosis

Osteoporosis or ‘porous bones’ is a pathology which is quite relevant in the modern world. When bones lose mineral and protein content, especially calcium, they begin to degenerate. Often this is not known to the client until a bone breaks. It is often termed the ‘silent pathology’. Breaks, or fractures, are most commonly seen in the spine, hip or wrist. Spinal fractures are most common in the thoracic spine where kyphosis (forward bend) develops. The anterior edge of the vertebral body weakens, resulting in a possible wedge fracture through this area.

We have cells called osteoclasts – a large multinucleate bone cell which absorbs bone tissue during growth and healing. Its function is critical in the maintenance, repair and remodelling of bones of the vertebral skeleton. We also have osteoblasts – cells with a single nucleus that are responsible for the synthesis and mineralisation of bone during initial bone formation and later bone remodelling. These cells work together regenerating our skeleton entirely every 10 years or so. Osteoblasts reach their peak at approximately the age of 30, however, from around 40 years old, osteoclasts work more than osteoblasts. This results in an increased occurrence of porous bone. The action of the osteoclasts further increases with ageing and by the age of 50 and post 75 years old, 50% of the population are osteoporotic.

Osteoporosis is more common in females post menopause, as oestrogen levels drop dramatically. Oestrogen is a bone protecting hormone. In males, testosterone is converted into oestrogen to protect bones and again with ageing, this reduces. By 6-7 years post menopause, bone density has reduced by 20%. Post 70 years old, females have lost 30-50% bone mass and men have lost 20-33%.

Drinking and smoking (potentially leading to poor nutrition), leads to increased incidence of osteoporosis. Lack of Vitamin D, lack of exercise and a diet low in calcium may also predispose one to osteoporosis. Asians and Caucasians are more susceptible to osteoporosis than Hispanics and Africans.

Osteoporosis is diagnosed via a bone density test. Those who indicate mildly lower bone density are termed ‘osteopenic’ and should be managed in a similar fashion to those with osteoporosis. There is no cure for osteoporosis but it can be controlled, particularly in addressing the kyphotic posture that may develop with the pathology.

Osteoporosis Australia advocate Vitamin D, good calcium absorption and exercise for managing osteoporosis. The exercise needs to be in the form of weight bearing more than resistance training. The weight bearing assists in bone reformation and strengthening. In particular we wish to strengthen the extensor group of muscles (the back muscles). This assists developing postural strength and endurance and helps to reduce the forward bend or hump-like posture. In addition, we want to focus on scapular strengthening and thoracic extensor strength to protect the upper back and upper limb strengthening to reduce the chance of wrist fracture.

Pilates is an ideal form of exercise for osteoporotic clients and for osteoporosis prevention. The exercises are controlled and balanced, with specific emphasis on the extensor groups of muscles. Weight bearing can be achieved on the equipment with spring resistance. Working in closed chain or pseudo closed chain allows for controlled concentric and eccentric loading of the bones.

Whilst exercising, we should aim to avoid any loaded flexion (forward bend) as we don’t want to put undue load through the anterior aspect of the spine, for fear of creating a wedge fracture. The osteoporotic client can still work hard in the Pilates studio, increasing postural support and strength, building up bone density, correcting posture, improving alignment of the limbs and ultimately reducing the effects of osteoporosis. So let’s do Pilates and help keep our bones strong!

Author:
Jen Guest Bach App Sc (Physiotherapy)
Senior Educator Polestar Pilates Education

 

Image Copyright: rob3000/123RF Stock Photo

Reviewed and republished October 2022