Treatment Tuesday: focus on Osteoporosis

WHAT IS OSTEOPEROSIS?

Osteoporosis is a disorder of progressive bone loss. While all bones normally cycle through a series of bone degradation (resorption) and new bone creation (deposition), bone loss occurs when the rate of bone resorption becomes faster than the rate of bone deposition. While we all experience age-related bone loss beginning around age 35, bone tissue deterioration can become pathological when it progresses < 1 ‘standard deviation’ (SD) from normal. Osteopenia is defined as between 1-1.25 SD below normal or a T score (measure of bone density) between -1 to 1.25. Osteoporosis is defined when bone density drops 2.5 SD or more below normal, or T score falls below - 2.5. Symptoms of low bone density typically include increased risk of fracture, increased thoracic kyphosis and pain. Osteoporosis can impact breathing and digestion if/when structural changes affect posture and spinal structure. Women are at higher risk for bone loss than men; women are 8x more likely to experience Type I osteoporosis(postmenopausal and related to loss of estrogen), and 2x more likely to experience type II (senile osteoporosis that occurs after 70 years old).

You can decrease your risk of developing Osteoporosis and/or improve your management of this disease by making certain changes in your lifestyle and activity:

✓ Participate in Regular Aerobic Activity and Strengthening: Participation in moderate to high intensity weight bearing aerobic exercise with a cyclical movement pattern has been shown to be beneficial to people with osteoporosis. Strengthening improves bone mass by the transfer of mechanical stress to bone via tendons and reduces your risk of falls.

✓ Improve your Balance and Reduce your Risk of Falls: Given the increased risk of facture in the setting of osteoporosis, it is critical to improve your balance and stay on your feet. Additionally, learning how to fall properly can protect your spine and joints in the case that you do lose your balance. Consult a physical therapist to determine how to best address these issues and incorporate a balance program as part of your normal routine.

✓ Postural Awareness and Use of Proper Body Mechanics: If you have already been diagnosed with osteopenia or osteoporosis, it is important to use proper posture and body mechanics to protect your spine and reduce risk of compression fractures. Excessive spinal flexion (bending forward) and twisting motions can increase risk of these types of fractures. Avoid activities that require these movement patterns and focus instead on spinal extension (leaning back) and improving your neutral posture and postural control.

✓ Follow any Medication and Diet Recommendations Provided by your Doctor: There are many good, effective pharmacologic treatments available for the treatment of osteopenia and osteoporosis. Your doctor may prescribe dietary supplements or bisphosphonates to slow bone degradation and encourage new bone deposition. Follow your doctor’s directions and make regular follow-ups routine.

BENEFITS OF EXERCISE

✓ Improved bone density

✓ Decreased risk of falls and fracture associated with falls

✓ Improved aerobic capacity, oxygen utilization, blood pressure and improved cardiac efficiency

✓ Improved sleep, mood and decreased daytime fatigue

✓ Improved weight management

CAUTIONS AND CONTRAINDICATIONS

While it is safe to exercise with osteoporosis, you should avoid high impact activities and exercises that involve twisting of the spine. This can protect your vertebrae from compression fracture.

Further Reading and Resources

Choose PT Guide to Osteopenia

Choose PT Guide to Compression Fractures

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Treatment Tuesday: Focus on Low Back Pain

🩺It's Treatment Tuesday here at HAE🩺

With my goal of promotion of healthy aging for the patients I treat, I also think it's important to share information on a larger scale. Each Tuesday, I will review either new literature or established best-practice standards that address the best treatment for a particular disease, disorder or dysfunction. To kick things off, I choose a problem I'd be willing to bet we've all experienced a time or two....Low Back Pain.

While Low Back Pain is common, it is often mistreated. Here is a review of the recommended, most effective treatments, treatments options that are sometimes appropriate, and lastly, the few that are least appropriate and often less helpful. Primary source of this information collected from ChoosePT.com, a patient education resource guide from the APTA. See links below for more information.

RECOMMENDED: 

🟢 Movement: While it may be tempting to stay in whatever posture doesn't bother your back, the more effective treatment  is movement. Try to move more in ways you can tolerate - walking, swimming, cycling or simply gentle stretching can help alleviate and prevent low back pain. Consult a Physical Therapist to help you establish a physical activity plan that is safe and effective at reducing low back pain.

🟢 Education: Low Back Pain can commonly be attributed to muscle imbalances within the trunk, legs and along the spine. When you combine that with prolonged sitting, standing or repetitive motions, you get pain and dysfunction. Learning about your imbalances and about proper posture can help you take control of your low back pain.

🟢 Cognitive-Behavioral Therapy: This type of therapy (using your behavior to retraining your brain to respond in an alternative way to a stimulus) has been proven effective for any type of chronic pain. Next time you have a painful experience, notice what your response is. Do you get immediately anxious? If it happens, take that opportunity to focus on your breathing, instead of your anxiety. While you take time to be aware of your symptoms, take 5-10 slow deep breaths instead of turning to panic or googling what to do. This 'changing the conversation' can help your brain begin to dampen the response to the pain stimulus instead of turning to panic.

SOMETIMES APPROPRIATE:

🟡 Yoga: With a focus on controlled breath with movement and on core activation, yoga can be a helpful adjunct to your low back pain treatment plan.

🟡 Massage: While massage may give you some short term relief, evidence has shown movement-based therapy is more beneficial in the long term.

🟡 Acupuncture: Results of acupuncture for low back pain relief is similar to those associated with massage; while it may be helpful on the short term, it should be combined with recommended treatments for long term relief.

🟡 Spinal Manipulation: As with massage and acupuncture, spinal manipulation may help initially with function, but should also be combined with exercise and movement-based treatments.

RARELY APPROPRIATE:

🟠 Opioids: The CDC recommends use of opioid medications only for chronic pain that has been resistant to other recommended treatments. They are less effective and have considerable side effects.

🟠 Heat: Everyone loves to throw on a heat pack, but there is limited evidence of any long term benefit. Ice may be a better choice, but regardless, any use of modalities should be used in combination with recommended treatments.

🟠 Imaging Scans: Evidenced has shown that imaging like x-rays and MRI's is not necessary to diagnose and treat low back pain. It can also lead to unnecessary treatment.

🟠 Spinal Injections: Evidence has not found any long term benefit from spinal injections and it does not reduce the likelihood of surgery.

🟠 Surgery: Surgical intervention is not necessary or recommended for most types of low back pain.

NOT RECOMMENDED: 

🟠 Bed Rest: Not only is bed rest ineffective, it will likely make back pain worse. Try to move, in ways that are comfortable instead. 

To learn more about the best practice guidelines for the treatment of low back pain, check out these links:

Choose PT Guide to Low Back Pain:

https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-low-back-pain

Choose PT Recommended Treatments for Low Back Pain:

https://www.choosept.com/resources/detail/recommended-treatments-low-back-pain-2

Choose PT Five Common Myths About Low Back Pain:

https://www.choosept.com/resources/detail/5-common-myths-about-low-back-pain