‘Spine-sparing’ strategies can help combat osteoporosis
According to a prediction from Osteoporosis Canada, by 2020, 50 per cent of people over the age of 50 will be at risk of bone fracture.
“To put this in perspective, fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined,” says Bonnie Lindsay, a personal trainer and certified Nordic walking instructor.
Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, which can lead to an increased risk of fracture. The most common sites of osteoporotic fracture are the wrist, spine, shoulder and hip.
While osteoarthritis put an end to Lindsay’s running obsession, Nordic walking became a big part of her recovery after bilateral knee replacements and a hip replacement.
She says it also improved her posture, correcting one of the earliest signs she had osteoporosis. After lots of training with her poles, she was able to complete a half marathon, hike down to and back up from the Colorado River in the Grand Canyon, and walk some 600 km of El Camino de Santiago trail.
Osteoporosis causes 70 to 90 per cent of 30,000 hip fractures annually, says Lindsay, 73. “Of those who suffer a hip fracture, 23 per cent die within a year, and of those who survive, 50 per cent are left with disabilities that leave them needing assistance in many activities of daily living.”
There are many things you can do to help, says Lindsay, but there are just as many things you might be surprised to find that you shouldn’t do. “Approximate 60 per cent of yoga postures are risky for those with low bone strength, either because of the posture itself, or what one has to do to get into them,” she says. “Yoga is great, but a person with low bone mineral density should learn alternatives to risky moves and postures.”
As well, she says, “people probably don’t think that repeatedly unloading their washing machine, dryer and dishwasher, or picking up small children might be risky activities if not done with spine-sparing techniques. And they probably don’t realize that sitting increases the pressure in their spine.”
She points out the risk factors: age and gender (females are more at risk); low body weight or body weight 10 per cent less than at age 25; parental hip fracture; rheumatoid arthritis; glucocorticoid use (e.g. cortisone); smoking; alcohol intake of three or more drinks a day; history of falls or poor balance; prior fractures.
While we can’t change many of these are factors, people can stop smoking, reduce alcohol intake, get help with balance exercises and build up muscle strength and mass, she says. “Prevention ideally starts in one’s childhood through early adult years, when we are most able to build bone. The greater your ‘bone bank,’ the more you could lose without being at great risk.”
Bone building at any age requires good nutrition, especially calcium and vitamin D, she says, and children and young adults build stronger bones if they are active running, jumping, climbing or playing soccer. “Beginning in our mid-20s, we start to lose bone mineral density, and by the time women approach menopause, they lose bone at two to three per cent per year, increasing to two to five per cent after menopause.”
If you already have or think you have low bone mineral density, what can you do to prevent or reduce further loss? Here are some suggestions from Lindsay:
Assess your calcium, protein, fats and carbohydrate intake and modify as appropriate. Have vitamin D level checked.
Do 150 minutes a week of moderate to vigorous weight-bearing aerobic exercise, done in bouts of 10 minutes or more. (Brisk walking is not recommended for those at high risk of fracture.) Do progressive resistance muscle strengthening two to three times a week for 45 minutes. To build bone, strains need to be unusual, unaccustomed and more than done in one’s activities of daily living, but not for prolonged periods.
Do progressive balance and fall prevention exercises daily, including posture and core stability exercises.
Apply spine-sparing strategies in your activities of daily living. Avoid repeated, rapid or end-range flexion, rotation and side bending.
Avoid multiple plane spinal moves (e.g. flexing and rotating at the same time) and end-range hip rotation.
Squat to take clothes out of front-loading washing machines, dryers and ovens.
Use golfers’ bend or squat to pick things up from the floor or unload a dishwasher.
If you are not sure what to do or how to do it, engage a personal trainer or physiotherapist who specializes in osteoporosis, read material on the Osteoporosis Canada website and sign up for their newsletters and seminars.
As for her own role in helping people, “Mostly I am a nag,” Lindsay says. “That means: ‘Watch your posture, stand up straight, carry your head level and right over your spine. If you’re doing strength exercises, do as many as you safely can while standing up.’ ”
Although she has done some group strength, balance and fall prevention classes, she prefers working with individuals or very small groups so she can better monitor and correct technique, and develop a program that people will actually follow and benefit from.
“Much of what drives me is a desire to pass on to others what I have learned,” she says, “so they don’t make the same mistakes I did. I’m passionate about the potential for fitness training to improve physical, mental and emotional wellbeing and allow us to thrive as we age.”
Bonnie Lindsay demonstrates one method for keeping a neutral spine while unloading a dishwasher.
Lindsay credits Nordic walking with improving her posture, correcting one of the earliest signs she had osteoporosis.