Physical Therapy for Osteoporosis

One topic I would like to discuss is treatment options for osteopenia/osteoporosis and how to provide a well-rounded approach to protect and improve bone mineral density.  If you break down the word osteopenia into the root words you get osteo- relates to the bone, and -penia represents porous. The word itself literally means porous bones. The bone becomes brittle and fragile leaving you vulnerable to fractures. Any bone in the body can be impacted, however, the most common sites of porous bones include the low back, the hips, and the long bones of the legs.

You can have your bone density assessed by your OBGYN using a test called a DEXA scan. It is a painless and quick procedure that assesses the common sites of decreased bone mineral density. It tells you how your bone density compares to people of similar gender and age (Z score)  as well as a comparison to the “gold standard'' healthy 25-30-year-old female who is at peak bone mineral density (T score). If your score is a certain percentage lower than the gold standard you are considered to have osteopenia. Osteopenia is the initial stage of Osteoporosis and can begin to be identified in your 40s and 50s. This is a critical time to tend to your bone health, although bone health begins in your early stages of life. In my opinion, it is not too early to begin considering your bone health in your 30s. 

My aforementioned patient left me wondering what I can do to help this group of women… middle aged women diagnosed with osteopenia who are too young and active to be involved in a program for osteoporosis but do not want to take medications with potentially risky side effects. In my schooling for physical therapy, I learned that the cells that create bone respond best to weight-bearing and pressure. This is your typical “If you don’t use it you lose it”. This process is referred to as Wolf’s Law and has been known for over a century. 

You may believe that because you have an athletic frame, you are not at risk. This is not always the case because you do not have a lot of weight that is carried around thus the demand is not placed on the bones to stimulate growth. Weightlifting is essential in maintaining healthy bone mineral density to prevent future fractures and debility. I don’t mean lifting five-pound weights, I mean lifting at a high percentage of your body weight to truly put a demand on the skeletal system. It is critical that you be taught proper form in your weight training so you avoid positions that put you at risk for fractures. 

Along with a safe weight lifting program, yoga can also be used to improve and maintain your bone mineral density.  The goal here is not to improve flexibility. When you contract your muscle, the tendons of that muscle “tug” on their attachments to the bone. This tells the bones that they are needed and bone growth is stimulated. Another factor worth mentioning here: as we age, your balance begins to decrease. This is a problem for women with osteopenia and osteoporosis because if your balance is decreased then you are at high risk for falls and fractures. Yoga can help improve your balance and can lower your risk of falling. 

It appears that we are not the only group that has similar concerns with this. In a study called “Yoga for Osteoporosis” by Fishman and Saltsonstall, they used a 12-minute yoga sequence daily for women who were already losing bone. Indeed, 82% of the subjects report gaining bone at the 2 year follow up. The poses were cautiously designed to reduce harm to the individual by avoiding forward folds The poses chosen safely add pressure on the fragile bones such as in tree pose where the long bones of the leg and the vertebrae are stacked. In this pose, strengthening occurs in the muscles along the spine (as well as others). Studies such as this are currently being done and also demonstrate positive results using yoga to improve bone health. 

The main benefit of performing yoga or weight lifting with a licensed physical therapist is that you can be certain you are getting the knowledge you need to safely perform the exercise daily at home. A physical therapist can work with you one-on-one to improve the strength and range of motion necessary to achieve the poses in the 12-minute yoga sequence for osteoporosis. You will get individual modifications to meet you where you are at while still getting the bone-building benefits of the postures. You do not have to have experience with yoga to access the poses as they have been carefully selected with various levels of experience in mind. The goal here is to provide you with a safe, easy, and quick sequence that you can perform at home to improve your bone mineral density alongside your current treatment options for bone health. If you want to take your yoga practice further or already have experience, the therapist at In Motion Integrative Physical Therapy can guide you to know what poses are safe and unsafe, then you can choose what community yoga classes are best for you. You can have an open dialogue with the teacher about your personal limitations. The Yoga teachers will have the knowledge for how to modify the poses to suit your needs.

If you are interested in how to create a weightlifting and yoga program to improve your bone health, please contact us at info@inmotionintegrativept.com. You can also speak with your doctor about getting a bone mineral density test and taking supplements, and a dietician about a healthy diet so that we can improve your bone health from all angles.