Osteoporosis: Physiotherapy Management and Prevention

Osteoporosis or low-density bone is a health problem that causes disability and various complications in the sufferers. It occurs when the normal bone becomes thin and porous due to poor nutrition or aging, which can decrease the ability of the bone to withstand the forces that are applied during daily activities.  This disease can be silent progressive with no prominent symptoms until complications like fracture occurs if left untreated or unidentified. Strategies to improve bone density and reduce the likelihood of falls are important in the prevention of osteoporosis. Physiotherapy plays an important part in treating this health problem. Certain exercises can help strengthen the bones when performed in a proper way and under the guidance of a well-trained professional. In this blog, we will discuss physiotherapy management for osteoporosis sufferers and the precaution to be taken to prevent the complications.

 

Role of Physiotherapy in the management of osteoporosis

Physiotherapists are trained professionals who treat osteoporosis by personalizing the treatment plan. There is no single exercise regimen for people suffering from Osteoporosis. Based on a medical evaluation of range of motion, muscle strength, fitness level, fracture risk, gait, and balance each regimen for the individual patient is specially tailored. They develop a specific program based on the individual’s need. The goal aims:

 

• To help manage osteoporosis with minimal risk of complications.
• To build or strengthen the bones and muscles to decrease the amount of bone loss and the risk of injury and help to stay independent.
• Teaches proper postural alignment and body movement to protect the spine from fracture during daily activities, like lifting, forward-stooping, and bending.
• Gives balance training and develops a program to help reduce the risk of falls.

Muscle grows when challenged by more than usual weight, same is the case with bone, bone grows when it is properly and sufficiently stressed.

 Physiotherapy management

Exercising for bone-building or slowing bone loss is very specific and similar for all ages.  

 

• Physiotherapist provides appropriate external devices, like bracing, to improve posture and promote healing.
• Uses different modalities which help reduce pain

 

·    Range of motion (ROM) and strengthening exercises

Physiotherapists aim to improve the overall posture through a gentle range of motion and strengthening exercises. Gradual fractures and wedging of the vertebra are due to the increased flexion through the thoracic spine. These conditions worsen with poor posture. Maintaining a good posture with the help of exercises gentle range of motion and strengthening exercises can maintain the healthy mobility of the upper back and core.

 Resistance exercises

As exercises lead to stronger bones, physiotherapist designs an appropriate exercise program, which can reduce the risk of falls and fall-related fractures. Exercise programs include the use of exercise bands, gravity resistance exercises e.g., squats, single-leg heel raises, prone trunk extension with cushion to protect lowest ribs, push-ups, lunges, sustained standing positions in neutral spine position.

 Loading exercises

To increase the overall stability and bone strength lifting weights and lower impact exercise can decrease the risk of fracture. People with osteoporosis are afraid to perform strengthening exercises and other strenuous exercises. For any physiological system to improve its function load larger than normal must be exposed for strengthening.  Bones must meet forces greater than those it sustains to improve strength on a day-to-day basis. Weight lifting in the proper spine and lower-extremity alignment can be done. Weight-bearing exercises stomping, heel drops, dancing, jogging are also done under the guidance.

 Balance and coordination exercises

Coordination and balance exercises also help in reducing fall risk. When walking on unstable surfaces or walking through narrow spaces, these exercises help to improve balance. Exercising on a bobath ball and placing challenges the whole walking can increase and maintain balance.

 As a part of an overall fitness program, exercises are performed 2 to 3 times a week.

 Things to avoid: 

• Avoid exercises that can put the greater risk for injury.
• Avoid exercises that overstrain or under strain the bone or muscle.
• Avoid exercises with any type of sit-up or crunch, and excessive spinal or hip twisting, forward or side bending.

 

Exercises to gain Strength and Mobility at home during COVID-19

Remaining active during this pandemic has become another big challenge for people all over the world. Social restrictions caused by COVID-19 continue to affect all of us. Being stuck at home and avoiding public gatherings has not only affected our mental health but also our physical activity. Therefore to maintain the overall strength of the body, few basic exercises should be done while staying at the home. These exercises won’t only boost your immune system but also will keep your mind busy. People who are at higher risk of COVID complications, such as old aged individuals, people suffering from Heart and Lung Disease, Cancer, HIV, and Diabetes should exercise on daily basis, whereas those infected with COVID-19 can do light to moderate intensity exercises while maintaining quarantine.  Vigorous-intensity exercises should be avoided for 2 weeks after a positive test, with close monitoring of the vital signs and symptoms. Here are some basic strengthening exercises, which you can do, while staying at home.

Cervical strengthening:

·         Start in a sitting position.

·         Place your hand on your forehead.

·         Apply pressure by pushing your hand towards the head, resist it back and hold.

·         Place your hand on the back of your head, apply pressure by pushing your hand towards the head, resist it back and hold.

·         Place your hand on the side of your head and apply pressure by pushing your hand towards the head, resist it back and hold.

·         Place your hand on the other side of your head and apply pressure by pushing your hand towards your head, resist it back and hold.

Bicep strengthening:

·         Sit in a chair.

·         Hold a weight in your hand, bend your elbow to raise your hand towards your face.

·         Relax and bring the elbow to the starting position.

Overhead strengthening, with dumbbell:

·         Hold a weight in your hands.

·         Raise your arm above your head and keep it straight.

·         Bring back your arm to the starting position and repeat.

Plank on-the-ball" Core/scapular strengthening:

·        Pile up few pillows of the same height same as the length of your arms or use a ball. Roll over the top of the ball or keep both your feet over the pillows until you have your hands under your shoulders, and the ball under your legs.

·        Note, the closer the ball or pillows are towards your feet, the harder the exercise.

·        Maintain this position with your shoulders strong, your core engaged, and your back flat.

·        Do not allow your back or shoulders to dip down.

Push-ups:

·         Lie on your front with your hands just wider then your shoulders and toes on the floor.

·         Tighten your buttock and abdominal muscles as you push yourself up with the help of your arms, keeping your body straight.

·         Your shoulders and your heels should be in a straight line.

·         Place your hands on the floor so that you fix your shoulder blades fully against your rib cage.

·         Keeping your back straight and control at the shoulder blades, bend your elbows, dropping down into a press-up.

·         Straighten your elbows again by pushing back on your hands.

Bridging with lifting heel:

·         Lie on your back keeping both your feet on the floor and maintaining your legs at hips-width apart. Bring one leg upwards at a time.

·         Lift your hips upwards until you have a straight line from your shoulders to your knees.

·         Hold this position and now raise one heel of one foot, then bring this heel back and raise the other.

·         Repeat the movement by keeping your hip your body upwards.

Plank, side (low)" Core/scapular strengthening:

·        Lie on your side.

·         Keep your legs straight and stack them on top of one another.

·         Use your elbow and feet to take your body weight, keeping your head to your feet in a straight line.

·         Hold this position for as long as you can, preventing the hips from going down.

Gluteus sets:

·         Lie on your back keeping your legs straight.

·         Tighten your buttocks and hold this position.

·         Relax and then repeat.

Quadriceps sets:

·         Sit on a bed keeping your legs straight.

·         Keep a pillow under your knee and try to apply pressure to the pillow by pressing down your knee without using your hands, hold this position.

·         Relax and then repeat

Hamstring set:

·         Lie on your back.

·         Bend your knee to an angle.

·         Pull your toes towards you

.

·         Gently push your heel into the floor.

·         Hold this position as instructed.

Heel raises:

·         Stand up straight by holding the back support of a chair.

·         With your legs hip-distance apart.

·         Rise on the ball of both feet.

·         Transfer your weight onto one leg by lifting your other leg from the floor.

·         Keeping your heel raised, hold this position.

·         Place the other foot back on the floor and lower yourself back down using both legs.

·         Repeat.

Squat, on a wall, with heel lifts:

·         Stand straight with your back towards the wall.

·         Lean your back and buttocks against the wall and move your feet apart to hips-width.

·         You may also need to move your feet forward a little.

·         Slowly slide down the wall to attain a squatting position with your hips and knees at 90 degrees.

·         Keeping your back and buttocks against the wall, hold this position while sliding back on the balls of your feet.

·         Lower your heels and then repeat.

Stay home, stay safe, and stay healthy.