Robin’s synopsis of EXERCISES for OSTEOPOROSIS with Dr. Sherri Betz
Sherri Betz is a doctor of physical therapy and Pilates teacher, specializing in geriatrics and osteoporosis.
Dr. Betz reviewed published research studies on exercise and osteoporosis. She believes that the findings are difficult to evaluate in that most studies are not long enough to make accurate conclusions. According to Dr. Laura Gregorio, also on the Summit, studies need to be at least 8 months long to see a change in bone density and the majority of the studies published are 12 to 24 weeks. Dr. Betz believes that future studies should be closer to a year to get accurate results on bone health.
The research findings that we have so far do show that high-intensity strength training gives the best results for bone growth. That is better than yoga, Pilates, or low-impact exercise. What this means is that you must use enough external force to build muscle which leads to building bone.
Dr. Betz emphasized that this does not mean that yoga or Pilates should be dismissed because these modalities emphasize alignment, posture, and core strength as a good foundation to any exercise program. In fact, current studies do show that combining high-intensity training with lower-impact exercises improves bone density better than high-intensity activities alone.
WHY ROUNDING OF YOUR BACK IS DANGEROUS
Bone loss in the spine usually occurs in the front part of the mid-back vertebrae causing a wedge shape. If you bend forward, allowing your mid-back to curve, you are putting more force on this front part and compressing the vertebrae, with a greater risk of fracture.
Never do crunches, roll-ups, windmills or yoga forward folds.
These activities put stress on the mid-back and are a fracture risk.
Keeping your spine aligned, avoiding bending in the midback, is not just an exercise, but should be attended to during all your daily activities.
HIP-HINGE is KEY
The key to any exercise is first learning to control your own body weight. Knowing how to bend at your hips, keeping your head aligned with your sacrum and pelvis, avoids any rounding of the midback. Both Marci and Dr. Betz emphasized that having someone watch you is important to make sure your alignment is good before you add lifting weights.
Always wear shoes for safety anytime you are using weights.
A dowel is an inexpensive way for you to check your alignment, keeping your head, midback, and sacrum against the stick while bending from the hips. You need to be able to hip-hinge, touch the floor, and stand back up again with good alignment before lifting anything from the floor. Once your alignment is good, you can start lifting an object. Starting with an empty basket, using handles if your hips prevent you from bending all the way to the floor, you can gradually add weight to the basket.
Dr. Betz believes that everyone should slowly build up to safely lift 50 pounds from the floor.
YOGA and PILATES
Traditional Pilates has many exercises that include rounding of the spine and twisting that are contraindicated with osteoporosis and no standing exercises that are good for balance. Dr. Betz has modified Pilates to make use of the components that will help bone and make it safe for those with osteoporosis and believes adding yoga poses for balance and leg strength, along with specific muscle-building exercises, is a perfect blend. Bridging and side-plank are two examples.
Many Pilates mat exercises combine bending, twisting, and side-bending, and should never be done. You can twist or side bend, but keep your length, lift your chest, and only move to 75% of your available range of motion.
RIB TO PELVIS TEST
One way to know if you have compression in your spine is to test the space between your ribs and your pelvis. You should be able to have at least 2 fingers width in that space.
You can check this before and after exercise to make sure you are not collapsing here and maintaining or increasing this space.
This space will often shorten if people are trying to engage their core by holding their abdominals tight and tucking their tailbone under.
HEAD POSTURE for Alignment and Core Strength
The best cue for core control is to lengthen your ribs off your pelvis, pulling your throat back which aligns your head, and this will engage your abdominals.
To reverse the rounding of the spine and open the front of the chest, lie on your back with a towel roll from (right to left, not up and down) or a soft ball behind your midback and your hands behind your head. Have your gaze up and behind you towards the molding on the ceiling and not rounded forward. First, lengthen your spine back to the floor keeping your gaze backward to stretch open your chest and allow the vertebrae to open in the front. Then, lift your arms and head to neutral. The neck is not moving and stays lengthened. This counteracts the forward motion we do all day. You can then move the towel or ball to a different place in the midback to impact another vertebra.
One rule: you must have an intensity that brings you to fatigue between 8-10 repetitions. If you can accomplish 15 reps, it is not high-intensity exercise to have an effect on your bones. If you cannot do 8 reps, then the weight is too heavy for you.
To strengthen the upper back, you lie on your stomach, put a pillow underneath you to protect your rib cage. Place your forehead on top of your hands, keep your pubic bone on the floor to protect your low back, and lift your head, hands, and elbows off the floor, keeping your eyes on your thumb to keep your neck long. Strengthening your back muscles will also strengthen your vertebrae. You can increase the intensity over time by lifting higher off the floor.
To strengthen both the spine and the hip, Dr. Betz recommends the deadlift, which was described above. Once you can safely lift a 30-40 pound box, keeping the spine in alignment, you can graduate to a barbell.
Two other favorites of Dr. Betz are single-leg stands and lunges using a dowel, 48 inches long, with rubber tips on the ends for safety. You can use a broomstick as an inexpensive option.
Keeping the feet together, hold the dowel on the floor beside you with one hand, and rise up on your toes. Then, see if you can do this without the support of the dowel. Once you can do this 15 times, put the dowel down and try one leg at a time, keeping your alignment. Then you can repeat holding a light weight in each hand. Household items, like soup cans or bags of rice, can be used.
Stand with your feet about 36” apart. Using the dowel for support on the side of the front leg, raise the heel of your back foot, which stretches the front of the hip. Then bend both knees and go up and down with good alignment. Once you can do this 10-15 times, repeat without the dowel and progress to holding weights in your hands. This is a good exercise as a warm-up before taking a walk.
If you want to check your alignment while doing the above exercise, you can stand in a doorway and slide your back up and down the doorframe. This is also helpful for people with knee problems.
Never increase your weight by more than 2 pounds at a time.
RECAP OF Dr. BETZ’S 5 Favorite exercises
- The deadlift
- Heel raises
- Long-stride lunge progression
- Back extension over the ball
- Back extension on the stomach, raising the trunk off the floor.
Many people are concerned about wrist fractures. Dr. Betz does not believe that you need to specifically strengthen bone in the wrist, but you need to keep the wrist in neutral alignment when doing any other exercise for the upper body.
People with wrist pain should not avoid weight-bearing exercise that puts pressure on the wrist as it is important for shoulder and upper body strengthening. You can modify weight-bearing on the arms by shifting your bodyweight a bit back, so it is not directly over the wrist, or make a fist by holding a five-pound dumbbell, or bending your elbows.
In conclusion, Dr. Betz emphasized that a good physical therapist will evaluate how a person moves to inform them what is causing someone’s pain or dysfunction. The results of X-rays or scans are not necessary and this can be done in-person or through telehealth. In addition, a therapist should stay with someone for their entire session and provide, education, treatment, exercise, instruction, alignment, and feedback. Every consumer should demand this.
The American Physical Therapy Association and the Academy of Geriatric Physical Therapy have worked over five years to create guidelines on the best exercises for changing bone in our bodies and how to evaluate patients with osteoporosis. Both of those papers should be published by early 2022.
My solution for creating new habits:
Start small, do it in community, and/or have an accountability partner!