Modifying Pilates for Clients With Osteoporosis
Find out who is at risk for fracture and which exercises they should avoid
Osteoporosis is globally epidemic in Europe and in USA : more and more people, younger and younger are concerned.
Why does this concern the fitness professional?
One in every 2 women and 1 in every 4 men aged 50 or older will suffer an osteoporosis-related hip, spine or wrist fracture during their lives
Among women over 50, 1 in every 2 who walk into your exercise classes has low bone density and is at risk for fracture.
In France : 3 millions of women are touched by osteoporosis and 130 000 fractures caused it.
Research has shown that given the fragility of the osteoporotic vertebrae, most fractures are caused by the stresses of everyday life (Cummings & Melton 2002; Keller 2003).
As the disease progresses, bones can become so vulnerable that fractures can occur spontaneously or through such mild trauma as opening a stuck window, lifting a light object from the floor with a rounded thoracic spine or even just coughing or sneezing.
What Is Osteoporosis?
Osteoporosis is the gradual and silent loss of bone and not a normal aging process. It is defined as a systemic skeletal disease characterised by low bone mass and deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture (NOF 2005). Osteopenia is mildly reduced bone mass—a loss of approximately 10%– 20%indicating the onset of osteoporosis.
Persons with osteoporosis usually discover bone loss insidiously or later at their on cost: often they find out that their pants, clothes are too long; People around notice that they are shrinking in height, they’re developing a dowager’s hump or their arms look longer. Other persons complain of waistline pain (caused when the ribs sit on the iliac crests), mid-back pain or neck pain. Hip pain is not common with osteoporosis and is present only after a fracture.
A Question of Lifestyle
In my practice as a Pilates instructor, I am finding that clients and even Pilates teachers are discovering they have osteoporosis at younger and younger ages.
Now I’m frequently seeing osteoporotic clients in Pilates studios, and health clubs where I teach Pilates mat classes. What are we doing wrong?
Evidence suggests that lifestyle is a major culprit. Studies have found that Americans & European are not engaged in enough physical activity, do not take in enough nutrients to support good bone health
In modern societies : we base our habits of daily living on convenience and time management. We have computers for shopping: TVs to entertain us; and microwaves, washing machines, elevators, escalators, cars and high-tech devices to “save time” and to make our lives more “efficient”. M
More efficiency means we are increasingly sedentary, and sedentary living is bad for our bones. We walk less, we bear less weight, and we do less physical labor.
In short, our high-tech assistant labor-saving lifestyle is destroying our bones.
Who is at risk ?
Instead of what we think osteoporosis is largely spread out among populations. We estimate that 30% of women at 50 years old, and 50% of women above 5Os have osteoporosis.
Women are more subject to osteoporosis than men:
Factors that help increase osteoporosis
- Hormones (lack of oestrogen during menopause or before)
- Some medications like pain killers, corticoïdes and hormones.
- High intake of alcohol and caffeine
- Big smokers
- Lack physical activity
- Lack of calcium and D Vitamin Intake
The Solutions: The Role of Pilates
The importance of weight-bearing exercise that loads and strengthens bone cannot be underestimated.In fact, research has shown that physical exercise alone can decrease the progression of bone loss.One program that is often suggested for building strength is Pilates.
Do the same contraindications apply to her as would apply to a client with osteoporosis?
The thoracic spine is the area of the spine at greatest risk of fracture. That’s because the vertebral bodies get smaller as you move up the vertebral column and also because the thoracic vertebral bodies’ orientation toward flexion loads the spine anteriorly. Statistically, we know that bone density decreases from the cervical to the lumbar spine. However, bone size and ability to distribute force load decrease from the lumbar to the cervical spine. So if someone has osteopenia of the lumbar spine, an exercise specialist should assume that the person may have osteoporosis of the thoracic spine.
What’s more, until the results of the client’s next bone density test are known, the instructor doesn’t know if bone loss is progressing as he or she is working with the client. Therefore, all exercise specialists should use the same precautions for clients with osteopenia as for those with osteoporosis.
Forward flexion causes excessive compression force on the anterior (or front) surface of the vertebral bodies, where most of the trabecular bone is located. Compression forces on the vertebrae are also excessive during side-bending of the thoracic and upper-lumbar spine. Forward flexion, side-bending and particularly forward flexion combined with rotation are therefore contraindicated for clients with osteoporosis—and hence for clients with osteopenia.
Spinal extension is a different story. These areas do get compressed as the spine moves into extension, but the movement is much less risky than flexion because of the strength of cortical bone.
Testing with Pilates
When clients with low bone density or newly healed fractures are ready to start a strengthening program, modified Pilates is an option. But safety must be paramount.
1. Make Sure Clients Have Obtained a Physician’s Clearance to Do Pilates. Anyone who has osteoporosis or is at high risk for it must have clearance before beginning a Pilates program.
2. Use Safe Evaluation Techniques. Do not test the spine’s mobility!