Adapting to Osteoporosis
Lucy dropped into the studio one rainy morning and asked if she could join a mat class. A simple question that evoked a big ‘yes’ … initially. Turns out there were complications. Not that you would guess it to look at her. She’s a slim, fit-looking woman in her very early 60s, radiating good health and energy.
Lucy has osteoporosis, or brittle bone disease. It was probably caused by eating disorders and resulting malnourishment when she was a teenager. Her doctor had advised against yoga and told her that Pilates should only be with an informed instructor because some exercises could be detrimental.
She was daunted by that. She loved Pilates. She had gone to classes at her local gym for more than 15 years but had stopped when diagnosed eight months previously. She was missing them like mad: not just the exercise method but also the social interaction and fun of it. The sheer size of the classes she attended at the gym meant she wouldn’t get the personal attention she needed; she wondered if a smaller studio environment could help her.
Yes – it could!*
Briefly, she has three crumbling vertebra half way down her spine (T10, T11 and T12 to be exact). The exercises she needs to avoid are flexing the vulnerable area (or bending forwards), rotating her back and doing lateral bends(bending sideways).
Quite a lot of the Pilates repertoire involves flexing, rotating and lateral movements. Some of our most popular exercises like The Hundred, Single and Double Leg Stretches, and Criss-Cross involve chest lifts which mean flexing the top part of the spine. We were going to have to put some thought into adapting the conventional movements to accommodate her needs. It was do-able, so she booked some private, one-to-one sessions and we set about deconstructing the Pilates repertoire and creating safe alternatives.
Before going any further, let’s get the run down on Osteoporosis.
Osteoporisis is a gradual loss of bone density, resulting in increased bone fragility and susceptibility to fracture. Mild loss of bone density is called Osteopenia, which doesn’t always develop into Osteoporosis.
There are a number of causes of Osteopenia:
• heredity
• less than ideal development of bone mass during childhood/early life (poor bone quality)
• medication – a number of medications used to treat other conditions have an impact on bone health;
Osteoporosis is not part of the normal ageing process. Genetics can give a person a propensity to develop the disease but lifestyle can prevent it.
Women are more likely to get it than men, particularly women who have gone through menopause. Slight women with small, fine bones are more at risk than their sisters of a heavier build. Caucasian and Asian ethnicity is a risk factor. Some medications can accelerate the loss of bone density. Lifestyle can result in low Vitamin D and calcium which are contributory factors. Salt, alcohol, caffeine and smoking are just some choices that further increase risk. Malnourishment, bulimia and anorexia can all have an impact.
It is sometimes called ‘the disease of affluence’ – our Western lifestyle of little exercise, poor diet and limited outdoor activity seems to be making younger, pre-menopausal women vulnerable where it used affect mainly older people.
The big message is ‘Exercise helps prevent osteoporosis’. Weight bearing and high impact exercises strengthen bones by stimulating them to produce more bone.
Pilates with small equipment like hand-held weights, resistance bands and magic circles make muscles work harder, and the pull of muscle on bone via tendons stimulates bone development.
Large equipment like the Reformer and Wunda Chair also help prevent Osteoporosis because springs add resistance and increase loading on muscle.
The right kind of exercise can play a part in both prevention and treatment. Conversely, the wrong type of exercise can cause serious injury.
Pilates osteoporosis-prevention programmes look at back strengthening exercises, particularly focussed on the thoracic (or upper) spine, plus hip and wrist strengthening. These are the areas where fractures are most likely to occur should clients later develop osteoporosis.
They also improve core strength which improves balance and helps prevent, or reduce the severity of, fracture-causing falls.
Such programmes should be combined with higher impact exercise such as brisk walking, jogging or running.
Although a client with fragile bone density could fracture any and every bone in the body, the thoracic spine is particularly vulnerable. That makes all thoracic flexion, lateral flexion and rotation strictly forbidden.
That’s the science part over. Back to Lucy…
The first time we worked together, I realised it was a bigger job than I anticipated. Adapting exercises to suit different physical needs is a relatively easy task. Adapting a client’s mental attitude is much harder.
I was alarmed at her gung-ho attitude.
“I’m not an invalid – I feel great – we only need to make small changes” was one hurdle I had to overcome. Although I wanted to make Lucy aware that she had to make major adaptations to protect her spine, it would have been counter-productive (if not destructive) to make her nervous of exercise and deprive her of both confidence and the joy of moving.
I had to be careful not to bombard her with negatives -” you shouldn’t, you mustn’t, you can’t” – and instead focus on the positives and advise her what she should and could do.
Another hurdle to overcome was Lucy’s gym-based culture – she didn’t think she’d done any work unless she finished a session sweating, aching and exhausted. The Pilates principles of concentration, control, flowing movement, centering and precision were not part of her mindset.
Her rushed, high energy approach posed a real risk of her losing her balance, twisting her back or even falling. We don’t want any client doing that, especially a woman with osteoporosis. A recurring theme through our sessions was Joseph Pilates words: “Concentrate on the correct movement each time you exercise, lest you do them improperly and lose all vital benefits.”
I took a small gamble in videoing part of an exercise routine that she tended to rush. When she saw how uncoordinated and uncontrolled her movements were, she was quite alarmed and slowed down, using breathing to regulate her movement.
In four private sessions, we went through the Pilates repertoire and adapted them to suit her back. There were few exercises that we just couldn’t adapt – the roll down and roll up; and seated exercises like the saw and spine twist. We worked out alternatives that she could do instead, rather than sit idle while everyone else in the class worked.
She then joined one of our classes and had a very happy season with us, before moving house and changing studios. We miss her!
* If you have recently suffered injury, illness, surgery or illness, or have a chronic or degenerative condition, consult your doctor, surgeon or physiotherapist before exercising. Pilates instructors are not medically qualified and cannot advise on serious illness or injury.
