Osteoporosis and Pilates

An Introduction

Osteoporosis is bone loss or “thinning” of the bones. The early stage of bone loss is referred to as Osteopenia, and research shows that more fractures occur during the Osteopenia stage than in the Osteoporosis stage.
Treat bone loss seriously. A quarter of all men and half of all women over 50 will break a bone due to Osteoporosis. Get a DXA scan if you have not had one yet. A DXA scan is a special type of x-ray that measures the amount of bone you have in your body. A proper reading of your DXA scan is essential for the accurate diagnosis and treatment of Osteopenia and Osteoporosis.
Exercise is good for osteoporosis, however, you should check with your doctor before you start any exercise programme to confirm that it is suitable for you.

The General Principles were developed as a guideline towards exercises in general because it is impossible to provide a list of safe exercises because no exercise is 100% safe. A patient with osteoporosis could sustain a fracture turning in bed or simply sneezing. However, exercising is generally safer than allowing your osteoporosis to get worse. Follow the General Principles and the motto “when in doubt don’t” Avoid activities that involve forward bending or twisting the spine as well as those that place you at high risk of losing your balance. Always follow these General Principles and guidelines when exercising:

Why is no exercise safe?

Some patients with osteoporosis get fractures after they fall, or while exercising, but others fracture simply turning in bed, lifting groceries, swinging a golf club, or even sneezing. It follows that no one can give you a list of exercises that they can guarantee are “safe”. Follow the General Principles as these will help you avoid exercises which are dangerous, inadvisable or unsafe.
Does this mean I should avoid exercising?
No. Exercising is good for your bone density, and it is also good for your strength and fitness, your balance and co-ordination and reflexes. Exercise always carries a risk – but overall, not exercising is likely to be more risky. If you lose strength and fitness, and your balance, co-ordination and reflexes deteriorate, you are more likely to fall and break a bone.

The General Principles of Exercising with Osteoporosis

Follow these six basic guidelines:

1. Start your exercise programme “where you are”.
2. Progress gradually and safely.
3. Do weight bearing exercises i.e. exercises or activities in which your body weight is born on your limbs. These stimulate bone.
4. When it is wet, rainy, windy or ice on the paths, you need to be very careful. Ensure to wear shoes with non-slip soles and use a stick or cane for extra support.
5. When you do an exercise, it should not hurt doing it, or immediately afterwards. Many people experience some mild soreness the next day (or the day after that).
6. Avoid the “Four C’s” Contact, Compression, Collision and Contortion (by contortion I mean excessive or repeated forward bending of the spine).

Avoiding the “Four C’s”:

1. Contact – sports like soccer, hockey, basketball, martial arts and so on.
2. Compression – heavy lifting, squats, dead-lifts.
3. Collision – skiing, skating, skateboarding, water-skiing. ANY activity jumping from a height (even low heights like 30cm steps).
4. Contortion – avoid all activities involving bending, particularly forward bending of the spine. e.g. some Yoga postures, some Pilates exercises, ALL types of sit-ups, trunk curls, crunches, toe-touches whether done in sitting, standing, lying OR on a machine or piece of equipment.

The Good News:

Bone density in some patients improves quickly, in others more slowly – in some, not at all. If your bone density reverts to normal with the correct treatment, you can progress to some of the “higher risk” exercises. Not all patients recover enough bone density for this, but some do. Remember to follow up on your DXA scans (and make sure a proper reading of the DXA scan is carried out by a qualified healthcare professional) to confirm the state of your bone density.

Pilates for Osteoporosis

If you are thinking of joining a pilates class at Pilates Lifestyle and you have been diagnosed with either Osteopenia or Osteoporosis you will need a private class first so that you can be assessed and taught modifications to some of the exercises we do in a Pilates class as not all Pilates exercises are suitable for clients with Osteoporosis.

Why Pilates?

There are several reasons why Pilates is recommended for clients with either osteopenia or osteoporosis, however, just because your healthcare professional has recommended Pilates does not mean that all exercises are safe. They are not.

If you consider that the goal of exercising when you have either osteopenia or osteoporosis is to:

• stimulate your bones to produce more bone;
• improve your muscular strength and endurance;
• improve your co-ordination and balance;

then yes, regular supervised pilates classes will help you to achieve all three of these goals.
However, there will always be exercises you will need to avoid completely and some which will need to be modified. The last of the Four C’s as discussed above under the General Principles becomes the most important one to be aware of in any Pilates class. To remind you, here it is again: Contortion – activities involving bending, particularly forward bending of the spine.

At Pilates Lifestyle, we modify these types of exercises so that you can still strengthen your abdominal muscles and mobilize your spine but these will always be within the accordance of the General Principles. These General Principles are guidelines set out by the Osteoporosis Society of Ireland and endorsed by Chartered Physiotherapists who specialize in patients with Osteoporosis.

The do's and don'ts in a Pilates Class:

To help you in your Pilates class, what follows is a set of rules for participating in a pilates class and a list of exercises and photographs showing you what movements and positions do not contravene the General Principles.

1. The head always needs to stay on the mat when performing exercises lying on your back. Raising your head off the mat flexes (forward bends) the spine and this contravenes the General Principles and is therefore advised against. So any exercise like sit ups, chest lifts, single leg stretch, double leg stretch are advised against, unless modifications are made where the head stays on the mat.
2. Any rolling exercises are to be avoided as these too contravene the General Principles as the spine is flexed. These include rolling like a ball, the roll up, the roll down, the c-curve, the seal, jackknife, neckpull – in fact any exercise which involves a forward bending or c-curve movement of the spine.
3. Any simultaneous twisting and forward bending movement contravene the General Principles therefore the Saw, the Spine Stretch Forward and the Spine Twist for example all need to be avoided.

So what is there left to do? Plenty!!

A few Golden Rules in your Pilates class:

It is really important to let your teacher know if you have either Osteopenia or Osteoporosis before you start. It is equally important to notify your teacher when your DXA scan results change as this may affect what you currently can and can’t do.

• Never lift your head up off the mat when lying supine (on your back) to perform an exercise.
• Avoid any movement which may require you to flex (forward bend and/or forward bend and twist the spine at the same time).
• Avoid putting yourself in situations where your balance might be compromised.
• Always adhere to the General Principles when exercising.
• Remember, no exercise is 100% safe 
• Remember there is NO list of “safe” exercises. When in doubt, don’t do it. Consult your Chartered Physiotherapist.

I have written this article based on research I have undertaken in my role as a Pilates teacher. I am not a chartered physiotherapist. For this reason, I would like to especially thank Mr Richard Shortall, MISCP, of the Dublin Spine and Sports Physiotherapy Clinic (https://www.physiotherapyclinic.ie/) as well as my clients with whom I have worked to produce this information sheet. Should you require any further information on Osteoporosis or Osteopenia please visit http://www.irishosteoporosis.ie. or contact your healthcare professional.