October 14th, 2016 228 post views
As a chiropractor, I see a large number of joint, muscle and nerve problems each day. Osteoporosis is one such problem I regularly encounter. Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility which can increase a client’s susceptibility to fracture (NICE 2013).
Many patients ask whether chiropractic is safe for those with this condition. The answer is yes, as a chiropractor we use a number of different techniques. From very light treatment suitable for babies to a high speed adjustment which would be suitable for most adults. If a patient were to have osteoporosis we can adapt our treatment so it is suitable for their needs.
More about osteoporosis
Bones contain collagen (protein), calcium salts and other minerals. Each bone is made up of a thick outer shell known as cortical bone and a strong inner mesh of trabecular bone. Like all parts of the body, our bones are alive and constantly changing throughout life. Old, worn out bone is broken down by cells called osteoclasts and replaced by bone building cells called osteoblasts, in a process of renewal. After the age of 35, bone loss increases very gradually as part of the natural ageing process. This bone loss becomes more rapid in women for several years following the menopause and can lead to osteoporosis.
Managing risk factors for osteoporosis
Healthy eating tips:
- Eat plenty of starchy foods but try to make them the whole grain variety, such as brown rice and pasta.
- Eat more fish. Try for two portions a week and remember oily fish, such as mackerel, are also a good source of vitamin D.
- Cut down on saturated fats and sugar. Check out food labels before you purchase. 5g or more of saturated fat per 100g and 10g or more of sugars per 100g is a lot.
- Try to cut down on the amount of salt you eat. Again, read food labels carefully and remember that 0.5g or more of sodium per 100g is high.
- A calcium intake of at least 1000 mg/day is recommended for people at increased risk of a fragility fracture. 10 micrograms (400 units) of vitamin D with at least 1000 mg of calcium daily, available as Calcichew D3® chewable tablets (calcium 500 mg, colecalciferol 5 micrograms).
Bone is a living tissue which reacts to increases in loads and forces by growing stronger. It does this all the time, so exercise will only increase bone strength if it increases the loading above normal levels.
These types of activities are often recommended for people at high risk of fracture or recovering from fracture:
- Strength-training exercises (exercises using body weight as resistance), especially for the back.
- Weight-bearing aerobic activities.
- Flexibility exercises.
- Stability and balance exercises to reduce the risk of falling.
- Aerobic training with controlled movements.
- Prolonged exercise is not necessary in order to stimulate bone.
What exercises not to do with osteoporosis
- It is important not to rush into unaccustomed exercise too quickly – Begin with activities you know you can do comfortably and then gradually increase the intensity.
- A little muscle stiffness for a day or two after exercise indicates that you have done more than usual; this will stimulate improvements – However, persistent pain may be a sign of injury and if it persists for longer than a few days you should arrange to see your GP.
- Think carefully about undertaking activities that may increase the chance of a fall.
- Always maintain an upright posture – Avoid too much forward bending, such as touching the toes.
- Avoid: High-impact, fast-moving exercises such as jumping, running, jogging or skipping.
- Avoid: Exercises in which you bend forwards and twist your waist, such as touching your toes or doing sit-ups.
Suitable osteoporosis home exercises
These exercises target the muscles that support the spine and enable us to maintain an upright posture. They can be done in bed if you do not find it possible to lie on the floor.
Lying-down exercises for strength (on your front) – Put your arms at the sides of your body, with your palms facing downwards and resting on the floor. Your forehead should also be facing downwards and resting on the floor. Raise your back, head and shoulders, keeping your hips and legs on the floor. Repeat the exercise. Progress by turning the palms and forearms up towards the ceiling, still resting on the floor.
Back, neck and head lifts – Lie on your back. Push your hands and arms gently into the floor and raise your forehead off your hands by a few inches, keeping the back of your neck long as you do so and keeping your chin in. This will help you to get the feel of the movement.
Leg lift – Lying on your front, rest your head comfortably on crossed arms. Keeping your legs straight, tighten your buttock muscles and, keeping the leg as long as you can, raise one leg slowly off the floor by a few inches. Hold then lower slowly back to the floor. Keep both hips in contact with the floor throughout. Count five on the way up and five on the way down. Relax completely for a count of 10. Repeat with the other leg.
Build up to two sets of 10 repetitions. This is also an excellent exercise for helping to reduce spinal curvature. You may like to use ankle weights, to increase the effectiveness of this exercise.
Cat-Camel – Get onto your hands and knees, making sure that your shoulders are above your hands and your hips are above your knees. Start by make a U shape with your back. Take a deep breath in, as you exhale face ahead, relax your lower back and allow your pelvis to move forwards towards the floor. Only move as much as is comfortable. Hold for a few seconds and release.
The second stage involves making your back into an arch shape, breath in and as you breathe out, gently pull your tummy in and press your back towards the ceiling. Let your head drop so that you’re looking at the floor. Hold for a few seconds and release.
Weight-bearing aerobic activities involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical (cross) training machines and stair climbing. These types of exercise work directly on the bones in your legs, hips and lower spine to slow bone loss. They can also provide cardiovascular benefits, which boost heart and circulatory system health.
Swimming and water aerobics have many benefits, but they are not generally classed as weight-bearing and don’t have the impact on the skeleton required to influence bone strength.
- Stationary bikes – The seat of your stationary bike needs to be positioned high enough so your knees do not bend more than 90 degrees or come up higher than your seat when you are pedalling. With the pedals positioned further away like this, you reduce stress on your knees. A regular, upright stationary bike provides a more intense workout than a recumbent bike. However, a recumbent bike reclines and is designed to reduce stress and strain on your knees and lower back.
- Elliptical trainer – An elliptical trainer provides a low-impact workout, similar to walking, but with a high-intensity cardio workout. The elliptical trainer, a cross between a stair climber and stationary bike, works all of your major muscle groups and can help you lose weight and shape up without hurting your knees (Eustice 2014, Arthritis Foundation 2014).
- Tai Chi– is a safe intervention for reducing multiple fracture risks. The slow movements help to improve balance while its deep breathing techniques aid relaxation. Tai Chi addresses muscle strength, flexibility, balance, and, to a lesser degree, aerobic conditioning (Graham 2011).
If you have found this blog post helpful and would like to read more from me, then you can find more here on Backblog or on my own chiropractic site www.clearlychiropractic.co.uk for more information.
Caroline Mulliner, Doctor of Chiropractic.