Treatment of vertebral fractures due to osteoporosis

M. Sinaki; M. Pfeifer

doi:10.1055/s-0037-1622038

Osteologie, Table of Contents

Osteologie 2015; 24(01): 7-10
DOI: 10.1055/s-0037-1622038

Assistive technology and musculoskeletal health

Schattauer GmbH

Treatment of vertebral fractures due to osteoporosis

Role of Posture Training Support (PTS) and Spinal Proprioceptive Extension Exercise Dynamic (SPEED) programTherapie vertebraler osteoporosebedingter FrakturenDie Bedeutung des Posture Training Supports (PTS) und des Spinal Proprioceptive Extension Exercise Dynamic (SPEED)-Programms

M. Sinaki

¹Department of Physical Medicine and Rehabilitation, Mayo Clinic and Mayo Medical School, Rochester, USA

,

M. Pfeifer

²Institut für Klinische Osteologie und Klinik “DER FÜRSTENHOF”, Bad Pyrmont, Germany

› Author Affiliations

Abstract

Summary

The objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. A significant reduction in back pain, kyphosis, and risk of falls and an improvement in the level of physical activity have been achieved through the SPEED (Spinal Proprioceptive Extension Exercise Dynamic) program. In addition, the application of a “Posture Training Support” (PTS) using a backpack may decrease kyphosis and pain related not only to compression fractures but also reduce iliocostal friction. Therapeutic exercise should address osteo - porosis-related deformities of axial posture, which can increase risk of fall and fracture. Thus, the role of a therapeutic exercise program is to increase muscle strength safely, decrease immobility-related complications, and prevent fall and fracture. As with pharmacotherapy, therapeutic exercises are individualized.

Zusammenfassung

Das Ziel der medizinischen Trainingstherapie bei Osteoporose besteht darin, die Rückenmuskulatur zur Verbesserung der aufrechten Körperhaltung zu kräftigen. Deshalb sollte ein spezifisches Trainingsprogramm entsprechend den individuellen Fähigkeiten des Patienten zuerst im Sitzen begonnen werden, um dann mit zunehmendem Kraftzuwachs in eine immer aufrechtere Körperhaltung überzugehen. Mit abnehmender Brüchigkeit und zunehmender Stabilität kann dann auch ein isometrisches Krafttraining für die Rückenmuskulatur begonnen werden. Eine signifikante Verbesserung von Rückenschmerzen, Kyphose, Sturzrisiko und Leistungsfähigkeit im Alltag kann durch das SPEED-Programm erreicht werden. Dabei handelt es sich um ein dynamisches, propriozeptives Training zur Kräftigung der Rückenstreckmuskulatur. Hierzu wird das “Posture Training Support” (PTS) eingesetzt. Diese Unterstützung besteht aus einem, je nach Trainingszustand, unterschiedlich schweren Rucksack, der zu einer Abnahme von Rundrücken und Schmerzen führen kann, wie sie durch Wirbelkörperkompressionsfrakturen entstanden sind. Durch die verbesserte Aufrichtung wird dann auch ein Reiben von Rippen auf den Beckenkämmen, was in extremen Fällen durchaus auftreten kann, vermieden. Insgesamt sollte die medizinische Trainingstherapie zu einer Zunahme an Muskelkraft führen, ohne die Wirbelsäule durch zusätzliche Kräfte zu sehr zu belasten, um dadurch auch Komplikationen wie sie durch Bewegungsmangel entstehen können, wirksam zu verhindern. Dadurch gelingt es dann auch, Stürzen und Frakturen vorzubeugen. Ähnlich wie bei der medikamentösen Behandlung sollte auch die Bewegungstherapie individuell dosiert werden.

Keywords

Osteoporosis - back extension exercise - rehabilitation - Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program - Posture Training Support (PTS)

Schlüsselwörter

Osteoporose - Training der Rückenmuskulatur - Rehabilitation - SPEED-Programm - Posture Training Support (PTS)

Full Text

References

References
1 Sinaki M. Postmenopausal spinal osteoporosis: physical therapy and rehabilitation principles. Mayo Clin Proc 1982; 57: 699-703.
2 de Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC. Exercise interventions to reduce fallrelated fractures and their risk factors in individuals with low bone density: a systemic review of randomized controlled trials. Osteoporos Int 2009; 20: 2111-2125.
3 Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil 1984; 65: 593-596.
4 Ekin JA, Sinaki M. Vertebral compression fractures sustained during golfing: report of three cases. Mayo Clin Proc 1993; 68: 566-570.
5 Sinaki M, Wahner HW, Offord KP, Hodgson SF. Efficacy of non-loading exercises in prevention of vertebral bone loss in postmenopausal women: a controlled trial. Mayo Clin Proc 1989; 64: 762-769.
6 Sinaki M, Brey RH, Hughes CA. Significant reduction in risk of falls and back pain in osteoporotic kyphotic women through a Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program. Mayo Clin Proc 2005; 80: 849-855.
7 Sinaki M, Brey RH, Hughes CA. Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int 2005; 16: 1004-1010.
8 Itoi E. Roentgenographic analysis of falls of posture in spinal osteoporotics. Spine 1991; 16: 750-756.
9 Itoi E, Sakurai M, Mizunashi K. Long-term observations of vertebral fractures in spinal osteo- porotics. Calcif Tiss Int 1990; 47: 202-208.
10 Sinaki M, Nwaogwugwu NC, Philips BE, Mokri MP. Effect of gender, age, and anthropometry on axial and appendicular muscle strength. Am J Phys Med Rehabil 2001; 80: 330-338.
11 Sinaki M, Wollan PC, Scott RW, Gelezer RK. Can strong back extensors prevent vertebral fractures in women with osteoporosis?. Mayo Clin Proc 1996; 71: 951-956.
12 Lynn SG, Sinaki M, Westerlind KC. Balance characteristics of persons with osteoporosis. Arch Phys Med Rehabil 1997; 78: 273-277.
13 Ishikawa Y, Miyakoshi N, Kasukawa Y. Spinal curvature and postural balance in patients with osteoporosis. Osteoporos Int 2009; 20: 2049-2053.
14 Kasukawa Y, Miyakoshi N, Hongo M. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab 2010; 28: 82-87.
15 Itoi E, Sinaki M. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc 1994; 69: 1054-1059.
16 Sinaki M, Itoi E, Wahner HW. et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of post- menopausal women. Bone 2002; 30: 836-841.
17 Hongo M, Itoi E, Sinaki M. et al. Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteoporos Int 2007; 18: 1389-1395.
18 Sinaki M, Grubbs NC. Back strengthening exercises: quantitative evaluation of their efficacy for women aged 40 to 64 years. Arch Phys Med Rehabil 1989; 70: 16-20.
19 Frost HM. A determinant of bone architecture: the minimum effective strain. Clin Orthop Relat Res 1983; 175: 286-292.
20 Sinaki M. The role of physical activity in bone health: a new hypothesis to reduce risk of vertebral fracture. Phys Med Rehabil N Am 2007; 18: 593-608.
21 Sinaki M. Critical appraisal of physical rehabilitation measures after osteoporotic vertebral fracture. Osteoporos Int 2003; 14: 773-779.
22 Sinaki M. Falls, fractures and hip pads. Curr Osteoporos Rep 2004; 02: 131-137.
23 Kaplan RS, Sinaki M, Hameister M. Effect of back supports on back strength in patients with osteoporosis: a pilot study. Mayo Clin Proc 1996; 71: 235-241.