best recovery from a spinal Compression fracture
You have been through the pain, you might feel scared to move, you might be doing only half of the daily activities you used to, never mind thinking about returning to exercise and fun. Returning to the fun stuff in life is possible with a little guidance.
My first osteoporosis patient years ago was a 65 year old who came in after her compression fractures in her lower back. She had learned that she had osteoporosis when she fractured the 5 lower back vertebra while making the bed. She looked at me and asked what I knew about osteoporosis. I explained what I had learned in physical therapy school. She smirked and said well then we are going to really learn how to treat this together. And so the journey into guiding and helping those with bone density issues began.
Many clients, years, and courses later I am once again facing two clients who want to be active again after their fractures. So I went looking for the research. Clients want to know how to progress through the recovery and back to exercise so they can stay strong, practice and challenge our balance, decrease the risk of future fractures, and live with vitality and confidence rather than fear. Please note that I use the word, “client” rather than “patient” because once you have recovered from the pain of the fracture, I like to shift the mindset away from being injured or sick and focus on return to living your life.
The Research and a Protocol
The research suggests 3 phases to recovery: acute, subacute (middle period, less pain, still easy to re-injure), and chronic/maintenance (ready to move into harder exercises and life). To some extent these are self-explanatory. But let’s dive deeper.
Phase 1 - acute 0-2 weeks after the fracture
This is when the pain tends to be at its worst, you feel the most limited and many are truly scared of the pain and of further injury.
The recommendations I found suggested that we want to focus on recovery rather than “rehab” fro a minimum of 2 weeks.
That means be patient, keep your activity level lower than you want. We would focus on
pain management,
gentle mobility as tolerated for activities of daily living (ADLs), and
learning and practicing “spine-sparing” techniques for these ADLs
Your doctor might recommend using a brace for up to 8 weeks if needed for pain control. A brace also serves as a reminder to avoid bending and twisting so that you avoid further injury to your spine.
Spine-sparing is a fancy way to say move in a way that avoids twisting the spine or rounding the spine because these motions may further irritate or damage the fractured segments. To normalize this verbiage I will remind you that we teach the exact same techniques to our back pain patients with disc issues or muscle strains. This would include things like:
keeping shoulders and pelvis in the same parallel plane or be sure both are facing the activity you are performing.
hinging at the hips with a bend in the knees and spine straight when reaching down (remember the “lift with your knees advice”?😉)
lead with your belly button rather than your hands when reaching to pick something up.
drop down to one knee, then both, to hands and knees rather than bending and reaching hands to the floor when getting down.
Also, check out the videos on the Bone Health and Osteoporosis Foundation Website (click here for videos) to see what that really looks like for day to day activities.
In case you are curious Body in Tune would love to collaborate with you to “check your form” and help your body learn these spine sparing movements for all your activities.
Phase 2 Subacute; the next 2-12 weeks.
This phase can get challenging because as you start to feel better, your body wants to revert back to its old habits and way of moving. But the problem is your fracture(s) are still vulnerable to further injury and rather easy to irritate. The safer alignment and practices can help you along in your recovery.
You may have heard that it takes 28 days to form a new habit? Keep this in mind as you start to move around more. Look for ways to catch your body reverting back to old habits and keep trying to teach it to learn the new and safer ways of moving.
The research strongly recommends that working with a physical therapist for more than just a one-time consult is more effective. The focus would be on
gaining flexibility,
postural training,
core strengthening,
balance training for your daily activities, and
practicing spine-sparing movements for the things you do during your day
Breaking these down:
Flexibility exercises help us maintain good mobility and stability in the hips, shoulders, extremities so that we can maintain a neutral spine to minimize the bending and twisting.
Postural training involves exercises that extend or unbend your spine, aka spinal extension exercises.
Core strengthening involves waking back up our anti-gravity muscles from the abdominals, the deep spinal stabilizers and the hip extensors. The stronger our back muscles, the better we support and protect the segments of our spine from compressing against each other.
Balance training involves daily exercises starting with support and progressing to no support. Did you know that your abdominals play an important role in your balance?
“Functional activities” are the day to day movements we do getting in and out of bed or a chair, climbing stairs, and lifting items from the back of the car or cabinets, to name a few. Physical Therapists like to create exercises that mimic what we do on a daily basis to create meaningful exercises while strengthening and training you live your life.
Good news! Body in Tune would love to collaborate with you to teach you a precise movement or yoga practice and to support your spine so you can enjoy your life off the mat with confidence.
Phase 3 Chronic/Maintenance, starting at 3+ months
This is when you might start to feel like you could even think about returning to your hiking, exercise routine at the gym, your exercise, yoga, or Pilates class. You are ready to begin progressive resistance training to build strength and get you back to your desired level of activity safely and without re-injury.
Daily dynamic balance challenges or practice so you are ready for uneven terrain, you stay upright when you get bumped or surprised in a crowd, and you test and find your tipping point, ie. the how far off balance you can get and still recover.
Aerobic conditioning with low-impact activities to build endurance and stamina so we can do more before being at increased risk of a loss of balance and a fall.
Posture or upper back strengthening. The taller we stand with our head in line with our shoulders, the less likely we are to lose our balance.
I’m hate to tell you but exercising on your stomach is in your future. We need to be able to lift your upper back into alignment against gravity to have the endurance to stand tall throughout your day.
Recovery from a spinal compression fracture is a process that is best done with the support of an osteoporosis exercise specialist or BoneFit trained professional. Check out the Bone Health and Osteoporosis Foundation to find a professional near you. (https://www.bonehealthandosteoporosis.org/bonefit-find-a-professional/)
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If you are in Maine, please find me. This is what I do. I encourage you to fight this disease. Strengthen your muscles and bones so that you can keep up with your friends!
Body in Tune, LLC was born from a belief that quality of life matters; both life and physical balance matters.
I would welcome the opportunity to be part of your support team with regards to women’s health, your muscles, joints, bones and osteoporosis. The goal is, after all, to help you feel confident in your body so you can play with your grand children, take that long-dreamed of vacation and get outside and enjoy a walk with friends.
