What does it mean, “Don’t Bend and Twist with Osteoporosis?
If you’re active, over 50, and living with low bone density or osteoporosis, being told “don’t bend or twist” can feel confusing, limiting, and honestly a little intimidating.
Does it mean avoiding everyday movements?
Giving up exercise you enjoy?
Or constantly worrying you might move the “wrong” way?
Let’s move away from the fear and see if I can offer more clarity and insight.
What I know and believe is that understanding how your spine works and how to move safely, you can stay strong, active, and confident without second-guessing every move you make. So it’s time to talk about what this looks like in your life, from the anatomy, to learning new movements, and deciding what exercise is right for you.
This is why I love to collaborate with active adults anxious or frustrated about their bodies to help you feel strong confident, and agile so you can reconnect and keep up with your friends.
I do this on a daily basis with my clients with low bone density, osteopenia, or osteoporosis.
Like, Donna, who came in age 55 with a new diagnosis of osteoporosis and now was afraid to go to her yoga class and to do her gardening. After working with me to learn what safe spinal alignment looked and felt like in real life and what the best exercises were for fighting bone loss, she had a plan to manage the disease and enjoy her life.
Karen came in after a compression fracture in her spine. Since she was in the acute recovery phase we targeted pain management with ways to decompress the spine. We started a flexibility and stretching program. We practiced her squats to improve her ability to maintain safe spinal alignment with her daily activities and to keep her safer when she was cleared to do lifting activities at home. She said it felt good to be able to do something while the fracture healed and not just get weaker from lack of activity.
Good news! Body in Tune would love to collaborate with you to create a strength training routine or yoga practice and to support you so you can move confidently through your life and favorite activities.
A Quick Anatomy Lesson
Our spine is a stack of 24 small bones (vertebrae) and the triangular sacrum at the base that protect your spinal cord, help hold you upright, and let you move. Each vertebrae is a thick ring of bone. The spinous processes are the nubbies you feel when you try to feel your spine from the back and the transverse processes are supports that stick out sideways and are where muscles attach to hold things together and control the movement of the stack of bones.
The spine has curves and is ideally concave backward in the neck, concave to the front in the ribcage and concave backward again in the lower back. Our weight and ground reaction forces are meant to go through the vertebrae equally. With osteoporosis we start to see an increase in the forward bending or concavity of the ribcage area which in turn focuses forces through one or a few vertebrae rather than spreading the forces through all the vertebrae evenly. This places the vertebrae more at risk for repeated compression and injury.
Bone Density vs Bone Quality
Our DEXA scan measures bone density. This is a measurement of the of the amount of minerals, primarily calcium and phosphorus, contained within a certain volume of bone. This indicates the bone strength and rigidity. Higher density means stronger bones, while lower density indicates higher risk for fractures and conditions like osteoporosis or osteopenia. Bone quality looks inside the bones at the structural, material, and architectural characteristics of the bone that determines its strength and ability to resist fracture, separate from bone mineral density.
Bending
When we bend over to pick up something off the bed or floor, we round the spine thereby changing the even distribution of forces through the vertebrae and focusing more force on one or two segments. With postural changes like the rounding in the upper back, the forces will tend to be more focused in that area.
Twisting
When we turn or twist our spine as with reaching for the seatbelt in the car, looking over our shoulder to back up, or when playing tennis or pickleball, this creates a torsion within the bones. When done in a controlled manner with the spine in good alignment, there is less risk. But when we are sitting in the car seat built to suck us in and keep us safer in an accident or when there is added speed and force as in tennis or pickleball, we get concerned about compressing and twisting at the same time due to the increased forces targeted at one or two vertebrae.
so what is Safe Spinal Alignment anyway?
Safe spinal alignment means to attempt to keep the spine straight while performing daily tasks. It is our best defense against a fracture in the spine aside from not falling. It is something physical therapists teach to every back pain patient who comes into the clinic. The purpose is to keep even forces through the spine and to activate the stabilizing muscles to support the natural spinal curvature while reducing excessive forward rounding and twisting with increased weight or resistance, especially with rapid or repetitive movements.
When we bend we attempt
to maintain a straight spine to perform a “hip hinge” or bending at the hips,
to bend our knees
to initiate the lift with the legs, not the upper back
to support our spine with our stomach muscles
to use the upper back muscles to avoid rounding
to look up or forward rather than down
In case you are curious Body in Tune would love to collaborate with you to help you learn safe spinal alignment to fit your life.
What does safe spinal alignment look like in daily life?
We must acknowledge that we rotate our spine and pelvis when we walk. This is normal and not something we will try to change. However we often absentmindedly
bend our spine when we sit and look at our phones
reach to the floor next to our chair when we drop something
roll up rounding the spine when we jack knife out of bed
add force and rotation when vacuuming
lift with our upper back first when lifting the mattress to make the bed
reach with our arms and round our backs to pick up the laundry basket, groceries, or weights at the gym.
This is a list of movement, although not comprehensive, is a great example of where safe spinal alignment to protect our bones can be learned and applied. With osteoporosis or low bone density it is about cultivating awareness and making small adjustments and less about being perfect. It is a lifestyle change in which we focus on spine-friendly movement patterns and avoid extra load when bending and aggressive twisting. We can learn to:
sit with better posture
squat down to pick up an object from the floor
roll to our sides getting in and out of bed
use a forward/backward weight shift to propel the vacuum
push through out feet first to lift with our legs thereby supporting the upper back when we lift the mattress
squat or lunge down to the level of the laundry basket to pick it up
Sadly, I noticed recently that when I stand, I hold fairly good posture, but once I sit down at a table, I find myself slumped and rounded. This is a habit I am trying to change. We are all human and changing habitual movement patterns take time.
Karen, the client with the compression fracture, learned quickly while recovering from her fracture that if she avoided rounding her spine, her back hurt less. I would hope the majority of us can make changes in our strength and movement patterns without having a fracture to restrict us.
What about exercise?
The first answer is yes, exercise is one of the best things we can do for our bones especially for your children and grandchildren so that they build strong bones before we naturally start losing bone mineral density after 30 years old. But there is also plenty of research to suggest the most effective exercises to slow bone loss. Equally important, the research suggests that the more muscle we have, the stronger our bones. Muscle strength and bone strength go hand in hand.
We need:
resistance training either using body weight or with weights or bands
balance training as in yoga or tai chi or with a physical therapist for higher level training
cardiovascular training to maintain our endurance, when fatigued we are more likely to fall.
postural or upper back strengthening and
impact training as in walking, dancing, jumping (ask a professional for advice on jumping as it will depend on your fracture history and bone density scores).
It is helpful to have a physical therapist, yoga teacher, pilates instructor or personal trainer who understands osteoporosis-safe practices who can guide you to create an exercise regime and knows how to offer modifications to your favorite exercises and postures to allow for safe spinal alignment while you get stronger. You can find a trained practitioner through the Bone Health and Osteoporosis Foundation. click here to visit website. If yoga is your jam, then check out Dr. Loren Fishman’s Yoga vs Osteoporosis series, You can find a certified yoga teacher here. Personally, I do resistance training 2 -3 days a week and practice Yoga vs Osteoporosis 3-4 days per week.
Living with osteoporosis doesn’t mean putting your life or your activities on hold. When you understand what “don’t bend or twist” really means, it becomes less about restricting your activities and more about moving with intention. With awareness, mindfulness, knowledge,support, and a good plan, you can continue doing the activities you love while protecting yourself and your spine and build your strength, agility, and confidence for the years ahead.
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 children and grand children, take that long-dreamed of vacation and get outside and enjoy a walk with friends.
