Monday, November 9, 2009

Pilates, Fitness, and Bone Density - the Dilemma of Osteoporosis

By Lynda Lippin

I have recently noticed an increase in the number of physicians referring their patients with low bone density to Pilates classes. And while a modified Pilates program, especially one utilizing the Pilates equipment, is wonderful for maintaining and even increasing bone density, strength, and flexibility while improving posture, there are many Pilates exercises that must be modified or eliminated so as not to put osteoporotic women and men at risk of spine compression fractures and the dreaded “dowager’s hump” (see and the Osteopilates Blog)

The issue of osteoporosis has come up a lot in my Pilates career, both in my higher end studios in the US and at he beautiful A List Parrot Cay resort in Turks and Caicos where I am the Resident Pilates and Fitness teacher. My client base has typically been made up of mostly caucasian women over 50 (and it is a fact that one in two women over the age of 50 will experience an osteoporosis related spinal fracture), many of whom are breast cancer survivors. On the whole, these beautiful active women all look pretty healthy. They have decent posture, play tennis and golf, walk a lot, and really try to eat well. They have access to the best doctors, the latest medical treatments, and the most cutting edge gyms, personal trainers, and Pilates studios.

Even so, most of them have low bone density (osteopenia and osteoporosis), and the majority move on a daily basis in ways that put them at greater risk of fracture—EVEN THOSE WHO HAVE GONE TO CERTIFIED PILATES TEACHERS AND PERSONAL TRAINERS.  My purpose is to educate you about osteoporosis so that you will know what to do and not do for yourselves and those you care about.

Basically, osteoporosis means porous bones. In Greek it translates as “passages through bones.”  The human skelaton reaches its maximum bone mass (amount of bone tissue) and density (how tightly it is packed) around ages 20-30, after which bone removal begins to occur faster than bone production. Bone density is measured by comparison to a healthy young adult; this is called a T-Score. Normal Bone Density is defined by the World Health Organization as density within -1 standard deviation (SD) of the 20-30 year old norm (10-15% bone loss). Osteopenia, or low bone density, is defined as within -1 to -2.5 SD (15-25% bone loss). Osteoporosis is defined as lower than -2.5 SD (over 25% bone loss).

Primary osteoporosis is caused by either a natural estrogen deficiency or age, while secondary osteoporosis is caused by certain medical conditions such as cancer, early removal of overies, reduced testosterone levels in men, spinal cord injury, blood & bone marrow disorders, sex hormone deficiencies, overactive thyroid or parathyroid, overactive adrenal glands, and anorexia nervosa or exercise induced amenorrhea. Osteopenia should be treated like osteoporosis in terms of preventing future loss.

Once diagnosed with osteoporosis, an individual has a documented severe and established loss of bone. While bone density testing is typically done at several sites such as the hip, wrist, or spine, these findings should be generalized to your entire skelatal system. Many clients have told me that I should not worry about their spine because their osteoporosis was only in their hip-WRONG! If you are losing bone you should be worried, period.

All sources are in agreement that getting enough calcium, magnesium, and Vitamin D combined with proper exercise is necessary to prevent osteoporosis and to decrease your liklihood of fracture and prevent further bone loss if you do have osteopenia or osteoporosis. On the medication front, biphosphonates such as Fosomax and Actonel have been shown to increase bone density and reverse bone loss.

Our bones hold 99 percent of our body’s total calcium. If we do not ingest enough calcium to assist the bone remodeling process, our body takes it out of the bones themselves. Therefore, adults over 50 years of age should take 1,200 to 1,500 mg of calcium per day along with 600 to 750 mg of magnesium and 400 to 600 mg of Vitamin D to assist absorption. As our bodies do not hold on to the calcium we don’t use, it is better to spread your calcium supplements over the course of the day. And always take your pills with eight ounces of water.

In addition to nutrition and medication, exercise is the best thing. Wolff’s law states that bone becomes stronger in response to increased stress i.e., exercise. Weight bearing activities such as walking and dancing are done upright and require our bones to fully resist the forces of gravity.

To best maintain what you have and avoid more loss, follow these rules:

DO weight bearing exercise on your feet every day. Weight bearing in our case means standing on your feet! Walking, Jogging, standing pilates, weight training, cardiovascular exercise.

DO work on your balance in standing as often as possible. The less you fall the less your risk of wrist or hip fracture. Standing yoga poses and Standing Pilates can be very helpful here. Even just practicing standing on one leg is good.

DO resistance, cardiovascular, and flexibility training within safe guidelines.

DO focus on spine and torso extension. As our bodies give in to gravity we begin to round forward. It is crucial that we work constantly to stay upright with a gentle squeeze of the shoulder blades and a lovely lift of the breastbone.

DO be careful sneezing and coughing. Many spinal compression fractures happen during forceful coughing and sneezing. Try to stand or sit with your back against something for support.

DO NOT flex your spine forward. Don’t bend over to tie your shoes or pick something up off the floor. Don’t round forward while getting in and out of bed. Do not do sit ups or crunches, plows or shoulder stands. And never roll around on your spine! The microfractures occur in the front of the spine and are irreversible. Do you want to look like a round ball all the time for the rest of your life? I know I don’t!

DO NOT roll around on your spine. I know, I’m saying it again, but this is so important! And I am scared to tell you how many clients with osteoporosis I have seen who have been given extreme flexion exercises by certified Pilates teachers in studios.

DO NOT forcefully twist your spine. Be nice to your spine. Forceful torsion will hurt.

DO NOT do sit ups or crunches! Remember the flexion discussion above? A good Pilates teacher or Fitness trainer can show you many abdominal strengthening alternatives.

DO NOT take your leg far out to the side of your body (abduction). This is where many a hip fracture has occurred.

Now, is there a chance that you could do all of the movements I say are bad for osteoporosis and be fine? Sure. But why take the chance? The death rate after hip fracture is 20 percent for women and 30 percent for men. Spinal fractures can cause the “dowager’s hump” which is uncomfortable, unattractive, and unhealthy.

Pilates Mat Exercises to Eliminate with Low Bone Density:
• Roll-Over
• Rolling like a ball
• Spine-Stretch
• Open leg rocking
• Corkscrew
• Neck-Pull
• Jackknife
• Seal
• Control balance
Pilates Mat Exercises to Modify with Low Bone Density MAT EXERCISES TO MODIFY IF YOU HAVE OSTEOPOROSIS
• Hundreds
• Single leg stretch
• Double leg stretch
• Saw
• Spine-Twist
• Shoulder bridge
• Teaser
• Twist
• Boomerang
• Push-Up

About Lynda:  
Lynda Lippin is a Pilates Teacher with 2 decades of teaching experience, a Usui Reiki Ryoho Master Teacher, and an ACE Certified Personal Trainer. She currently lives (with her husband and dog) and works as the Resident Pilates and Fitness Teacher at the exclusive Caribbean Parrot Cay Resort in Turks and Caicos Islands.

In her spare moments Lynda writes several blogs, creates digital Pilates programs for people to follow at home and while traveling, and writes articles and reviews for BlogCritics and Amazon.

Lynda also enjoys reading, cooking and eating, snorkeling, meditation and yoga, knitting and crocheting, movies, and music.

1 comment:

  1. I love Lynda Lippin's work, she is always involving you into the main issue. Pilates and stuff are a great way to reach happiness