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Osteoporosis and core strengthening exercises

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Sammo, May 2, 2008.

  1. Sammo

    Sammo Active Member

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    Hi all,

    I've just had a 35 y/o lady in for an assessment. She was Dx in 2004 with osteoporosis, following 2 fractures of the r/5 metatarsal which have since resolved and are not causing any pain.

    She has a very active job where she is on her feet for the majority of the day.

    Her main concern is that there are particular problems at T7 in her vertebrae and she wanted to see if there was anything that I could do to help improve her posture using insoles.

    My assessment showed very few abnormalities in her gait and posture with the exception of excessive amount of pronation occuring in mid stance around the mid foot for which I will be prescribing insoles.

    I was considering sending this lady to a physio or to something like pilates classes to try to condition the core muscles to keep good upper body posture and it is suggested in literature (according to a few things I have found on the internet, although I am unable to find said literature) that exercise can improve bone mass density and reduce injury and # risk.

    I just wanted to get a few other opinions before I do this.

    Any help or guidance greatly received.

    Kind Regards

    Sam Randall
  2. DaVinci

    DaVinci Well-Known Member

    I would certainly get her into some sort of total contact orthotics to spread weight to hopefully prevent recurrence.

    A 35 yr old with osteoporosis bad enough to be a risk factor for fractures in foot, is certainly not common, so hopefully the medical management of this is being looked after.

    Pilates, physio etc for posture would be essentail, especially if she is symptomatic as a result of poor core strength or postural alginment.

    I would be somewhat skeptical of the use of pilates etc for the osteoporosis. My understanding is the osteoporosis needs weight bearing (ie pounding the pavement) types of activities (hence the need for total contact orthotics)
  3. Craig Payne

    Craig Payne Moderator

    Sam mentioned that she already has a weightbearing job; so I with you in that she must have something serious going on to have osteoporosis at her age.
  4. I'm quite bad with this sort of thing.

    How do you tell, in a case like this, if poor posture is symptomatic as a RESULT of poor core strength as opposed, say, to having poor core strength because of lack of weight bearing exercise because of OP / limping around on fractured mets or with compressed nerves from a crumbly spine.

    What i am getting at is that i can see how poor core stability strength can cause poor posture. I can also see how poor posture, along with a variety of other things could cause poor core strength. Egg, chicken. Chicken, egg.

    I'd also be very interested if anyone has to hand any references for studies showing changes in posture from core stability exercises. As i say, its a bit of a gap in my knowledge.

    Much thanks
  5. David Wedemeyer

    David Wedemeyer Well-Known Member


    I agree with DaVinci and Craig Payne that a woman who was diagnosed with osteoporosis at 31 years of age is alarming but it is not unheard of in my experience. I wonder if her primary has tested her for the obvious causes, estrogen levels (precocious onset of menopause), thyroid and parathyroid function, diet and possibly excessive protein intake, tobacco, alcohol and caffeine usage. Does she exhibit a very low body weight?

    The problem that I see with core strengthening versus weight-bearing exercise and particularly strength training is that where there is ample evidence that strength training does contribute to increased bone density (and has been proven to do so in the literature), I am unaware of any studies validating strictly core exercises for this purpose. While a strong core does contribute to the efficiency of performing many other activities, including strength-training, its most beneficial reward is that of postural control and stabilization of the body to prevent injury. I am not aware of purely core training being utilized for patients with osteoporosis alone.

    The core is really comprised of 29 muscles of the lumbo-pelvic-hip complex and progressive strengthening of these muscles staves off the ravages of upper and lower cross syndromes which do create postural defects, decreased function and often pain syndromes. Her problem appears to be more global than her core alone, would you agree?

    Osteoporosis of course can and does cause postural changes and resultant fracture due to these changes, chicken vs. the egg :cool:. Perhaps as part of her rehabilitation including these exercises would benefit her posture in the long term

    I give my spinal patients specific stretches and core exercises following resolution of their complaint. Compliance is a whole other issue. When bone density is a problem they are always referred out to a PT (physiotherapist) and to their primary in severe density loss for the possibility of Fosomax or Actonel and they are given a high dose calcium and magnesium (1200-1500 mg MCHC, citrate, phosphate or in combo) with D, boron and phosphprous.

    The book “Core Performance: The Revolutionary Workout” by Mark Verstegen is a really good resource on the subject. I will look further for studies directly related to core exercises and osteoporosis but my results from the search I fear will be the same as your own.

    I can’t imagine that if she has had 5th met fractures that offloading any pressure areas would not indeed help this woman.


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