We often think of exercise as a means of working on our muscle strength, flexibility and cardiovascular health....but what about our bone health? Bones are a living organism which are continually depositing and re-modelling, which simply means that everyday our body breaks down old bone and creates new bone tissue.

As we age more bone is lost or broken down than is created - this is a normal process of ageing. If we lose too much bone it can lead to a low bone density and a weakness of the bone structure, both characteristics of Osteoporosis. This results in an increase to the fragility of the bone, making it more susceptible to breaking. Osteoporosis is often referred to as a “silent disease” as it usually goes undiagnosed until a fracture occurs from a simple trip or fall that would not usually result in a fracture. The diagnosis is made following a DXA scan and it is classified as mild, moderate or severe, depending on the state of the bone.

 

 

Needless to say, falls prevention is one of the most important components in the management of Osteoporosis (you can read tips on how to prevent falls here).

 

*There is often confusion between osteoporosis and osteoarthritis. To think of it very simply: osteoarthritis is overgrowth of bone and osteoporosis is undergrowth of bone.*

 

 

What exactly is Osteopenia?

Osteopenia is really early stage Osteoporosis, when the bone has started to lose density and the structure of the bone has started to weaken. A diagnosis of Osteopenia, by a DXA scan, does not necessarily mean it will progress to Osteoporosis, take it almost as a warning sign - often by making some simple lifestyle changes you can prevent the progression of the disease.

 

 

What can you do to reduce the risk of developing Osteopenia & Osteoporosis?

You can incorporate some simple lifestyle changes to prevent the development of Osteopenia or Osteoporosis and also to help manage the disease to prevent it progressing further.

1. Diet

Calcium is required for bone health and Vitamin D is required for our bodies to absorb the Calcium (one needs the other to work effectively). Ensuring you meet recommended daily levels of both of these can reduce the likelihood that you will develop osteoporosis or Osteopenia.

 

2. Smoking

Smoking can accelerate bone loss and affect the absorption of calcium by the body which is essential for bone health. Reducing or ceasing smoking will help to reduce the risk of developing Osteoporosis.

 

3. Alcohol

An intake of over 200ml of alcohol per week has been shown to be associated with the development of Osteoporosis.

 

4. Exercise

Our bodies need weight-bearing exercise to stimulate new bone growth. Exercises focusing on strength and balance have also been shown to reduce the risk of falls, which will reduce the risk of sustaining a fracture.

 

5. Body Weight

Studies show that low body weight or low body mass, particularly amongst postmenopausal women, increase the likelihood of the development of Osteoporosis.

 

6. Medications

There are certain medicines that can cause bone loss (e.g. glucocorticoids). If you are on medications and concerned they are affecting your bone health you should discuss this with your doctor.

 

*In certain circumstances medications or injections may be required in the management of Osteoporosis.

 

What exercises are good for bone health?

1. Weight-bearing exercises

These types of exercises are essential for bone remodeling. Examples of these include:

• Walking
• Dancing
• Step ups or stair climbing
• Aerobics
• Playing tennis

 

2. Resistance exercises

Resistance exercises can help to strengthen bones and muscles. These are exercises involving:  

• Working against your own body weight 
• Using bands or weights

 

3. Balance Exercises

Exercises that appropriately challenge your balance have been shown to reduce the risk of a fall or a trip and in turn reduce the risk of a fracture occurring. Examples include:

• Exercises standing on one leg
• Exercises with your feet close together
• Exercises standing on an unstable surface
  (see some examples here).

 

If you would like to incorporate some of these exercises into your routine you can try our two week free trial!

 

 

Information based on:

Kanis, J. A., Cooper, C., Rizzoli, R., Reginster, J. Y., & Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2019). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(1), 3–44. 

Lane N. E. (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. Feb;194(2 Suppl):S3-11.

National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center (2018). Exercise for Bone Health. NIH Publication No. 18-7879-E.

Irish Osteoporosis Society: www.irishosteoporosis.ie

 

There are different types of arthritis, in this blog post I am specifically relating to osteoarthritis, the most common form of arthritis which primarily affects the hip and knee joints.

 

Osteoarthritis typically causes:

• Pain
• Stiffness
• Reduced movement of the joint
• Reduced function which may affect day-to-day activities.

 

The National Institute for Healthcare & Excellence advise that osteoarthritis can be diagnosed clinically without an X-ray if the individual:

• is over 45,
• has activity-related joint pain and
• Has no morning joint-related stiffness.

 

Structural changes on X-rays do not always correlate with the severity of pain the individual feels; for example, minimal changes on a scan may be associated with severe pain or the individual may experience very mild pain yet display modest changes on an x-ray.

 

Myths:

The most common myth about arthritis is that it is a normal process of ageing and gets worse as you get older - this is not true!

 

Treatment:

There are effective strategies that can improve pain and function for those with arthritis. The National Institute of Healthcare & Excellence advises all treatment plans for arthritis must include exercise. It is recommended for all ages and all pain levels. The exercises should include:

• Local muscle strengthening (e.g. pilates, weighted exercises)
• Aerobic exercise (e.g. walking, swimming, cycling)
• Stretching (e.g. pilates, yoga, home exercise programme)

 

Recent Cochrane systematic reviews (the highest level of evidence) found that exercise reduces pain and improves function in individuals with hip and knee arthritis.

 

Take home message: Exercise is the core recommendation for the management of arthritis.

 

Information based on:

 

Fransen, M., McConnell, S., Hernandez‐Molina, G., Reichenbach, S. (2014). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD007912.

Fransen, M., McConnell, S., Harmer, AR., Van der Esch, M., Simic, M., Bennell, KL. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD004376.

National Institute for Health and Care Excellence (2014, reviewed 2017). Osteoarthritis: care and management. Clinical Guideline CG177.

These simple exercises can be done at home to help you keep your back mobile!

1. Roll Down

a) Stand up tall with your feet about hip distance apart and a soft bend in your knees.

b) Start to walk your eyes down the wall in front of you and along the floor until your chin is close to or at your chest.

c) Start to round you upper back and shoulders as you imagine you are peeling your spine off a velcro wall behind you one piece at a time.

d) Leading with your arms (like they are heavy weights) continue to peel your spine off that imaginary velcro wall behind you. Rounding your upper back, mid-back and eventually your lower back.

e) Lower yourself as close to the floor as you feel comfortable going. Let your body hang heavy (like a Rag Doll).

f) If you feel tension in the back of your legs bring your weight towards the front of your feet.

g) Slowly roll yourself back up into standing.

h) Repeat 3 times.

 

 

2. Cat Stretch

a) Starting on your hands and your knees, bring your chin towards your chest.

b) Round your shoulders and your upper back, then round your mid-back, your lower back and lastly tuck your tailbone underneath you.

c) Then start to go the opposite direction - stick your bum up towards the ceiling, drop your stomach, drop your chest and look out in front of you.

d) Repeat this cycle 3 times.

*Members of JennyPhysioPilates click here to see a detailed video on how to do the exercise correctly & how to make adjustments for certain injuries or issues.*

 

 

3. Hip Stretch

a) Lie on your back and hug your right knee towards your left shoulder. You should feel this stretch in the outside/back of your right hip. Hold for 20-30 seconds.

b) Repeat on the opposite side.

*Members of JennyPhysioPilates click here to see a detailed video on how to do the exercise correctly & how to make adjustments for certain injuries or issues.*

 

Note: You should not feel any pain doing these exercises. You may feel the area working or stretching but it should not be painful - please stop the exercise immediately if pain occurs.

 

 

 

 

 

 

 

The upper and mid-back are collectively known as the Thoracic Spine. It spans the area from the base of the neck down to just above where the back starts to arch or hollow.

 

What is it made up of?

The Thoracic Spine consists of 12 vertebrae (spinal bones) stacked on top of each other and separated by intervertebral discs. These discs absorb shock and provide cushioning between the vertebrae. Each of the 12 vertebrae have attachments to the ribs, of which there are also 12! Many muscles (big and small!) span this area, alongside some nerve fibers too.

 

What shape is it?

The Thoracic Spine is naturally more rounded (kyphotic) compared to the neck and lower back, which tend to hollow or arch.

*[To visualize it: Think of your spine running from the top of your neck down to your tailbone as being a slight ‘S’ shape.]*

 

 

What does the Thoracic Spine do?

1. Protects the spinal cord
2. Acts as an anchor for the rib cage
3. Allows us to move our trunk in different ways

 

What movements does the Thoracic Spine do?

The Thoracic Spine typically offers more stability than it does mobility, compared to the neck and lower back. It does move in all different directions:

• Bending forwards and backwards
• Leaning to the side
• But most of all: TWISTING movements.

 

Did you know: The action of lifting your arm overhead requires a certain amount of movement to happen in the upper back. Without this we would be restricted in how high we can lift the arm!

 

What causes pain in this area?

Most commonly pain arises due to muscle or joint issues. It is extremely rare that a disc causes pain in this area.

Specific causes of pain include:

• Osteoporosis
• Osteoarthritis
• Shingles
• Trauma (e.g. a fall)
• Scoliosis
• Excessive rounding or kyphosis
• Other medical causes

 

Is it related to neck or low back pain?

It can be, yes. Commonly in clinical practice we see the Thoracic Spine contributing to neck or low back pain. Usually this presents as stiffness or a lack of movement in the Thoracic Spine which places increased demands on the neck and low back. By keeping the upper and mid-back as mobile as we can, helps to reduce the likelihood of this. By also keeping the muscles in the area strong you can reduce excessive curvature of the spine and help prevent shoulder, back and neck issues.

 

JennyPhysioPilates members click here to see videos on how to keep your upper & mid-back mobile.

 

1. Rest

Long gone are the days of bed rest for low back pain! Prolonged rest is associated with higher levels of disability due to the disuse of our joints and muscles. Movement is encouraged, even when in pain – even if this means just pottering around the house at the beginning. Often we fear moving when we are in pain and wait until the pain is gone before commencing movement again. Unfortunately this is not beneficial in the short term or long term. Movement is what aids the recovery of low back pain. Injuring the lower back is just like injuring any other joint – we may need to avoid aggravating activities for a few days after injury (like you would if you hurt your knee) however we need to gradually return to these activities.

Take home message: keep moving! 

 

2. Scans (x-ray, MRI etc)

Another common myth, probably the most common one that I hear, is that all back pain needs to be scanned. This is not the case at all at all! Scans are only indicated when serious pathology is suspected like infection, cancer or a bone break, which thankfully only accounts for 1-4% of all cases of low back pain! Scans will almost always show “something”, even in those who don’t have pain, for example:

• 30% of 20 year olds;
• 40% of 30 year olds;
• 50% of 40 year olds; and
• Up to 84% of 80 year olds have disc bulges

In addition:

• 37% of 20 year olds;
• 52% of 30 year olds;
• 68% of 40 year olds; and
• 96% of 80 year olds have disc degeneration

 

3. Medication

It is a common assumption that strong medication is needed for low back pain. Research done to date shows that taking strong prescription pain medication has no further effects than over the counter pain medication and can in fact have more side effects. It is important to liaise with your pharmacist and/or doctor regarding which medication to take, how to take it, how long to take it for and how to stop taking it.

 

4. Surgery

There are a few cases of low back pain where surgery is indicated, however for the most part conservative management is adequate. In fact research to date shows that the outcome from surgery has no greater effect than non-surgical or conservative treatment in the medium to long term. 

 

5. “Don’t bend”

Our spines are robust structures designed to move in different ways just like other joints in the body. If we perform an unaccustomed activity like lifting a heavy object or lifting in an awkward way we can be sore after. This would be the case with any joint after doing something we aren’t used to doing. If we completely avoid doing a certain movement like bending our bodies will never become accustomed to it.

 

6. Pain

There are lots of factors which influence our experience of pain. We now know that pain is not always a warning sign for damage. Our central nervous system, including the brain and spinal cord, have a strong influence over the pain we feel. For some the pain may start after an injury however our nervous system may then become overly sensitive and can increase the pain we feel, from activities which we may not previously have found painful.

Factors that can affect how sensitive our nervous system is include:

• Social factors – home life & work life
• Psychological factors – mental state, mood & emotion
• Physical factors – how we view movement, are we fearful or exercise? Are we avoiding certain movements because we believe them to be “bad”?
• Lifestyle factors – sleep, diet etc

 

7. Posture

One of the most common questions I get asked is “what’s the best posture for sleeping / sitting / standing?”. The answer to this question is: your best posture is your next posture.

There is no evidence to support low back pain being caused by particular postures. We do however know that movement is key. The best thing you can do is avoid being in one position for too long.