Tips for Your Trainer When You Have Low Bone Density

To My Personal Trainer or Fitness Instructor:

I have been diagnosed with Low Bone Density / Osteoporosis. Flexion-based exercises such as Sit-Ups, Crunches, Toe Touches, and bending at the waist are contra-indicated and have been shown to increase my risk of spinal compression fractures.

Strengthening back extensor muscles such as Rows and isometric Back Extension may be helpful in mitigating the risk of fractures and helpful in promoting bone mineral density-BMD. In addition, core strengthening without spinal flexion such as planks (either on knees or feet) will assist in maintaining a neutral spine during daily activities-making a bed, getting clothes out of the dryer, etc.

Resistance training combined with low impact activities are the most effective in affecting BMD in the lumbar spine and femoral neck.

Balance is another key component of a well-rounded osteoporosis fitness program due to the fragility of osteoporotic bones during falls. I need both static balance exercises as well as dynamic ones and if I am on medications that can affect my balance, this needs to be taken into consideration.

The following are guidelines from The Meeks Method with permission of Sara Meeks, physical therapist.

GYM EXERCISE GUIDELINES

To Protect Your Back

AVOID

Abdominal Crunches

Sit-Ups

Abdominal Machines

Ab Rollers

Knee to Chest unless client can maintain back in neutral

Toe Touches (Seated or Standing)

Pec Deck

Chest Press

Bench Press

Seated Hip Abductor/Adductor Machine

Stationary Bicycles – especially with moving handlebars

Pigeon Pose in Yoga

ENCOURAGE

Military Press

Behind-the-Neck Press (Use caution to avoid shoulder injury)

Hip Extension (either prone, cable or multi-hip machine--standing)

Hip Abduction (either side-lying or on multi-hip machine--standing)

Free Weights—Upright Rows, Over-Head

Presses, Deltoid and Triceps Strengthening)

Lower Abdominal Strengthening and Abdominal-bracing type exercises

Back Extensor Strengthening

Standing/Wall Squats—longer hold, fewer reps.

Treadmill with good gait mechanics, arms swing freely, no incline. Walk forward, backward, sideward (with supervision if necessary)—it is better to walk out of doors as the push-off phase of gait is lost on the treadmill

Free weights are superior to machines because they include elements of balance & coordination.

CAUTION

For seated exercise, be sure back is stable.

Avoid Pull Downs and Pullovers in anyone with shoulder limitation of range of motion.

Standing exercises--be sure back is stable.

Leg Extensions /Leg Curls /Leg Presses

Butt Blaster /Lat Pull Downs /Pullovers

Any Seated Exercise /Bent Over Rows /Biceps Curls

Stair Steppers /Elliptical Trainers / Seated Dips

Side-Lying Leg Raises—be sure you can maintain neutral alignment-head, upper back, tailbone, and heels touching an imaginary wall behind you.

Seated Rows—make certain scapular retraction is occurring and you are not pulling the weight with just the arms.

Clam Shell and Reverse Clam Shell—Exercise performed side-lying with knees/hips

bent. Strengthens hip rotators. Isometrics is recommended.

During any exercise program the back should be supported and stable with consideration given to protecting the normal lumbar lordosis with lower abdominal bracing (pelvic stabilization.) The movement should be able to be performed the movement without compression on the vertebral bodies and without compensatory or substitutive movement patterns and with the hips stable.

References:

• Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Archives of Physical Medicine and Rehabilitation 1984 Oct; 65.

• NOF.org. National Osteoporosis Foundation

• McCarthy J, MD, Davis A, MD, Am Family Physician. Diagnosis and Management of Vertebral Compression Fractures

• Osteoporosis & Exercise: What You and Your Clients Should Know. American Fitness Magazine Fall 2016

Use this reference below to select bone-building activities for clients in various age groups. In all cases, it is very important for the client to obtain a written clearance from their physician prior to participation.