So many of us are working with Goldeners (the Active Aging Population) that I thought it would be helpful to list a few of the Dos and Don’ts of working with Osteoporosis, especially as it concerns Pilates. (Disclaimer: I am not a doctor, and this list is not medical advice, nor should it be used as such), but I weeded through a few studies so that you don’t have too.
****The most important tip is first
Don’t use spinal flexion. Yes, that is a lot of the Pilates repertoire, but flexion puts pressure on the anterior surface of the vertebral bodies, and that is usually the weakened part of the bone. Flexion increased the risk of fracture in 89% of osteoporosis cases in this study.
2. Do use spinal extension. The posterior vertebral bodies have a higher degree of cortical bone and are at less risk of fracture. A study found that stronger spinal extensors led to increased bone density and less occurrence of spinal fractures.
3. Don’t side bend. Pressure on the vertebra are also excessive during side bending.
4. Do teach a hip hinge instead of flexion. It is imperative osteoporosis clients know the difference between spine and hip flexion (see #1 above).
5. Don’t twist. Again, excessive pressure on the vertebra.
6. Do teach isometric work. This is one of the best ways to get strong (and by now, you may be asking, “What can I do with a client with osteoporosis?”). Most of the isometric work can be found in the Pilates Fundamentals and are great for teaching control and strength in the core so clients don’t accidentally do little tiny twists or other contraindicated movement when moving their legs to the front or side.
7. Don’t work with a client if they can’t tell you their T-Score. Clients who have taken a Bone Mineral Density Test should be able to tell you their T-Score. A Standard Deviation of -1 to -2.5 indicates osteopenia, and -2.5 or more indicates osteoporosis. Why is this important to know? For every one point below the mean, fracture risk doubles.
8. Do teach these clients to stand and balance. They need to be weight bearing if possible. Standing weights, standing power circle, standing leg swings, and single balance work on one leg is very important. If these clients fall, they are likely to fracture, so they need to be taught how to stand tall.
Working with someone with osteoporosis can be a bit scary (and when in doubt, refer out), but it can be safely done with a knowledgeable Pilates instructor. The extension work, chest openers, standing series and the ease of adding weights to our work makes it a natural fit for the osteoporosis client. Remember, it is a silent disease, so your clients won’t have symptoms, but don’t let that stop you from following safety guidelines. Some clients like flexion because it feels good, but you need to be firm in your knowledge and confidence to tell them why that movement needs to be avoided.
Leave any additional questions in the comments below. I’ve been working with clients with osteoporosis for years and would love to help. Its a population that needs Pilates!