Bone Health and Osteoporosis
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Throughout your life, your bones are constantly changing. This is called ‘remodelling’. Bone cells called osteoblasts build new bone, while other bone cells (osteoclasts) break down and remove old bone. Osteoporosis means porous bone and its a 'silent' condition characterised by either not enough bone formation, excessive bone loss or a combination of these two situations and it is a concern as it increases the risk for fractures.
A bone density scan measures the mineral content of your bone and generates a score called a T score ( or a Z Score if you are pre menopausal). A normal range for this score can be between +1 and -1. If your score falls between -1 and -2.5 it can be considered as osteopenia or low bone mass, which is a precursor to osteoporosis. If the score is -2.5 or lower the greater degree of osteoporosis is considered.
There are several causes of osteoporosis, and working with your doctor to determine the core reason and your present bone image is critical. Primary osteoporosis is often associated with a reduction in hormone levels, in particular oestrogen levels. Which makes it a primary concern for women in midlife. Oestrogen levels drop during menopause and significant bone loss can occur within the first five years of menopause. Oestrogen has a protective impact on bone, and as levels decline, bone breakdown rises.
Secondary osteoporosis may also be induced through causes such as behavioural issues, medical conditions such as celiac disease, hormonal abnormalities, and drugs such as prednisolone.
Strategies to restore and strengthen your bone health include stress management, sleep, nutrition ( including your ability to absorb and utilise the nutrition), medication and importantly exercise.
Bones need to be stimulated with exercise and load to be reminded that they have a significant role to play in supporting the body and its health. Exercise is critical for creating strong bones while we are young and for maintaining bone strength as we age. Because bone is living tissue, it changes over time in reaction to external pressures. Weight bearing, resistance and impact exercises are required for your bone to maintain its present bone density level or even become stronger and denser.
Also an often overlooked factor is that exercise is incredibly important for increasing your balance, coordination and flexibility, which improves your ability to prevent trips and falls as much as 20-40%. Most fractures occur in the body due to falls. ” NO Fall, NO Fracture" is a good mantra to remember why you are also exercising.
Australian physical activity and exercise recommendations suggest that all adults be active for 30 minutes or more on most days, ideally every day. This involves at least two resistance training sessions every week. These recommendations actually increase once you are over 65 years of age.
Clinical Pilates allows us to achieve all three types of exercise required for bone health, weight bearing, resistance and impact. As well a demanding balance practise, making it an excellent option for focusing on bone health.
Powerful springs on Clinical Pilates equipment are used to provide resistance to the bones and muscles, particularly around the hips, wrists, and spine, all regions of the body that need excellent bone density and are the most common locations for fractures.
In addition to improving muscle mass and bone protection resistance training has a neuroprotective effect. Neuroprotective means "protecting nerve cells from damage, degeneration, or impairment of function." And recent studies show that other health conditions like heart health are also positively affected by similar measures that improve bone health. Mutli -component exercise like Clinical Pilates has multiple benefits for our overall health.
It is important to note that not all Pilates movements are indicated if you have osteoporosis, thus careful selection by a professional Therapist is essential. There are several "flexion" and "rotation" exercises available, however they could potentially increase the risk of fractures especially compression wedge fractures at the front of the spinal vertebrae
The other exercise issue which is often overlooked and again speaks to the importance of working with a trained therapist , especially in midlife age group is the tendon load. There is a high predisposition towards tendinous injuries as oestrogen levels drop. This needs to be understood with exercise planning and loading the tendons with weights.
The body is always evolving and throughout the years and needs frequent reassessment and appreciation for the stage it is at. A therapist will have the ability to look at co morbidities that occur at different stages along side osteoporosis e.g. how do we strengthen with weights while we have a frozen shoulder, what if you have a painful knee that wont allow you to do body weight or weighted squats. It is important to have that health and movement specialist working with you to create a balanced exercise program with all the considerations.