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If you or someone you love has been diagnosed with a compression fracture, you are probably feeling overwhelmed. What does this mean for your future? Can it get worse? What exercises are safe? How do you sleep, get dressed, or even get out of bed?
I have been treating clients with vertebral compression fractures for over 40 years as a physical therapist. In this comprehensive guide, I walk you through everything you need to know about treating a compression fracture, from understanding your diagnosis to specific exercises, bracing options, and practical advice for daily life.
Later in this post, you will meet Brenda, one of my clients who went from barely being able to walk five houses after her T9 compression fracture to covering three kilometres a day. Her story shows what is possible with the right approach.
What Is a Compression Fracture?
A vertebral compression fracture occurs when one or more of the bones in your spine (vertebrae) collapse or become compressed. These fractures most commonly affect the thoracic spine (mid-back, T1-T12) and the upper lumbar spine (lower back, L1-L5), with the T12 and L1 vertebrae being the most frequently affected.
There are three main types of compression fractures:
- Wedge fracture: The front of the vertebra collapses while the back remains intact, creating a wedge shape. This is the most common type and often leads to a forward-stooping posture over time.
- Biconcave fracture: The middle of the vertebral body collapses, creating a concave shape on both the top and bottom surfaces, while the front and back walls remain relatively intact.
- Crush fracture: The entire vertebral body collapses uniformly. This is the most severe type, as seen in Brenda’s case where her T9 vertebra was 70% compressed.
Most compression fractures are caused by osteoporosis, where weakened bones can fracture from everyday activities like bending, lifting, or even coughing. Some occur from trauma such as a fall or car accident. Understanding which type you have, and where it is located, helps your treatment team design the right plan for you.
Compression Fracture Symptoms
Many compression fractures develop gradually, and some people have no symptoms at all. In fact, more than two-thirds of vertebral compression fractures are detected incidentally on imaging rather than from symptoms. When symptoms do occur, the most common include:
- Sudden back pain that worsens with standing or walking and eases when lying down. This is the hallmark symptom of an acute compression fracture.
- Pain that intensifies with movement — particularly when bending, twisting, coughing, or sneezing.
- Loss of height over time. Each compression fracture can reduce your height by 1-2 centimetres or more.
- Increasing forward stoop (kyphosis) as one or more vertebrae wedge and shift the spine’s alignment forward.
- A band of pain that wraps from the back around the sides of the body, following the distribution of the nerves at the fractured level.
T12 and L1 Compression Fracture Symptoms
Fractures at the thoracolumbar junction (T12 and L1) often produce pain centred at the waistline. Because this area is where the relatively rigid thoracic spine meets the more mobile lumbar spine, fractures here may produce symptoms that feel like lower back pain, muscle spasm, or even abdominal discomfort. Pain typically worsens with prolonged sitting or standing.
You may see the term “compression deformity” on your imaging report (for example, compression deformity L1 or compression deformity T12). This is another way of describing a vertebra that has lost height due to compression. Whether your report says compression fracture or compression deformity, the treatment principles discussed in this guide apply.
When to Seek Immediate Medical Attention
Contact your physician promptly if you experience sudden, severe back pain (especially after a fall or lifting), new numbness or tingling in your legs, difficulty with bladder or bowel control, or progressive weakness in your legs. These may indicate a more serious fracture or nerve involvement requiring urgent assessment.
Compression Fractures Can Get Worse
My clients come to see me after they have been diagnosed and no one has told them that their vertebral fractures can get worse (until they meet me). Just because your spine has compressed 70%, it doesn’t mean that it can’t keep compressing.
If you have a compression fracture, it is so important for you to be really meticulous about your alignment because those fractures will get worse. Not only will the actual fractures themselves get worse but you are at a higher risk of fracturing more and more levels. But all is not lost.
Impact of Exercise on Compression Fractures
A recent study shows that a 12 month duration of exercise had a very positive effect for people who had experienced vertebral fractures. The outcome was that after 12 months they had a significant improvement in quality of life. They had an easier outcome of doing their tasks of daily living, their functional mobility was improved and their balance was improved.
If you have been diagnosed with a vertebral fracture do intelligent exercises, avoid all forward flexion, follow the guidelines that I have on my blogs and in Exercise for Better Bones and play it safe and know that you can still improve your quality of life and you can still be stronger.
If you are not sure whether you have a compression fracture, but have any of the six symptoms listed above, have it investigated.
Compression Fractures and Back Pain
A comprehensive study published in the Journal of Bone and Mineral Density identified a relationship between the incidence of compression fracture and back pain.
The research team examined data from 4,396 men over the age of 65. The men had enrolled in the Osteoporotic Fractures in Men study between 2000 and 2002. The key findings and conclusions were:
- Only 25% of new vertebral fractures are diagnosed by their physician.
- Approximately 60% of older men with small osteoporosis-related compression fractures reported new or worsening back pain.
- The percentage of men in the study reporting back pain with undiagnosed compression fractures (70%) exceeded those without compression fractures by 11 percentage points (59%).
- 93% of the men who had their fractures diagnosed during the study reported back pain.
- Prevention the compression fractures could have reduced the onset of back pain and further disability in the study group.
The study concluded that back pain is the most common symptom (of compression fractures). The study results are similar to findings in elderly women.
Thoracic Versus Lumbar Compression Fracture
A compression fracture can happen anywhere along the spine. The incidence of thoracic compression fracture is the highest among all parts of the spine because this area is the one where the postural stoop (or kyphosis) will occur. You could experience a lumbar compression fracture when you have an impact.
I had a client who went tobogganing with her grandchildren. As they were going down the snow run they hit a few bumps, enough to cause a lumbar compression fracture and considerable pain.
How Serious Is a Compression Fracture of the Spine?
This is one of the most important questions I want you to ask, because the answer determines how carefully you need to manage your movement going forward.
Can You Make a Compression Fracture Worse?
Yes, you absolutely can, and I wish more people understood this before it happens.
If you currently have a 30% compression of your vertebral body, it can become 40% or even 50% compressed depending on how you move. Some people compress their vertebral body so much that the vertebra is barely visible on X-ray. This is not meant to scare you. It is meant to empower you, because how you move is within your control.
How you get up in the morning, how you bend, how you tie your shoes, how you garden, all of these movements determine whether your fracture stays stable or gets worse. My client Brenda was never told this after her diagnosis, and that is unfortunately common. Many people do not understand the importance of good posture, good movement patterns, and the potential consequences for spinal health.
Flexion vs Extension: Why the Type of Movement Matters
The science behind which movements are dangerous, and which are protective, comes from a landmark Mayo Clinic study by Dr. Mehrsheed Sinaki. In the 1984 study, Sinaki and Mikkelsen assigned women with postmenopausal spinal osteoporosis to either extension exercises (bending backward), flexion exercises (bending forward), combined exercises, or no exercises. The results were dramatic: 89% of the flexion exercise group developed additional fractures, compared to only 16% of the extension exercise group (1).
This finding has been confirmed repeatedly over four decades of research. Sinaki’s 10-year follow-up study (2002) demonstrated that stronger back extensors reduced the incidence of vertebral fractures (2). A later case series from the Mayo Clinic showed that vertebral compression fractures developed in patients performing strenuous yoga flexion positions, even in those who only had osteopenia rather than full osteoporosis (3).
The biomechanical explanation is straightforward. When you bend forward, the front of your vertebral body is compressed. In osteoporotic bone, the anterior wall of the vertebra is typically the weakest point. Forward bending concentrates force exactly where the bone is most vulnerable, which is why wedge fractures, where the front collapses but the back stays intact, are the most common type. Extension exercises, by contrast, load the posterior elements of the spine and strengthen the erector spinae muscles that act as a natural brace against further compression.
Movements and Exercises That Increase Fracture Risk
Based on this research, the “Too Fit to Fracture” expert consensus guidelines specifically recommend avoiding these movements for people with vertebral fractures (4):
- Forward bending (spinal flexion): Bending to pick things up from the floor, tying shoes with a rounded back, reaching forward from a seated position
- Flexion exercises: Sit-ups, crunches, toe touches, rowing machines, and any exercise that rounds the thoracic or lumbar spine under load
- Yoga poses involving spinal flexion: Forward folds, plow pose, and other positions that place sustained flexion load on the spine
- Twisting under load: Twisting while carrying weight or performing rotational exercises with resistance
- Heavy lifting: Especially with a rounded back or poor mechanics
- High-impact activities: Jumping, running on hard surfaces, or jarring movements
Movements That Protect Your Spine
In contrast, the following movement patterns are protective:
- Spinal extension: Gentle backward bending, prone back extensions, and posture-correction exercises
- Hip hinging: Bending from the hips with a straight spine rather than rounding the back
- Walking: Particularly with activator poles to maintain upright posture
- Isometric core activation: Engaging the deep stabilising muscles without spinal flexion
The good news is that since you are reading this, you are taking things into your own hands. Understanding the science behind flexion and extension is the first step toward protecting your spine.
Compression Fracture Treatment Options
Treatment for a compression fracture depends on the severity of the fracture, the level of pain, and the stability of the vertebra. Most compression fractures are treated conservatively (without surgery), while more severe or unstable fractures may require intervention.
Conservative Treatment
The majority of compression fractures heal with conservative management, which includes:
- Pain management: Over-the-counter or prescription pain medication during the acute phase. Your physician will guide the appropriate level of pain relief.
- Physical therapy: A structured rehabilitation program that progresses from gentle mobility work to strengthening exercises (covered in detail below).
- Bracing: A back brace to provide stability during the healing phase, particularly for fractures at T12 or L1 (covered in the bracing section below).
- Activity modification: Learning safe movement patterns for daily activities like getting out of bed, dressing, and sitting.
- Nutrition for bone healing: Adequate calcium, vitamin D, and protein are important for fracture repair and ongoing bone health. If you have osteoporosis, your physician may also recommend osteoporosis medication to reduce the risk of future fractures. For detailed guidance on nutrition and bone health, see our posts on calcium, vitamin D, and prunes for osteoporosis.
When Is Surgery Needed?
For fractures that cause severe, unrelenting pain or significant instability, surgical options include kyphoplasty and vertebroplasty (discussed in a dedicated section below).
It is worth noting that research on life expectancy after compression fracture has found that the type of treatment (conservative vs surgical) did not significantly affect long-term survival outcomes. What matters most is how actively you engage in rehabilitation.
Treatment for Compression Fractures in the Elderly
Older adults require careful consideration in their treatment approach. The principles are the same, pain management, progressive exercise, and safe movement patterns, but the starting point may be much gentler, and the timeline for recovery typically longer. The presence of other health conditions, reduced bone density, and deconditioning all need to be factored into the treatment plan.
For elderly patients, I often start with very basic movements and progress slowly, ensuring each exercise can be performed without pain before advancing.
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Physical Therapy for Compression Fractures
Physical therapy is a widely recommended cornerstone of compression fracture recovery and rehabilitation. A well-designed compression fracture rehabilitation program addresses pain, restores mobility, builds strength, and teaches you how to move safely for the rest of your life.
What to Expect from Physical Therapy
Your physical therapy program should progress through three phases:
Phase 1: Acute (weeks 1-6): Focus on pain management, gentle mobility, and learning safe movement patterns. Treatments may include myofascial release, gentle stretching, and education on body mechanics. As my client Brenda found, myofascial release was particularly effective for the vice-like spasms around her hip.
Phase 2: Subacute (weeks 6-12): Gradual introduction of strengthening exercises, postural training, and increased walking tolerance. This is when most people begin to notice meaningful improvement.
Phase 3: Return to activity (3+ months): Progressive strengthening, functional exercises, and return to daily activities with confidence. The goal is building enough muscle support that your body becomes its own internal brace.
Lumbar Compression Fracture Physical Therapy Protocol
For lumbar compression fractures (L1, L2, L3, L4, L5), the focus is on:
- Core stabilization through deep abdominal activation (not crunches or sit-ups)
- Hip and gluteal strengthening to support the lower spine
- Pelvic tilts and bridging exercises progressed gradually
- Walking programs with gradual distance increases
- Education on lumbar-safe bending and lifting mechanics
Thoracic Compression Fracture Physical Therapy
For thoracic compression fractures (T5 through T12), the emphasis shifts to:
- Thoracic extension exercises to counteract the forward pull of kyphosis
- Scapular retraction and mid-back strengthening
- Chest stretches to open the front of the body
- Postural awareness training
- Breathing exercises to maintain rib cage mobility
Recent research supports early, guided rehabilitation after vertebral compression fractures. A 2023 randomized controlled trial by Kataoka et al. found that combining rehabilitation with pain management that targets activity avoidance, encouraging patients to increase daily activities despite pain rather than waiting for pain to resolve, improved physical activity levels and reduced depression and pain catastrophizing in older adults with acute vertebral fractures (5). A Canadian multicentre trial (VIVA) is currently underway to evaluate virtual rehabilitation for people with osteoporotic vertebral fractures, reflecting the growing clinical consensus that structured exercise should begin early in recovery (6).
It is worth noting honestly that the evidence base is still evolving. A Cochrane systematic review found that while individual trials reported benefits, the overall quality of evidence was very low and called for larger trials (7). However, clinical consensus guidelines such as “Too Fit to Fracture” (Giangregorio et al., 2014) continue to recommend exercise for people with vertebral fractures, and this aligns with what I have seen consistently in over 40 years of clinical practice (4).
Compression Fracture Exercises
Exercise is widely recommended by clinical guidelines and physical therapists as a cornerstone of compression fracture recovery. The right exercises, focusing on extension and avoiding flexion, as Dr. Mehrsheed Sinaki’s research demonstrates, build the muscle support your spine needs, improve your posture, and reduce your risk of further fractures. In my clinical experience, the clients who commit to their exercise program consistently achieve the best outcomes.
Below are examples of exercises I prescribe for my clients with compression fractures. I need to make two very important points.
- These exercises might not be appropriate for you. Your exercise protocol depends on your specific situation, so I recommend you get a proper assessment by a trained health professional, such as a physical therapist with experience treating patients with compression fractures, before you start any exercise program.
- Always get the clearance from your physician or surgeon before starting an exercise program. Your compression fracture needs appropriate healing time before you increase your activity level.
Start with the number of repetitions you can manage without pain, even if that is just one. Brenda started with a single rep and could barely lift her head off the floor. Within weeks, she was doing ten reps of every exercise I gave her.
L1 Compression Fracture Exercises
For L1 fractures (the most common location), these exercises target the muscles that directly support the injured vertebra:
- Pelvic tilts: Lying on your back with knees bent, gently flatten your lower back against the floor. Hold for 5 seconds. This activates the deep core without stressing the fracture.
- Bridging: From the same position, lift your hips off the floor while keeping your spine neutral. Start with a small lift and progress as strength builds.
- Prone back extension: Lying face down, gently lift your head and shoulders a small amount. This is a key extension exercise that strengthens the muscles protecting your lumbar spine, consistent with Sinaki’s research on the protective role of back extensors.
- Standing hip hinge: Learning to bend from the hips rather than the spine. This is both an exercise and a movement pattern you will use every day.
Lumbar Compression Fracture Exercises
For fractures at L2, L3, or L4, the same foundational exercises apply, with additional emphasis on:
- Side-lying hip strengthening (clamshells, side leg lifts) to build lateral stability
- Supported squats using a chair or counter for balance
- Wall push-ups to build upper body strength without loading the spine
Thoracic Compression Fracture Exercises
For thoracic fractures (T5-T12), focus shifts to mid-back and postural muscles:
- Chin tucks: Gently draw your chin back to align your head over your shoulders. This counteracts the forward head posture that worsens thoracic kyphosis.
- Chest stretches: Doorway stretches or supine stretches over a rolled towel to open the front of the chest.
- Scapular squeezes: Gently draw your shoulder blades together and down. Hold for 5 seconds.
- Prone back extension: Especially important for thoracic fractures to maintain extension strength.
Compression Fracture Exercise Source
These exercise choices are based on a study published in BMC Musculoskeletal Disorders by Bennell. These can be broken into two major groups: one set of exercises for posture and flexibility and the other for strengthening. I explain these in more detail below.
I do not recommend that every one with a compression fracture do all of these exercises. Everyone is different and the exercises will need to be broken into groups and delivered at apace that works for you.
The best thing you could do is to work closely with a Physical Therapist who is knowledgeable in the treatment of compression fractures.
If that person is not accessible, then I recommend you start with the Posture Exercises outlined in my book, Exercise for Better Bones.
The Bennell study (2) looked at the effects of compression fracture exercises and manual therapy on physical impairments, function and quality-of-life in persons with osteoporotic compression fractures. The study concluded that there are positive benefits of physical therapy prescribed compression fracture exercises for patients with compression fractures.
Spine Fracture Treatment Exercises and Thoracic Compression Fracture Exercises
The exercises I have listed are appropriate as spine fracture treatment exercises and thoracic compression fracture exercises.
Compression Fracture Exercise Program
For a structured, progressive exercise program designed specifically for people with osteoporosis and compression fractures, my Exercise for Better Bones program provides detailed instructions with modifications based on your fracture level and bone density. The program includes physical therapy exercises PDF downloads that you can print and take to your sessions. Over 40,000 copies have been used by people around the world.
Physical Therapy Compression Fracture Treatment Guidelines
Once your muscles have started adapting to the change in height caused by the spinal compression fracture and the compression fracture has had time to heal (usually 8 to 12 weeks after the episode of increased pain) you should start a compression fracture exercise program.
The goals of compression fracture exercise program are to:
- Decrease your pain at rest and with movement.
- Increase your standing tolerance and overall strength.
- Reduce your risk of falling.
I recommend that you invest time and understand how compression fractures occur and learn how to avoid all activities and postures that can make your compression fracture worse. Both of these items are covered in this blog post and in the Exercise for Better Bones program.
Exercises to Avoid
As discussed in the flexion vs extension section above, exercises that round the spine forward are the most dangerous. Understanding compression fracture exercises to avoid is just as important as knowing which exercises to do. The Sinaki study showed an 89% fracture rate in the flexion group, a number I share with every one of my clients. For a complete guide, read our detailed post on exercises to avoid with osteoporosis and compression fractures.
How to Strengthen Your Spine After a Compression Fracture
Rebuilding strength after a compression fracture is a gradual process. If you are wondering how to strengthen spine after compression fracture, think of it as a progression from dependence (on braces, medication, and assistance) to independence (your own muscles providing the support your spine needs).
The key principles are:
- Start where you are. If you can only do one repetition of an exercise, do one. Brenda could barely lift her head off the floor when we started. Within months, she was walking three kilometres with Nordic poles and a weighted kypho-orthosis vest.
- Progress consistently. Add repetitions before adding resistance. Move from lying exercises to seated exercises to standing exercises as your strength allows.
- Build your internal brace. Your abdominal and spinal muscles are designed to function as your body’s own back brace. Sinaki’s research showed that stronger back extensors directly reduce the incidence of vertebral fractures (2). Every strengthening exercise you do is training these muscles to protect your spine during daily activities.
- Be patient with yourself. Recovery from a compression fracture is measured in months, not days. Celebrate small victories: the first time you get out of bed without pain, the first time you walk to the corner, the first time you can prepare a full meal.
Can I Wear or Use a Weighted Vest After a Compression Fracture?
Weighted vests are a popular exercise device for many people with osteoporosis but should you wear one if you have a compression fracture? I answer that question in this video:
Back Brace for Compression Fractures
A back brace for compression fracture provides external support while your fracture heals and your muscles strengthen. A 2023 systematic review and meta-analysis of randomized trials by Squires et al. found that rigid bracing resulted in significantly less pain at 3-6 months compared to no bracing, leading the authors to conclude that bracing should be considered as first-line management for patients with painful vertebral compression fractures (8). However, not everyone with a compression fracture needs a brace, and choosing the right one matters.
Do You Need a Back Brace?
For minimal compression fractures with little pain, very little support may be needed. Many people heal naturally without a brace. However, if you are experiencing significant pain or your physician has determined that your fracture is unstable, a more rigid brace will be necessary.
My observation is that only about 10% of individuals with compression fractures receive brace recommendations from their orthopaedic surgeons. This makes professional guidance even more important when selecting the right device.
Types of Back Braces for Compression Fractures
The right brace depends on the location and severity of your fracture:
- Soft lumbar support: For mild lumbar fractures. Provides gentle support and a reminder to maintain good posture.
- TLSO brace (thoracolumbosacral orthosis): For more significant fractures, particularly at the thoracolumbar junction (T12-L1). Provides rigid support through both the thoracic and lumbar regions.
- Weighted kypho-orthosis vest: For ongoing postural support, particularly with thoracic fractures that increase kyphosis. Unlike rigid braces, this actively trains your muscles to hold you upright.
Support for L1 and T12 Compression Fractures
Compression fractures at L1 or T12 require special consideration because they sit at the junction between the lumbar and thoracic spine. A standard short lumbar brace will not provide adequate support. You need a longer brace that extends from the lower lumbar region through the upper thoracic area.
I recommend the Spinomed back brace for my clients with compression fractures. It is the only back brace that has been studied in this population and provides comprehensive support through the entire spine. A 2022 study by Weber et al. demonstrated that continuous wearing of a dynamic brace for 6 weeks resulted in more upright posture with a positive effect on gait and stability, though the authors noted that higher-level evidence is needed to confirm whether the improvements were attributable to the brace or to natural recovery (9).
Professional Fitting and Why Amazon Is Not the Best Option
Purchasing a back brace from online retailers like Amazon is not recommended for compression fractures. These braces are not fitted to your specific body dimensions, you cannot determine whether a particular brace is appropriate for your fracture location and severity, and there is no way to verify it provides the right level of stability. Instead, seek care from a local orthotist who can offer a variety of braces and provide personalised recommendations.
How Long Should You Wear a Back Brace?
If you are using a non-fitted, off-the-shelf brace, limit wear time to activities where you specifically need additional stability. Avoid wearing an uncustomised brace during all activities, as prolonged use can weaken your core stabilising muscles rather than strengthen them.
The long-term goal is to gradually transition from brace dependence to natural muscle support. Once your physician gives permission to begin core strengthening and you feel your deep core muscles becoming stronger, start weaning from the brace during specific activities.
For detailed guidance on choosing and fitting a back brace, read our complete guide to back braces for compression fractures.
Brenda’s Back Brace Experience
Understanding how back braces work in practice can be helpful when making your own decision. Brenda tried three different types of braces throughout her recovery, each serving different purposes.
The Weighted Kypho-Orthosis Vest was Brenda’s most useful brace. Designed to counterbalance the weight of the head and upper body pulling forward, she found it particularly helpful during walking, food preparation, and any activities requiring prolonged standing. It helped her walk more upright because, as she describes it, her body naturally wants to go forward, “that’s the go-to position and I have to fight that all the time.” Unfortunately, this specific brace has been discontinued. While similar products exist on Amazon, they do not follow the same research-based protocols regarding weight distribution and cannot be recommended as substitutes.
The ObusForme Back Brace was a belt-style brace Brenda purchased from a medical supply store when her back pain was at its worst. She found it gave her a sense of stability, it felt like it “held things together” during her most challenging days. She wore it on days when she felt weaker or needed extra support. I usually do not recommend this type of belt for most compression fractures, as it may not be sized properly or provide sufficient stability around the fracture site.
A basic lumbar support was Brenda’s third brace, and it did not meet her needs. It lacked adequate firmness and did not provide the specific support her compression fractures required. She eventually gave it to a friend. This experience illustrates why professional fitting matters, not all braces are appropriate for compression fractures.
Support Devices for Compression Fracture Recovery
Beyond bracing, several support devices can make a meaningful difference in your recovery and daily comfort. Brenda’s experience illustrates how the right tools, used correctly, can accelerate progress.
Weighted Kypho-Orthosis Vest
The weighted kypho-orthosis vest (also called a weighted kypho orthosis) is a specialised device designed to counterbalance the forward pull of kyphosis. Small weights positioned over the scapulae (shoulder blades) provide a gentle posterior force that reminds the body to stay upright and activates the back extensor muscles. Brenda wore hers during walking and meal preparation, finding it especially helpful for maintaining posture during activities that required prolonged standing.
Dynamic Taping
Brenda found dynamic taping to be what she called “a little miracle worker.” Applied by a trained physical therapist, the tape supports the strained muscles along the spine and provides proprioceptive feedback, a constant, gentle reminder of where your body is in space. When the tape was not there, Brenda could feel the difference immediately. While not a standalone treatment, dynamic taping can be a useful complement to exercise and bracing during recovery.
Pillows and Positioning Aids
Simple positioning aids can make a significant difference in comfort. A lumbar support cushion for sitting, a wedge pillow for sleeping, and a pillow between the knees for side-lying can all reduce pain and protect the fracture during rest. These are covered in more detail in the daily activities section below.
Heat Pad
Brenda uses a heating pad a lot. When she starts to feel achy, she sits down for 15 minutes and puts it on. It helps take the ache away. When she does her stretching exercises, she has it underneath her as well.
Reacher
The reacher was very handy in the initial stages because everything seems to drop when you don’t want it to drop. You can use one for the garden for picking up things like sticks.
Shopping Cart
When Brenda goes to the large shopping stores, she will lean on the cart handle to take some of the pressure off her back. Sometimes she will put her purse in her back and adjust it so it is in the small of her back. It operates like the weighted kypho orthosis vest mentioned earlier in this blog post.
Nordic Walking Poles
Activator poles (also called Nordic walking poles) help maintain upright posture during walking and provide additional stability. For someone with a compression fracture, they serve two purposes: they keep you from hunching forward (reducing flexion load on the spine), and they give you confidence to walk longer distances.
Brenda used activator poles throughout her recovery. Before the compression fracture, she walked five kilometres or more daily. After the fracture, the most she could manage was five houses and back, and that exhausted her. With the poles and her weighted kypho-orthosis vest, she gradually built back to three kilometres at a steady pace. Read more about Nordic walking and osteoporosis.
Kyphoplasty and Vertebroplasty for Compression Fractures
For compression fractures that cause severe, unrelenting pain despite conservative treatment, two surgical procedures may be considered.
Kyphoplasty
During kyphoplasty, the surgeon inserts a balloon into the compressed vertebra to re-inflate it, then injects bone cement to stabilise the restored height. This procedure is most effective when performed within the first six to eight weeks after the fracture.
My client Brenda’s T9 compression fracture was 70% compressed by the time it was diagnosed, and the window for kyphoplasty had already passed. This is why early diagnosis is so important.
Vertebroplasty
Vertebroplasty involves injecting bone cement directly into the fractured vertebra without first inflating a balloon. It provides pain relief but does not restore vertebral height.
Important Considerations
While both procedures can provide significant pain relief, they do not stop the progression of further compression fractures. There has long been concern that the cemented vertebra creates a rigid section that increases stress on adjacent vertebrae. However, a 2024 network meta-analysis of randomized controlled trials by Essibayi et al. found that the risk of adjacent-level fractures was similar whether patients had vertebroplasty, kyphoplasty, or no surgical treatment at all (10). This suggests the adjacent fracture risk may be driven more by the underlying osteoporosis than by the cement itself.
That said, a 2025 meta-analysis of 26 studies (7,604 patients) identified specific risk factors for adjacent re-fracture after vertebral augmentation, including cement leakage into the disc space, excessive restoration of vertebral height, and low bone mineral density (11). Approximately 20% of patients experience a new vertebral fracture within one year after augmentation, underscoring the importance of treating the underlying osteoporosis aggressively (12).
This means that good body mechanics, consistent exercise, osteoporosis medication where indicated, and ongoing vigilance remain essential even after a successful kyphoplasty or vertebroplasty.
Recovery After Kyphoplasty
After kyphoplasty, most people experience significant pain reduction within 48 hours. However, return to full activity should be gradual. Gentle walking can typically resume within days, but kyphoplasty recovery exercises should begin under professional guidance once your surgeon clears you. A structured exercise program (like the one described in the exercises section above) focused on back extension is the foundation of post-kyphoplasty rehabilitation. Sinaki’s research at the Mayo Clinic showed significantly fewer refractures after vertebroplasty in patients who engaged in back extensor strengthening exercises (13), reinforcing the importance of post-procedure rehabilitation.
Some patients report continued back pain after kyphoplasty, which may be due to muscle weakness, adjacent vertebra stress, or pre-existing spinal conditions. If you experience ongoing pain, discuss it with your treatment team rather than assuming the procedure failed.
Living with a Compression Fracture: Sleep, Driving & Daily Activities
A compression fracture affects nearly every aspect of daily life. Here is practical guidance for the activities my clients ask about most.
Best Way to Sleep with a Compression Fracture
Sleep is often the biggest challenge in the early weeks after a compression fracture. One of the most common questions I hear is “what is the best way to sleep with compression fracture?” Here are the positions that provide the most relief:
- On your back with a pillow under your knees to reduce pressure on your lumbar spine. A small rolled towel under your lower back can provide additional support.
- On your side with a pillow between your knees to keep your spine aligned. Hug a pillow in front for additional chest and shoulder support.
- Elevated using a wedge pillow or adjustable bed to keep your upper body slightly raised. This can reduce pain from thoracic fractures.
Avoid sleeping on your stomach, as this forces your spine into extension and rotation that can stress the fracture.
How to Get Out of Bed with a Compression Fracture
Learning how to get out of bed with compression fracture is one of the most important skills to learn. Here is the technique I teach all of my clients:
- Roll onto your side as a unit (log roll), keeping your spine straight.
- Use your arms to push yourself up to a sitting position while simultaneously lowering your legs off the side of the bed.
- Sit on the edge for a moment before standing.
- Use your legs, not your back, to stand up.
This technique avoids the dangerous forward bending that can compress the fracture further. Brenda used a walker to get from bed to the bathroom in the early weeks, and even this small journey exhausted her initially.
Driving with a Compression Fracture
Many clients ask me about driving with compression fracture, specifically when it is safe to get behind the wheel again. In the early weeks after a compression fracture, driving is typically not safe. The combination of sitting posture, vibration from the road, and the need to turn and check mirrors can all aggravate the fracture.
Brenda could not drive for nine months after her T9 compression fracture. When she did return to driving, she noticed she sat three inches lower in the car seat due to the height lost from her compression fractures.
Return to driving should be a conversation with your physician and physical therapist, based on your pain levels, range of motion, and ability to safely control the vehicle.
Sitting with a Compression Fracture
When sitting:
- Use a chair with good lumbar support, or place a small cushion behind your lower back
- Keep your feet flat on the floor
- Avoid soft, deep couches that force your spine into flexion
- Stand up and move every 30-45 minutes
- When working at a desk, position your screen at eye level to avoid looking down
Sex After a Compression Fracture
Intimacy is a topic that many patients feel uncomfortable raising, but sex after compression fracture is an important part of quality of life that deserves honest guidance. The key principles are:
- Avoid positions that put your spine in flexion or rotation under load
- Use pillows for support and comfort
- Communicate openly with your partner about what feels safe
- Lying on your back with support is generally the safest starting position
- Wait until your acute pain has subsided before resuming intimacy
Your physical therapist can provide specific guidance based on the location and severity of your fracture.
Helping a Partner or Family Member with a Compression Fracture
If you are caring for someone with a compression fracture, whether that is your husband, wife, parent, or friend, here are the most important things you can do to help:
- Learn the safe movement patterns alongside them (log rolling out of bed, hip hinging instead of bending)
- Help with tasks that involve bending, lifting, or carrying during the acute phase
- Encourage their exercise program without pushing too hard
- Understand that recovery takes months and there will be good days and bad days
- Attend a physical therapy session with them so you can understand the exercises and help at home
Brenda's Compression Fracture Recovery Story
Of all the individuals I have worked with who have compression fractures, Brenda is the most positive and persistent client. Her story shows what is possible when you combine the right treatment with determination.
Watch Brenda’s full story in the video below (25 minutes).
How Brenda’s Compression Fractures Happened
Brenda is a retired teacher who was always physically active. In her thirties, she recognised her risk: her mother had fractured both hips and her pelvis. Brenda was proactive, watching her calcium and vitamin D, exercising, and eventually taking Prolia for four years. When a repeat DEXA showed improvement, she discontinued treatment.
Then, on the first day of a dream holiday in Africa, she experienced severe back pain after moving heavy bags. By the trip’s end, her pain was unbearable. X-rays back in Canada revealed a 70% T9 compression fracture, with four other vertebrae showing some level of compression.
What Brenda Was Not Told
Brenda was never told that her compression fracture could get worse depending on how she moved. She did not know her T9 was 70% compressed and could not be fixed. This gap in patient education is unfortunately common, and it is one of the reasons I created this guide.
Brenda’s Recovery Progression
Brenda’s recovery demonstrates the power of consistent, guided exercise:
- Starting point: Could barely lift her head off the floor. Could only walk five houses before exhaustion. Needed a walker to get to the bathroom.
- Weeks 1-4: One repetition of each exercise. Myofascial release for the severe spasms. Dynamic taping for muscle support.
- Months 2-3: Three repetitions became five, then ten. Targeted stretches held for up to 10 minutes for fascial release. Introduced Nordic walking poles.
- Months 4+: Walking three kilometres daily with poles and weighted kypho-orthosis vest. Preparing meals independently. Getting out of bed in one smooth motion.
Brenda describes her recovery as “baby steps progress.” She was fastidious about tracking her exercise chart, and seeing the numbers improve kept her motivated.
Brenda’s Advice
Looking back, Brenda wishes she had:
- Chosen a general practitioner who would be a strong advocate and communicate clearly
- Been more assertive about getting answers from her medical team
- Kept hard copies of all test results to trace her health history
- Brought someone with her to appointments when she was in severe pain (the brain is fuzzy under pain)
- Not been afraid to get a second opinion
- Known which exercises were safe and which were dangerous for her spine — the Sinaki research on flexion vs extension is something she wishes she had known from the start
Nutrition and Compression Fractures
In this section we will cover the nutrition advice Brenda follows to reduce the pain associated with her compression fracture.
- While calcium is important, you should make sure you have adequate amounts of nutrients including vitamin D, magnesium and vitamin K.
- Prunes have been shown to play an important role in bone health.
- Protein is one of the main building blocks of bone health. I find that many of my clients do not have enough protein in their diet. If you find protein to be acidic, make sure you increase you intake of fresh fruits and vegetables which are alkaline and help balance the acidity in protein.
Managing Your Compression Fractures
My online course, Living with a Compression Fracture, is designed to help you manage your compression fracture.
Compression Fracture Treatment FAQs
Margaret Martin
Further Readings on Compression Fractures
References
- Kim L Bennell, Bernadette Matthews, Alison Greig, Andrew Briggs, Anne Keppy, Margaret Sherburn, Judy Larsen, John Wark. Effects of an Exercise and Manual Therapy Program on Physical Impairments, Function and Quality-of-life in People with Osteoporotic Vertebral Fracture: A Randomized, Single-blind Controlled Pilot Trial. BMC Musculoskeletal Disorders. Posted 03/19/2010
- Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593-596.
- Sinaki M, Itoi E, Wahner HW, et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10-year follow-up of postmenopausal women. Bone. 2002;30(6):836-841.
- Sinaki M. Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Pain Pract. 2013;13(1):68-75. doi:10.1111/j.1533-2500.2012.00545.x
- Giangregorio LM, Papaioannou A, MacIntyre NJ, et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int. 2014;25(3):821-835. doi:10.1007/s00198-013-2523-2
- Kataoka H, Hirase T, Goto K, et al. Effects of a rehabilitation program combined with pain management that targets pain perception and activity avoidance in older patients with acute vertebral compression fracture: a randomised controlled trial. Pain Res Manag. 2023;2023:1383897. doi:10.1155/2023/1383897
- Sevinc A, Papaioannou A, Morin SN, et al. Virtual Intervention for Vertebral frActures (VIVA): protocol for a feasibility study of a multicentre randomized controlled trial. Pilot Feasibility Stud. 2025;11(1):94. doi:10.1186/s40814-025-01665-x
- Giangregorio LM, MacIntyre NJ, Thabane L, Skidmore CJ, Papaioannou A. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev. 2019;7(7):CD008618. doi:10.1002/14651858.CD008618.pub3
- Squires M, Green JH, Patel R, Aleem I. Clinical outcomes after bracing for vertebral compression fractures: a systematic review and meta-analysis of randomized trials. J Spine Surg. 2023;9(2):139-148. doi:10.21037/jss-22-78
- Weber A, et al. Multicentre randomised controlled trial evaluating the effectiveness and cost-effectiveness of dynamic bracing versus standard care for osteoporotic vertebral fractures. 2022. (As cited in Teixeira Taborda A, De Miguel Benadiva C, Sanchez Tarifa P. Rehabilitation and orthopaedic management of osteoporotic vertebral compression fractures. Rev Esp Cir Ortop Traumatol. 2024;68(6):624-628. doi:10.1016/j.recot.2024.07.004)
- Essibayi MA, Mortezaei A, Azzam AY, et al. Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures: a network meta-analysis of randomized controlled trials. Eur Radiol. 2024;34(11):7185-7196. doi:10.1007/s00330-024-10807-3
- Liao C, Zhu H, Ma G. Risk factors for adjacent vertebral fracture after kyphoplasty or percutaneous vertebroplasty in osteoporotic vertebral compression fractures: systematic review and meta-analysis. Eur Spine J. 2025. doi:10.1007/s00586-025-09111-5
- Kim YJ, Lee JW, Park KW, et al. Pain intervention for osteoporotic compression fracture. Korean J Neurotrauma. 2024;20(3):159-167. doi:10.13004/kjnt.2024.20.e32
- Huntoon E, Schmidt CK, Sinaki M. Significantly fewer refractures after vertebroplasty in patients who engage in back extensor strengthening exercises. Mayo Clin Proc. 2008;83(1):54-57.
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