Table of Contents
This article identifies ten osteoporosis exercises to avoid. (The term “osteoporosis exercise contraindications” is the medical term for “osteoporosis exercise to avoid”). In addition to these osteoporosis exercise precautions, I cover several yoga and Pilates exercises to avoid if you have osteoporosis.
Introduction to Osteoporosis Exercises to Avoid
Research and clinical studies show that flexion of the osteoporotic spine, especially in situations where force is applied, can lead to compression fractures of the vertebrae. Unfortunately, this scientific fact is not well known within the fitness community and, as a result, there are Personal Trainers (and some medical professionals!) encouraging exercises (like traditional crunches) that cause flexion and potentially put you at risk of a compression fracture.
Ten Osteoporosis Exercises to Avoid
The following are ten osteoporosis exercises to avoid:
- Crunches
- Chest Fly
- Chest Press
- Knee Extensions
- Lat Pulldown (behind the head)
- Seated Rows
- Toe Touch with a Twist (Rotation)
- Hamstring Stretches
- Back Stretches
- Cardiovascular Exercises that encourage flexion
Each of these is described in detail in the section below.
Unfortunately, many fitness professionals do not know how to modify exercises programs for people with osteoporosis. It is up to you to take care of your bone health and either avoid the exercise or ask your Personal Trainer make appropriate modifications.
The book Exercise for Better Bones has a comprehensive list of osteoporosis exercises to avoid (or modify) with accompanying descriptions and photo illustrations. It also has (and this is important) exercises you should do if you have osteoporosis based on your activity level and risk of fracture. Consider sharing your copy with your Personal Trainer or encourage them to purchase their own.
Osteoporosis Exercise Contraindications
Clients with osteoporosis come to my clinic for a bone-friendly exercise program. These clients find that some Personal Trainers do not adequately considered their bone health when assigning them an exercise program. In fact, some of the exercises increase their risk of a fracture!
Flexion, Rotation, Osteoporosis and Exercise Contraindications
People with osteoporosis, osteopenia and low bone density should avoid movements and exercises with flexion and the combination of flexion and rotation (twist). Many of the osteoporosis exercises to avoid, covered in this blog, encourage either flexion or rotation (or, in some cases, both movements).
Many of these exercises have been with us for years. You have probably done a number of them in your past (hopefully for the last time!). You may be surprised by some of the exercises I am asking you not to do.
Let’s start with the most popular of exercises: the traditional crunch or sit-up – used by many people to build their abs.
Exercise Recommendations for Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
1. Crunches
Traditional “crunches” (also known as sit-ups) are popular with most exercise programs for development and strengthening of the abdominal muscles. There are many variations of the crunch. The illustrations to the right demonstrate two of the many variations.
Due to the risk associated with vertebral fractures, this exercise is not advised for people with low bone density, osteopenia or osteoporosis. The crunch is one of a number of osteoporosis exercises to avoid.
There are many other exercises you can do to strengthen your abdominal muscles that are safe and do not place your spine at risk. These are covered in the Strength Exercises section of the Exercise for Better Bones program. This blog post lists several safer Abdominal Exercises for Osteoporosis.
You can also refer to my book, Strengthen Your Core, available in both Kindle and print formats, for a complete and safe program to strengthen your core.
2. Chest Fly
When using gym equipment, most women have to adjust their body position to accommodate the machines. The Chest Fly machine may cause undue stress on the vertebrae, possibly risking a compression fracture for people diagnosed with osteoporosis. I recommend you approach this exercise with caution.
3. Chest Press
When using gym equipment, this exercise (like its sister exercise, the Chest Fly) causes undue stress on the vertebrae, possibly risking a compression fracture for people with low bone density or osteoporosis.
I recommend that you avoid this piece of gym equipment altogether unless you can keep your spine in perfect postural alignment.
4. Knee Extensions
This exercise encourages a “slouched” posture, potentially risking a fracture of the vertebrae for people with osteoporosis.
If you are able to perform this exercise without the forward lean (the slouch position), then you should be okay with the exercise.
In my experience, most individuals find it difficult to maintain their posture while repeatedly doing this exercise and, over time, they gravitate back to the slouch position.
5. Lat Pull Down (Behind the Head)
Doing a lat pull down behind your head, as illustrated in the photo on the right, places excess stress on your shoulders, neck, and spine. I strongly advise that you do not do this exercise this way as it can cause a number of problems including shoulder pain. The lat pull down behind the head is one of a number of osteoporosis exercise contraindications.
A lat pull down, when done correctly, is an excellent exercise. The following are some simple instructions to follow for good “lat pull down” form.
- The bar should be pulled down in front of you, just below your chin.
- You should keep your breastbone high.
- Tuck your shoulder blades towards your pockets on the back of your pants as your elbows descend.
6. Seated Rows
This exercise, when done incorrectly, encourages a “slouched” posture, potentially risking a fracture to the vertebrae for people with osteoporosis. This slouch position is illustrated in the photo. Note the curvature of the upper back caused by the model leaning forward to follow the cord. This position should to be avoided.
This exercise can be performed safely when the person assumes a better posture – as illustrated in the picture. Note that the model has kept her posture straight and aligned. There is no forward lean or slouch.
The challenge for most people will be to maintain a straight posture when they pull, pick up, and return the pulley to the rack. If you decide that this an exercise you want to keep in your routine, make sure that you maintain your posture throughout the execution of this exercise.
7. Toe Touch With A Twist
The toe touch with a twist is often the staple flexibility exercise in many Personal Training routines. The problem with this exercise is that it encourages a twist and bend in the spine, potentially risking a fracture to the vertebrae for people with osteoporosis.
This exercise is high up on the list of osteoporosis exercises to avoid because it combines both flexion and rotation. For most people, this exercise is best avoided altogether.
In this blog post on the hip hinge and standing forward bend, I explain why this movement is problematic. However, for those of you who insist on doing this exercise, I explain one way that you can safely modify the forward bend.
8. Hamstring Stretches
This stretch (and its variations) encourages flexion, potentially risking vertebral fracture for people diagnosed with osteoporosis. It is one of the more “popular” osteoporosis exercises to avoid.
The two photos illustrate common variations of this exercise.
The traditional hamstring stretch is frequently used to increase flexibility. Note that in the demonstrations, the model has a curvature of the back caused by the forward lean. This curvature or flexion needs to be avoided by people with low bone density and osteoporosis and is one of those osteoporosis exercises to avoid.
In the Flexibility section of the Exercise for Better Bones program, there are excellent and very effective hamstring stretches that do not put your spine at risk. Read this post on How to Stretch Your Hamstrings to learn safer and more effective ways to get flexible hamstrings.
I suggest you avoid the traditional hamstring stretch demonstrated on this page and instead use the exercises in the Flexibility section of the Exercise for Better Bones program.
The traditional hamstring stretch is one of a number of osteoporosis exercise contraindications and is one of those exercises to avoid with osteoporosis.
9. Back Stretches
This back stretch exercise position, illustrated in the photo, encourages flexion of the spine with a lot of loading – potentially risking vertebrae fracture for people with osteoporosis.
Since there are no modifications that can be made to this exercise to address its shortcomings, the exercise is best avoided. The back stretch is one of a number of osteoporosis exercise contraindications and is one of those osteoporosis exercises to avoid.
10. Osteoporosis and Cardiovascular Exercise Considerations
Good posture is important to maintain throughout your cardio routine. Osteoporosis exercise contraindications can happen while you perform weight bearing exercises.
Remember maintain proper posture and avoid positions that cause flexion of the spine while doing your cardiovascular (or weight bearing) exercises.
In the photo above, the model is deliberately slouching forward as she is using the cycling machine. She should change her seat position so that she maintains postural alignment while using the machine.
Exercise Machines to Avoid with Osteoporosis
I encourage you read my blog post on modifications for gym exercises. You can also look at the video below:
Osteoporosis Physical Therapy Contraindications
I frequently encounter very motivated people who, without the guidance of a trained professional, select exercises that increase their risk of fracture instead of decreasing the risk.
For example, I recently had two male clients who had been diagnosed with osteoporosis in the last year. Both of these motivated and well-intentioned men started exercise programs because of the diagnosis.
Unfortunately, the self-prescribed exercise programs they were following increased their fracture risk! Some of the well intentioned, but potentially dangerous, exercise choices that these gentlemen made were:
Gym machines that encourage flexion.
This was especially true with the use of the preacher curl bench. This device forces your upper back into a rounded (or flexed) posture. At most gyms, this bench is the starting point for both the bicep curl and the tricep extension. The preacher curl bench forces you into a slouched position – a posture that is associated with increased compression fractures of the spine.
Crunches.
I strongly advise people with low bone density not to do this exercise because it places the subject in a flexed position. Crunches are frequently done either on a mat or on a machine and neither of these variations is safe. This exercise is frequently used by people to build abdominal strength. The MelioGuide Exercise for Better Bones Program has safer alternative exercises that build strength appropriate for people with low bone density.
Standing and seated hamstring stretches.
This is another popular exercise used during the flexibility phase of an exercise program. The major problem with the exercise is that it encourages flexion. This is one I suggest you avoid. Instead the MelioGuide Exercise for Better Bones Program has many safe alternative exercises for flexibility.
Bench press on a bench.
The problem with this exercise is that it is virtually impossible to safely get on and off a bench without flexing your spine. The situation is even more challenging when you perform the dumbbell bench press. The dumbbell bench requires that you hold two heavy weights as you get onto the bench. The same exercise on the floor would allow you to roll down through your side and avoid the flexed position. The MelioGuide Exercise for Better Bones Program includes a list of exercise safety tips to help you perform your exercise program in a safe fashion.
Elliptical machine for cardio.
The elliptical machine creates no ground force and, as a result, is does not challenge your joints and bones enough to stimulate bone building.
It also encourages flexion of the spine when performed improperly. Note in the picture that the client is having to slouch or flex forward to reach the handles.
There are many cardiovascular exercises that are safer alternatives to the elliptical. In the MelioGuide Exercise for Better Bones Program, I suggest a variety of safe cardio activities based on your activity level and fracture risk.
Recommended Modifications to Their Exercise Programs
After consulting with the two gentlemen, I made the following modifications to their exercise programs to make them more effective and safe for someone with osteoporosis. If you are following a program similar to their program and have low bone density, osteopenia or osteoporosis, you should consider these modifications as well.
Incorporate more free weights into your routine.
This allows a more functional type of lift. You are working the main muscle but also all the smaller supportive musculature. The added bonus that free weights deliver, when done with good posture, is that they allow your deep spinal muscles to kick in and help you build stronger bones in your spine (vertebra).
Focus on strengthening the transverse abdominus.
Other than martial artists, and competitive tennis, soccer and volleyball players, few recreational athletes need to develop their rectus abdominus. The rectus abdominus is the muscle strengthened by crunches.
Your focus when it comes to abdominal strengthening should be on the transverse abdominus. This muscle is your built in corset. It wraps around your torso and attaches into the fascia that is directly connected to your spine. Training your transverse abdominus will not only eliminate the potentially dangerous crunches from your program but it will also reduce dangerous torques and shearing forces that place your spine at risk.
Eliminate stretches that place you in a flexed position.
Lying flat on your back to stretch your hamstrings will reduce your tendency of bending forward at the spine to touch your toes.
Modify your bench press position.
Executing a bench press from the floor allows you to roll down and back up in a safer manner. With guidance, the use of a burst resistant ball also allows you to execute a bench press with safer ascent and decent. Replacing a bench press with a push up has the added benefit of increased loading through your wrists.
Select a safer cardio alternative.
Both men would benefit more from brisk walking either outdoors on the sidewalk or trail. When the inclement weather sets in, they could use the treadmill.
Exercise Recommendations for Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
Pilates and Osteoporosis Exercise Precautions
Individuals with osteoporosis need to practice caution when doing certain Pilates poses and exercises. Before starting a Pilates program with a new student, a qualified Pilates instructor should gather important information about the student’s physical condition and health—including if the student has, or is at risk of, low bone density or osteoporosis.
If your instructor is not aware of your condition, then you should alert him or her and inquire about appropriate modifications before starting a Pilates program or session.
As a general rule, students should modify their Pilates programs as they progress in age. For the student with low bone density or osteoporosis, it is critical that the student and teacher monitor the student’s spinal alignment to reduce the risk of vertebral fracture.
Forward bends of all kinds should involve flexion of the hip only. Students need to maintain a normal curvature of the spine throughout the pose. Bending at the hips, rather than at any point in the spine, is essential. Pilates instructors need to be aware of the risks to clients with low bone density of forward bends that involve spinal flexion. Modify or eliminate poses that cause negative stresses on the spine.
Certain Pilates poses can increase the risk of vertebral fracture for people with low bone density or osteoporosis. Pilates poses that involve forward flexion of the spine need to be modified or avoided. Avoid or modify these Pilates poses for clients with osteoporosis:
- Hundred
- Side Bend Exercise or Spinal rotation
- Roll up
- Spine twist
Yoga Osteoporosis Exercises to Avoid
Certain exercises, including some yoga and Pilates poses, can cause strain on the vertebrae of a person with osteoporosis — to the point where the risk of a compression fracture is quite high. As a result, certain yoga and Pilates poses need to be modified or avoided for people with osteoporosis.
My book, Yoga for Better Bones, is about yoga exercises for osteoporosis and specifically identifies osteoporosis exercise contraindications and poses that should be modified or avoided for people with osteoporosis.
Exercise for Better Bones
I am sure that you have done some of these osteoporosis exercises to avoid at one point in your life. Time to move onto an exercise program that builds bone strength and reduces the risk of fracture.
In Exercise for Better Bones I cover, in detail osteoporosis physical therapy contraindications exercises as well as exercises you should do to that are safe and effective for your activity level and fracture risk.
I encourage you to embark on your Exercise for Better Bones program!
Margaret Martin
Further Readings
Comments