In this blog, I will cover ten osteoporosis exercise contraindications that should not be a part of your exercise program. I will also briefly discuss yoga exercises to avoid with osteoporosis.
Research and clinical studies have shown that flexion of the osteoporotic spine, especially in situations where force is applied, can lead to fractures of the vertebrae. Unfortunately, this scientific fact is not well known within the fitness community and, as a result, you will find Personal Trainers (and some medical professionals!) in books and magazines encouraging exercises (like traditional crunches) that cause flexion and potentially put you at risk of a fracture.
Osteoporosis Exercise Contraindications
I frequently have clients, with known diagnosis of osteoporosis, come to my clinic for a bone-friendly exercise program once they realize that the Personal Trainer they are using at a gym has not taken into consideration their specific health needs when assigning them an exercise program. They are surprised (and frequently shocked) when they learn that the exercises that they have been doing, under the guidance of a Personal Trainer, have actually been increasing their risk of a fracture.
I tell them that it is important for them, given their medical condition, that their exercise program (and all their movement patterns) needs to consider osteoporosis and exercise contraindications.
Flexion, Rotation, Osteoporosis and Exercise Contraindications
Flexion and the combinations of flexion and rotation are not recommended for people with osteopenia or osteoporosis. Many of the exercises to avoid with osteoporosis, covered in this blog, encourage either flexion or rotation (or both).
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.
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 or osteoporosis. The crunch is one of a number of osteoporosis exercise contraindications and is one of those exercises to avoid with osteoporosis.
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.
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 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 fracture for people with low bone density or osteoporosis.
I recommend that you avoid this exercise and that you avoid using this piece of gym equipment altogether unless you can keep your spine in perfect 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. The lat pull down behind the head is one of a number of osteoporosis exercise contraindications and is one of those exercises to avoid with osteoporosis.
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 and 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 to the immediate right. 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 to the immediate right. 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 exercises to avoid because it combines both flexion and rotation. There is no way to modify the exercise to make it safe for you. This one is best avoided altogether.
8. Hamstring Stretches
This stretch (and its variations) encourages flexion, potentially risking vertebral fracture for people diagnosed with osteoporosis.
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.
In 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.
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 exercises to avoid with osteoporosis.
10. 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 that even while doing your cardiovascular (or weight bearing) exercises to sure that you maintain proper posture and avoid positions that cause flexion of the spine.
In the photo to the right, 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.
Yoga Exercises to Avoid with Osteoporosis
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 part of the set of exercises that are considered osteoporosis exercise contraindications and one of those exercises to avoid 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.
A Safer Exercise Program
It is now time to leave them behind and to move onto an exercise program that builds bone strength and reduces the risk of fracture in a safe and effective way. You should congratulate yourself for taking a step in the right direction. I encourage you to embark on your Exercise for Better Bones program!
Osteoporosis Exercise Plan
Visit my Osteoporosis Exercise Plan page for more information on this topic.