In this video I discuss osteoporosis posture guidelines for people with osteoporosis, osteopenia, or low bone density.
I explain some key concepts related to postural alignment. I describe the difference between flexion and extension, I review the vertebral column and discuss compression fractures, and I explain vertebral fractures and vertebral compression. In other articles on this site and in Exercise for Better Bones, I provide exercise recommendations to correct your posture.
Here is a table of sections for the article:
Hi, I’m Margaret Martin at MelioGuide. Today I will review why it’s so important when you have osteoporosis, osteopenia or low bone density to move carefully and meticulously.
Best Postural Alignment
We should do all our daily activities with our best alignment and avoid an osteoporosis posture.
I will explain the difference between flexion (doing slouching movements) and extension (the safer movement pattern).
Let’s have a look at the vertebral column — also known as our spinal column.
Our head is sitting at the very top and our pelvis is sitting on either side of the sacrum.
This vertebral column would be the side view of my vertebral column based on how I’m standing right now. Here’s the stomach side and here’s the back side.
If I go to feel the little knobby bits behind my neck, what I’m feeling is the spinous process back here. What we’re concerned about when it comes to osteoporosis is the stomach side because that’s the part that tends to get compression fractures.
That’s the vertebral body. Within that vertebral body there’s a different kind of bone. On the outside we can see a hard bone that is called a cortical bone. On the inside it’s a trabecular bone — also referred to as spongy bone.
Vertebrae and the Tracbeculae
Between every vertebrae, we have a disc. Let’s have a close-up look at this.
What I have here is a magnified model that I created of two vertebrae. It doesn’t have the spinous process but it does have the bodies of the vertebrae.
On the outside, as I’ve shown on the chart, it looks like hard, firm bone. You have one vertebrae, you have disc, another vertebrae disc and that goes down all the way along the vertebral column.
But the inside of the vertebrae isn’t hard firm bone. It’s actually a spongy or porous bone composed of tracbeculae. The inside of the bone is actually very sponge like — the tracbeculae. The sponge is very vibrant and moving. It allows the vertebrae to be light and flexible within the vertebrae. It absorbs shocks.
Trabeculae and Shock Absorption
But it is important to realize that that sponge, as it’s absorbing forces, is always going to be strongest when it absorbs the forces evenly.
When you are standing in your best postural alignment and distributing forces evenly throughout the day, all of those little trabeculae on the inside absorb the forces evenly.
You have all those thousands of little trabeculae absorbing the forces — and that’s great.
What Goes Wrong When You Have Poor Postural Alignment
Things go wrong when you are constantly doing things that bring you into a forward bend (or flexion or an osteoporosis posture). Here are some examples of when you are slouching without realizing it is happening:
- You have a bad cold and you bend forward as cough.
- You go to tie your shoes and you bend forward.
- You open the fridge door and reach into the fridge
- You hang over your iPhone to text your friends (like the young lady in the photo).
In each of these instances, you have a constant forward leaning on the front of the vertebral bodies. Eventually those little trabeculae, maybe not the first time, but each time you do something a few of them crack.
And then a few more crack, and then a few more crack.
It’s not that one time when you go to open the window, or the one time that you weren’t careful and you vacuumed.
It’s not that one incident usually that causes a fracture and a crack in the outer shell. It’s those thousands of little repeated motions that snaps one of the trabeculae, one of the cross bridges in this internal sponge of the body of the vertebrae.
Another one snaps, another one snaps, and eventually when you go to do something, that little internal scaffolding is going, it can’t hold you up anymore and an outer crack develops.
Leading to Vertebral Compression
And then from an outer crack, you start getting more compression of the vertebrae, which is why oftentimes they won’t diagnose it as a vertebral fracture, but rather a vertebral compression.
Because what happens is you’re getting a slow compression of the vertebral body.
Save Those Forward Flexions
Keep those flexions (oran osteoporosis posture) that you want for precious moments in your life like when one of the grandkids runs up to you and wants to be picked up.
Scoop down and pick them up. But do not use any of those forward flexion movements for things like crunches and movements that you shouldn’t be doing anyway.
Bone Density Explained
When looking at the sea sponge you’ll notice how the top one is less dense than the bottom one. The bottom one would be somebody with more normal bone density and here at the top one would be somebody who’s starting to lose density of the bone.
You’re going to see that there’s more space between the cross bridges. There’s not as many cross bridges.
That means when you’re starting to put pressure on the vertebrae that this one’s just not going to be able to handle the stress. This less dense vertebrae isn’t going to handle as much pressure as a more dense vertebrae.
Now just to bring back into context where this sea sponge is in regards to your bones, that’s the trabecular bone. And that trabecular bone, this is an example of a seal bone that I found on a beach in California.
Here’s that nice outer shell, the cortical bone, the hard bone that I showed you earlier that you could see in the photos. But on the inside, through the whole vertebrae, is that sea sponge type bone. It’s not a very, very strong bone, and so that little sea sponge bone, that’s the trabecular bone.
We have a lot of it in our spine. We have it in our ribs. We have it in our hips. These are the bones that tend to fracture the most when we have concerns with low bone density and osteoporosis.
Well, hopefully that helps to explain the difference between the two types of bone and the reason to be more cautious.
I hope you found this explanation of the osteoporosis posture informative.
If you want to learn more about the BMD or DEXA test procedure, read my blog on bone density test. I also prepared an article on understanding bone density test results and, in another blog, explain the FRAX Calculator.
I look forward to seeing you next time on MelioGuide.
A MelioGuide Exercise for Better Bones client recently contacted me about her program and specifically here osteoporosis posture exercise program. She was wondering whether she would gain much from an additional osteoporosis posture exercise set.
Here is her question in detail:
Hi Margaret, I remember that you said that the Floor M exercise would be especially valuable to me. Since then I have done 1 to 2 sets of Floor M every other day.
It’s sometimes hard to do 2 sets; but one set is doable.
How much more benefit do you get from doing 2 sets versus 1 set? (I am using 3 pound sand weight on my upper back/shoulder area when I do the exercise.)
I must say I have reached the point where I feel the difference in my body; I stand up straighter and my husband has noticed! I feel better! I really LOVE your program! Thanks again.
Osteoporosis Posture Exercise • The Answer
I was excited to hear about her dedication and her progress. Here is my response:
Thank you for sharing the good news about your posture changes. Very exciting!!
Studies have shown up to a 40% increase in strength when going from 1 set to 2 sets. So it is worth it! You can consider using 1 to 2 pounds for the second set until things get easier.
The Lesson Learned
I am glad I was asked this question. It was a good one. It demonstrates that a small change in someone’s exercise program can have dramatic effects.
In this case, increasing the number of sets by one could lead to a 40% strength gain. And if the leap was initially too much, the client could gradually build up her sets by incrementing (or decreasing) her weight so that she could progress.
Could your quest for the perfect posture causing you low back pain? I have client who is a perfectionist. I have coached her to be more careful about her postural alignment. She follows everything I say — to the letter.
I have encouraged her to flex from the hip and avoid flexion of the spine. As a result, she has completely eliminated spinal flexion in her exercise movements and activities of daily living! However, this has lead to a condition called flexion dysfunction which, in turn, has caused her to experience low back pain.
Osteoporosis Posture, Low Back Pain and Flexion Dysfunction
I have since started to coach my client that she needs to make sure she maintains a full range of motion in her spine. I am not telling her that she needs to practice poor posture and flex from the spine in an unsafe way. However, I do urge her to do some flexion in unweighted positions. The video illustrates these recommended movements.
Treating Flexion Dysfunction
If you are a Physical Therapist, lookout for this condition when assessing your clients. If you are a client, you probably should seek guidance from an experienced Physical Therapist.
Posture and Low Back Pain
Hi. Welcome to MelioGuide. I’m Margaret Martin, and today what I’m going to talk about is something called flexion dysfunction (sometimes referred to as postural dysfunction).
For those therapists listening you’ll understand right away what it is.
For those of you who have never heard of the term, flexion dysfunction is something that occurs when you’ve been so immaculate about keeping your back in extension, or in its safe alignment, that when you do go into flexion, that it actually causes discomfort. We call it a flexion dysfunction because you actually get tight going into flexion.
This doesn’t occur very often, but I have seen a client of recent and she is a perfectionist.
When she first came to see me and I spoke to her about the activities of daily living. I also reviewed how she sits and how she moves at work and at home. We spoke about her being more careful about her alignment and moving from the hips and not from the spine.
She listened to my guidance and followed my recommendations 110%! She did everything with immaculate alignment and posture — but so immaculate that she is experiencing a little bit of low back pain because she is actually getting tight in the ability to flex.
If you are a Physical Therapist reading this blog, this is something that you might come across with your clients.
If you are an individual, you might want to seek guidance from a Physical Therapist.
I’m not advocating that you incorporate the movements that we have identified as being unsafe (that is, your exercises and activities in flexion).
But I am advocating that you do some flexion in unweighted positions. These could be in the water or lying on your side — where you’re allowing your spine to get into it’s full range of flexion and extension — so that you don’t get tight into flexion and you don’t develop a flexion dysfunction.
Perfect Posture and Postural Alignment
I have a page dedicated to Perfect Posture. You can find information on how to get that perfect posture. For those of you interested in dedicated Physiotherapy, I also offer one-on-one Physical Therapy postural alignment through my Posture Alignment Therapy.