For a normal person, brisk walking ( where heart rate is increased and there is mild perspiration) is useful. When a person is able to do this relatively easily.
we can tie light weights on the wrists, around the lower spine, or on the ankles, so-called power walking (these weighted belts in various types are available in sports shops). A younger person can start jogging. One can also start light weightlifting with free weights or do regular yoga. Patients who have osteopenia ( thin bones) need to be told to avoid heavy lifting and vigorous exercises to avoid vertebral fractures.
Vertebral compression fractures may be sudden with severe pain or gradual as a result of micro-fractures. Micro-fractures can occur during normal daily activity. Lifting an object in forward bending position can produce compressive forces on the lumbar spine, which are 10 to 20 times greater than the weight lifted.
A person must rise with the weight instead of bending and lifting it (see illustration on ‘picking up an object’, page 67) . patients should be taught chest stretching, deep breathing and back – extension exercises to avoid stooping posture. Swimming or cycling is also recommended. Exercises in water are very useful for improving mobility and muscle strength, and running or walking on sand are similarly very useful.
Other Guidelines for Prevention of Fractures
- Use walking sticks.
- Make bathrooms and staircases safe.
- Wear proper glasses.
- Ensure good lighting at home.
The objective in case of established osteoporosis is to maintain and improve posture, relieve or lessen pain, increase activity, and improve mobility.
What are the Goals in Treating the Complications of Osteoporosis?
Osteoporosis is known as a silent diseases and there are no discomforts until fractures occur. Sometimes, fractures associated with type-2 (old age) osteoporosis may not bring the patient to a physician’s attention. In these cases, the pain may develop so gradually that it may not be taken seriously. In some patients fracture may occur suddenly, due to a fall, lifting a heavy object, or while performing any strenuous activity.
Management of pain: Pain is usually due to a recent vertebral fracture. It can be diminished with rest in lying down position with a pillow under the head, a pillow under the knees and another under the lower part of the back.
Analgesics ( pain relievers) and anti-inflammatory drugs may be given in the acute stages. During this phase, a rigid brace or belt can also be used. Chronic pain ( pain that lasts for long) may be due to vertebral fracture or may result from forward or sideward bending changes in the spine, with inappropriate stretching of ligaments.
Extension exercises are recommended along with other exercises for the back. These are complemented with abdominal muscle strengthening exercises. Flexion ( forward bending) exercises are not recommended because they increase the compressive forces of the spine. Assistive devices such as walkers, canes, and wheelchairs eliminate the strain on the spine and reduce pain. General principles of pain management are given at the end of the book.
Management of fractures: This depends on the site of fracture. Fracture of neck of femur and that of the spine are the commonest fractures seen in osteoporosis and in both, plaster cannot be used. Usually some kind of surgical method has to be employed to put the parts in alignment and to keep them in place with nails or plates.
How to Manage the Psychological Reactions in Osteoporosis?
When a fracture leads to a diagnosis of osteoporosis, a sense of fear may set in of even routine activities which are likely to cause fractures. This fear leads to further limitation of activities that worsens the overall physical condition of the patient. there may be loss of sleep and diminished appetite. Patients may be deprived of their social life.
Chronic pain also leads to tension and worry. It might generate feeling of worthlessness resulting in loss of self-esteem. The pain drains so much emotional energy that patients have little left to manage the other symptoms. It should, therefore, be energetically managed with drugs, injections, braces, and exercises.
Patients should be helped to accept and internalize physical changes such as a ‘hump’ or ‘stoop’ . social support and psychological counseling is, therefore, crucial for all patients afflicted with severe osteoporosis.
In the next chapter, we will understand our spine.
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