What is a vertebral compression fracture?
According to the Mayo Clinic, compression fractures occur when your vertebrae (the bones in your spine) weaken to the point of failure. This can cause back pain, loss of height, and a hunched over posture (Mayo Clinic, 2021).
How common are vertebral compression fractures?
Vertebral compression fractures are the most common type of fracture resulting from osteoporosis, affecting over 700,000 Americans annually (McCarthy, 2016). Vertebral compression fractures affect 25% of postmenopausal women older than 50 years of age and 40% of women by age 80. A new vertebral compression fracture occurs every 22 seconds worldwide. The annual incidence of vertebral compression fractures is close to 1.5 million, and the estimated direct annual health care cost of managing osteoporotic spine and hip fractures is $10 to $15 billion (Goldstein, 2015).
What are risk factors for vertebral compression fractures?
Risk factors for vertebral compression fractures include osteopenia, osteoporosis, older age, a history of a previous vertebral compression fracture or falls, inactivity, use of corticosteroids, weight less than 117 lbs, female sex, consumption of greater than 2 alcoholic drinks per day in females or greater than 3 in males, smoking, vitamin D deficiency, and depression (McCarthy, 2016).
Why should you be worried about vertebral compression fractures?
Compression fractures are associated with significant morbidity and mortality. Compression fractures may cause height loss or posture that is stooped or hunched (Bone Health & Osteoporosis Foundation, 2018). They can also cause pain, reduced mobility and independence, as well as psychological distress. In addition, the long-term mortality of patients with a history of a vertebral compression fracture is significantly higher than the general population (Goldstein, 2015). Patients with vertebral compression fractures have a five-fold increased risk of future vertebral compression fractures and a two to three-fold increased risk of fractures at other sites (Bone Health & Osteoporosis Foundation, 2018).
What can you do to help prevent compression fractures?
Performing your everyday activities in a safe way can help prevent compression fractures by decreasing the load on your spine. Here are some tips for safe performance of your activities of daily living:
- Always maintain proper posture, with your head stacked over your shoulders and your shoulders stacked over your hips. You should sit and stand with a neutral spine position, being careful to avoid slouched, or bent over, postures.
- Avoid spinal flexion (bending over) during your everyday activities. Instead, bend at your hips and knees, keeping your spine straight. For example, when you bend forward to brush your teeth, bend from your hips with your back straight rather than bending your back.
- Avoid spinal rotation during your everyday activities. Move your feet when you need to turn rather than twisting your back.
- When lifting, make sure you bring objects close to your body, bend at your hips and knees rather than your back, and avoid lifting heavy loads.
In addition, appropriate postural exercises can help decrease your risk of vertebral compression fractures (Bone Health & Osteoporosis Foundation, 2018). For example, back extensor strengthening can improve strength and bone density and reduce the risk of future vertebral compression fractures (McCarthy, 2016). Proper posture and back extensor strengthening exercises are part of Wellen’s personalized exercise programs for osteoporosis.
Exercises to prevent compression fractures
As mentioned above, postural exercises can help you improve spinal alignment, reducing your risk of developing spinal compression fractures. Here are 5 examples of exercises to prevent compression fractures, pulled right from Wellen's exercise library:
1) Standing isometric thoracic extension against wall
Purpose: This exercise activates your thoracic spinal extensors -- muscles that help keep your upper back and shoulders upright and prevent the spine from rounding forward.
How to do it:
- Stand with your back against a wall.
- Bring your feet about a foot away from the wall with your knees slightly bent so that your entire back is flat against the wall.
- Gradually press into the wall with your shoulders, as if you are trying to arch your mid back. You should feel the muscles in your mid-back contracting.
- Hold the position for 5 seconds, and then relax.
- Repeat for 5 to 10 reps.
Tips:
- This is an isometric exercise, so you won’t actually be moving through any range-of-motion.
- Avoid holding your breath.
2) Standing scapular retraction
Purpose: This exercise is designed to strengthen the muscles between your shoulder blades, leading to improved posture and decreased stress on your neck, shoulders and upper back.
How to do it:
- Stand with your feet hip width apart.
- Begin with good alignment, with your shoulders stacked on top of your hips.
- Imagine that a string is pulling you upward, lengthening your spine.
- When ready, squeeze your shoulder blades together.
- You can pretend that you are trying to squeeze a pencil between your shoulder blades.
- Hold this position for 5 seconds, then relax.
- Repeat for 2 sets of 10 repetitions.
Tips:
- Make sure the movement is coming from your shoulder blade muscles.
- Keep your lower abdominal muscles engaged, and avoid arching your low back or puffing your chest out as you perform the movement.
3) Standing alignment
Purpose: Standing with proper posture helps to decrease stress on your spine and joints. Having good standing alignment is the foundation of safely performing many exercises. Having proper alignment will help you avoid excessive flexion, or rounding, of your upper and mid-back, which will can help reduce your risk of compression fractures.
How to do it:
- Get into a comfortable standing position with your feet about hip width apart. You can use a mirror if you find it helpful.
- Imagine you have a string pulling you up from the top of your head, lengthening your spine.
- At the same time, push the floor away with your feet as you imagine yourself growing taller.
- Gently squeeze your shoulder blades together, making sure you are not arching your low back as you do so.
Tips:
- Keep your lower abdominals engaged, and do not arch your low back excessively as you try to stand tall.
4) Horizontal shoulder abduction with band
Purpose: This exercise helps strengthen your shoulder and upper back muscles -- both of which are important for preventing forward, rounded shoulders and poor spinal alignment. Targeting these muscles helps promote good posture.
How to do it:
- Stand tall with your feet hip width apart.
- Hold a resistance band with both arms straight out in front of you with your elbows extended.
- Your arms should be at about a 90 degree angle to your body and your palms should be facing up, and shoulder-width apart.
- Keeping your arms straight and at chest level, pull the band out to the sides with both arms as far as is comfortable while squeezing your shoulder blades together.
- You can extend your arms until they are out to your sides in line with your shoulders, but don’t go beyond that.
- Think about squeezing your shoulder blades together at the end of the movement.
- Then slowly return to your starting position.
- Repeat for 2 sets of 10 repetitions.
Tips:
- If it’s possible for you, you can extend until your arms are out to your sides in line with your shoulders, but don’t go beyond that.
- You want to get a good retraction of your shoulder blades without flaring your rib cage.
- Be careful not to round your shoulders or lift your shoulders as you are doing this exercise. Your shoulder blades should just be squeezing back.
- Keep your arms straight and level throughout the movement. Don’t bend your elbows or allow your arms to move up or down.
- Your spine should stay in a neutral position.
5) Quadruped alternate shoulder flexion and hip extension
Purpose: This exercise helps address muscles in the shoulder, hip and core, while focusing on good spinal alignment. Strengthening the muscles behind the body by lifting them against gravity is a great way to improve postural strength and awareness.
How to do it:
- Start on your hands and knees.
- Your hands should be directly below your shoulders, and your knees should be directly below your hips.
- Your back should be neutral as if forming a tabletop.
- Engage your lower abdominal muscles and elevate one arm forward and the opposite leg backward. Your thumb should be pointed up toward the ceiling.
- Hold this position for 5 to 10 seconds, then return to the starting position.
- Repeat with the other arm and leg.
- Alternate so that you do 1 set of 5 on each side. Then rest for 30 seconds and begin a 2nd set of 5 on each side.
Tips:
- Make sure you do not arch or twist your back as you do this exercise.
Exercises to avoid if I have a compression fracture
Just as there are exercises you should do to prevent compression fractures, there are also certain types of exercises and movements to avoid if you have a compression fracture. For starters, having one compression fracture means you are at risk for developing other compression fractures, so here is a list of exercises to avoid if you have a compression fracture:
- Jumping or high-impact activities: Jumping and other high-impact activities such as running can put an increased force through the spinal bones, which may increase your risk of fractures. Stick to low-impact exercises and activities to be safe. If you're not sure what's best for you, check with your doctor.
- Bending or twisting exercises: Bending or rounding forward at the spine, and twisting movements, can all increase your risk of spinal compression fractures. It is best to avoid exercises that involve twisting or rounding of the spine to protect it from fractures.
- Extreme extension: While some extension (arching rather than flexing or rounding forward) is ok, you don't want to go into excessive extension such as back bridges or certain yoga poses. These can put the spinal bones in a more vulnerable position.
Concerns about vertebral compression fractures
If you are concerned about vertebral compression fractures, or worry you might have one, make sure you speak with your doctor to determine if any further testing needs to be done. But don't worry -- it's never too late to prevent future fractures and start working towards stronger bones.
