Safe Core Exercises for Osteoporosis

Core exercises are crucial for everyone, but they are especially important for people with osteoporosis. They help strengthen the muscles around the spine and abdomen, which are vital for maintaining balance, stability, and overall function, and they can help protect your body during everyday activities such as lifting grandchildren, stair climbing, and carrying heavy groceries. While it might not seem directly related, core strength also plays a large role in protecting people with low bone density from osteoporotic fractures by helping to maintain balance, minimize falls and risk of fractures, and improve spine health and trunk stability.

There are many core strengthening exercises out there, but not all are appropriate for people with low bone density. So how do you determine which core exercises are safe for people with osteoporosis? Keep reading to learn more.

What makes a core exercise for osteoporosis safe?

Safety is key when it comes to core exercises for people with osteoporosis. But what makes a core exercise safe or unsafe? It all comes down to a few key guidelines, which we’ll outline below. By following these simple rules – in addition to listening to your body and following any guidelines set out for you by your healthcare provider or physical therapist – you can stay fit and strong while reducing your risk of injuries and fractures.

1. Avoid flexion and twisting

First and foremost, it's important to steer clear of excessive spinal flexion (forward bending) and twisting (rotation), as these movements can cause compression fractures in weakened vertebrae (spinal bones) (Mayo Clinic, 2021). Certain core exercises, like crunches and sit-ups, involve rapid spinal flexion and should be avoided by people with low bone density (Bone Health and Osteoporosis Foundation, 2018). While these are common and familiar core exercises for many people, they put an excessive amount of stress on the anterior portion of your spinal bones, which can lead to fractures in people with weakened bones.

But don’t worry – there are plenty of other core exercises that can keep you strong and safe. Try different types of exercises where you can maintain a neutral spine throughout the exercise. This simple adjustment will benefit your spine health rather than harm it.

2. Move slowly to maintain control

Emphasizing slow, controlled movements not only encourages proper form but also minimizes the risk of injury. Fast or jerky motions can lead to poor form and increase your chance of fracturing. If you are new to an exercise, be sure to take the time to learn how to do it with proper form and positioning before doing multiple repetitions. 

Even though strength training and resistance exercises are good for your bones, exercises that are too difficult, involve too much weight, or too strong of a resistance band can also strain your core and surrounding muscles. A safe core exercise should offer modifications or alternatives to cater to beginner to advanced fitness levels and consider how your body can move.

This flexibility allows you to progress at your own pace while keeping injuries at bay. And last but not least, remember the importance of gradual progression. Start with lower intensity exercises and build up slowly to avoid overloading your muscles and bones and avoid injury.

Core exercises for people with osteoporosis

Without further ado, here are 6 core exercises from the Wellen exercise library that are safe for people with osteoporosis or osteopenia. Each of the exercises below are low-impact and involve maintaining a neutral spine – both of which are foundations for safe exercises for your core. Read on to learn more about each one.

1. Diaphragmatic breathing

Diaphragmatic breathing may sound like just a breathing exercise. However, in addition to helping with overall body relaxation, this exercise helps facilitate proper coordination of the diaphragm. The abdominal and pelvic floor muscles work together to form the 360-degree core that helps with trunk stability and balance.

How to do it:

• Get into a comfortable position lying on your back with both knees bent and your feet flat on the floor. 
• Place your hands on your belly or the sides of your rib cage to monitor for expansion when you inhale.
• Take a slow, deep breath in through your nose, and feel your belly rise toward the ceiling and your rib cage expand outward to the sides. 
• Try to perform your inhalation over a count of 3 to 5 seconds if possible. If you can’t initially perform the breath this slowly, you can gradually increase the amount of time it takes you to inhale with practice. 
• Then gradually release your breath out through your mouth as you notice your belly flatten toward your spine and your ribs return to their starting position. Your exhalation should also be performed over 3 to 5 seconds. Performing this exercise slowly will enhance overall body relaxation.
• Be sure not to arch your low back off the floor during inhalation.
• Repeat for 5 to 10 breaths.

2. Supine marching

Supine marching (also known as supine alternate lower extremity march) is another core exercise that can be performed in the supine (or lying down) position with a neutral spine. It is designed to strengthen and improve the recruitment of your lower abdominal muscles, which provide support for your low back.

How to do it:

• Begin lying on a mat with your knees bent and feet flat on the floor. 
• Place your fingers on your lower abdominal muscles just inside of your hip bones so you can feel when they are contracting.
• Tighten your lower abdominal muscles and slowly lift one knee up toward the ceiling like you are marching, then lower your foot back to the starting position.
• Repeat on the other side.
• Be sure not to arch your back off the ground as you lift your knee, and do not let your pelvis rotate as you lift your leg.
• Breathe normally.
• Repeat for 5 repetitions on each side (a total of 10 lifts). 

3. Plank

A standard plank is an excellent but challenging full-body exercise. Not only does it target the core, but it also helps improve strength in the shoulders, arms, and hips. But it’s not for everyone. Remember, if you have pain in your wrists or if a standard plank is too hard, you can always modify it. As an alternative, try an incline plank, which is still an effective trunk stabilizing exercise that can ultimately protect the spine and help improve posture. 

How to do it:

• Start on your hands and knees, with your elbows straight and both hands on the floor shoulder-width apart.
• Slowly reach your feet back one at a time, lifting off of your knees, and pushing up onto your hands in the process. 
• Your entire body should be supported by your hands and toes. 
• Make sure your spine is long, your belly is drawn in, and your elbows are straight. 
• Continue to push the floor away from you with your hands.
• Hold this static position for 15 to 30 seconds.Then relax.
• Repeat 2-3 times. 

4. Eccentric single leg bridge

Eccentric single leg bridge strengthens the core muscles that support your lumbar spine, including your lower abdominals and lower back muscles. As a bonus, it also strengthens your hip muscles, including the glutes and hamstrings. This type of bridge exercise is a progression from the standard bridge exercise and is a little more challenging for the hips and core. Feel free to stick with your standard bridge if it is too challenging. However, if you’re up for a challenge, give it a try!

How to do it: 

• Start by lying on your back with your knees bent and feet flat on the floor and hip-width apart. Your arms should be down by your sides with your palms facing down.
• Slowly lift your hips up toward the ceiling as high as you comfortably can. You ideally want your body to form a straight line from your knees to your shoulders at the top of your bridge.
• At the top of your bridge, lift one knee up toward the ceiling like you are marching. Slowly lower your hips back down to the starting position. Then return your foot back down to the starting position.
• Repeat this movement on one leg for 10 repetitions, then switch to the other side.
• Be careful not to lift your hips so high that you feel discomfort or pain in your lower back.
• Make sure your pelvis stays level as you perform this exercise. Do not let it rotate. You may place your hands on your hip bones to monitor your pelvis for motion.

5. Quadruped alternate hip extension

Quadruped alternate hip extension is a full-body exercise that targets the core while strengthening the muscles and bones of the upper body and hips.

How to do it:

• Begin by getting into a hands and knees position. Your hands should be directly below your shoulders, and your knees should be directly below your hips. 
• Make sure your spine is in a neutral position, as if forming a tabletop.
• Engage your lower abdominal muscles and elevate one leg straight backwards.
• Hold this position for 5 seconds, then return to the starting position and repeat with the other leg.
• Make sure you do not arch or twist your back as you do this exercise.

6. Modified side plank

Your core is not just the abdominal muscles that line the front of your abdomen – some of the muscles wrap around your body at an angle. The side plank helps target some of those other core muscles, called the oblique muscles, which help provide multi-directional support for your trunk.

How to do it: 

• Begin lying on your side, propped up on one forearm. Your knees should be bent so that your feet are in line with your hips.
• Place the top hand on your top hip and slowly lift your bottom hip off the ground as you engage your abdominal muscles. 
• Hold for 5-10 seconds, then slowly lower down.
• As you do this exercise, make sure you stay long through your spine and neck. 
• Do not twist your torso – your top hip is stacked directly over your bottom hip, and your top shoulder is stacked directly over your bottom shoulder. 
• Breathe normally as you hold. 
• Repeat for 2 to 3 reps on each side.

Now that you have a list of core exercises that are safe for people with osteoporosis to get you started, consider signing up for Wellen’s comprehensive personalized exercise program, which incorporates safe and effective core exercises as well as weight-bearing, resistance training, and other general strengthening exercises for the entire the body into every workout. Improved strength, balance, and posture await you!