5 Best Exercises following Vertebral Fracture

Vertebral compression fractures are fairly common fractures in older adults with osteoporosis, mostly seen in the junction of the thoracic and lumbar spine. A compression fracture occurs when one or more of the bones in your spine (vertebrae) collapse or become compressed due to injury or bone weakness. Often it is a complication secondary to osteoporosis and the risk of fracture increases with age, being female and post-menopausal. However, men over the age of 65 are also at risk of compression fracture. Typically, compression fractures can occur through trauma, infection, poor bone density or cancer.

Sometimes compression fractures are also called anterior wedge fractures, wedge fractures, collapsed vertebrae, osteoporotic vertebral fracture, or occasionally patients describe having a “crumbling spine” which is a term we don’t recommend is used.

Patients mostly complain of back pain after trauma such as a fall. You may find difficulty walking or standing and very rarely you might experience numbness or tingling in the arms or legs. In very rare cases bowel or bladder incontinence is possible if the fracture has affected the nerves that control these functions, however, in my experience I have never seen this and I’ve personally seen hundreds of compression fractures. The majority of compression fractures occur between T12 and L2 due to the forces exerted. In the presence of severe osteoporosis theses fracture can occur during the most unassuming things for example lifting a small object, a vigorous sneeze/cough or turning in bed. In patients that have moderate osteoporosis, fractures can occur with low velocity trauma such as falling from a chair or lifting a heavy object. Whereas patients that have no presence of osteoporosis require severe trauma such as a car accident or a fall from height.

In many cases vertebral compression fractures can be obscure and go unnoticed. If left untreated multiple fractures may occur in the spine. A loss vertebral height can also lead to a forward curvature of the spine known as kyphosis and a loss of height. In some cases, patients have a fall, get back pain, heal, and carry on with their lives as normal.

Vertebral compression fractures can be distinguished in three categories: wedge, biconcave and crush. Of these, the wedge fracture is the most common and happens when there is a force applied to the spine in a flexed position. The second most common is the biconcave fracture, where fractures occur in the middle portion of the vertebra. The least common are crush/compression fractures where most of the vertebral body has been compromised. Typically, the diagnosis of a fracture is confirmed by an X-ray, MRI or CT scan. It is very hard to identify a vertebral fracture by way of a physical examination. This is because the area which fractures cannot be directly palpated, and the tests for it are highly unreliable. X-ray or MRI is generally the best way to confirm diagnosis as mentioned earlier.

Treatment often involves rest, pain relief, back support (to reduce forward bending) and physiotherapy. Pain management can be gained through ice/heat packs or from medication (but be careful if you are a senior planning to take anti-inflammatories). The best solution for vertebral fractures is the engagement in physiotherapy. Physiotherapy is significant in restoring normal function, improving strength, balance and can improve bone density in people with osteoporosis, reducing the risk of future fractures. Back support bracing can be prescribed for six to eight weeks to help with pain. This depends on the severity however this may also affect your muscles in a negative way and increase stiffness.

In cases where the fracture is not responding to treatment a percutaneous vertebroplasty or balloon assisted kyphoplasty are common minimally invasive procedures used to improve symptoms. Vertebroplasty involves injecting liquid cement into the fractured vertebral body, this helps to improve the vertebral height. Kyphoplasty involves injecting a balloon into the vertebral body and inflating it to restore the vertebral height, an injection of liquid cement is then commenced to reduce pain. We are lucky to work with one of the world’s leading surgeons, Michael Kotrba, based at Shirley Oaks Hospital in South London, UK. Michael is a world-leading authority on kyphoplasty and vertebral fractures.

At Surrey Physio we approach these fractures with a rounded approach involving your GP and consultant. We use the most up to date evidence to ensure your recovery is optimised. We follow national guidance including Strong, Steady and Straight. We have experienced physiotherapist who work with you to achieve your goals and improve your function. As exercise is significant to improving your outcome, we have put together the best 5 exercises using our clever software. Please give them ago!!

Gently Improve Spinal Rotation

Sit upright on a chair, with your feet flat on the floor. Cross your arms over your shoulders. Gently rotate to one side. Repeat to the opposite side. This exercise is a great mobility exercise for the spine.

Try 10 reps 4-5 daily

Bird Dog for Seniors: Decompression

Position yourself on all fours on your bed, and keep good posture. Draw your tummy inwards (towards the ceiling). Lift your hand and opposite knee upwards, but always keep contact with the floor, so there is no weight going through them. Repeat each side. You will be surprised how well this works the deep abdominal muscles to improve core stability and control.

Hold for 3 seconds with 14 reps 3-4 times daily

Bruegger's Posture sitting

Sit on the edge of a chair, and open your legs and allow them to relax outwards. Keep your body and spine tall, lift the crown of your head towards the ceiling, and arch your lower back slightly. Turn your arms outwards so your palms are facing forwards, and draw your shoulder blades down and towards the midline. Make a gentle double chin with your head at the same time. Breathe deeply throughout. You will feel a stretch across your chest and front, as well as muscles working in your back, all helping to improve your posture.

Hold for 3 seconds with 14 reps 3-4 times daily

Arm Lifts Sitting

Sit upright with good posture. Lift both arms gently in front of you. Take your arms as far as feels comfortable. If you cannot get your arms above your head, just take your arms to your comfortable end of range. Slowly lower your arms. This will help mobilise your shoulders and upper back, and strengthen your arms.

Hold for 3 seconds with 14 reps 3-4 times daily

Back Pain Advice: Avoid Forward Bending

Be careful when you bend forwards! Repetitive forward bending can aggravate underlying disc problems. Keep your back straight and bend your knees to take a lot of strain off the spine.

Vertebral compressions fractures are a fairly common (and potentially problematic) condition that can cause acute severe back pain. They can also cause chronic lower back pain. Treatment may involve conservative options such as rest, pain medication and physiotherapy. More invasive procedures such as kyphoplasty may be necessary in some cases. If you think you may have some of the symptoms mentioned in this article please come and see us in clinic at Surrey Physio.

(Therapists: if you are reading this page, these videos are provided by Rehab My Patient – the best exercise prescription software for therapists to prescribe exercises www.rehabmypatient.com. Free trial available on their website. Patients: If you are a patient needing advice or a course of treatment, call Surrey Physio to book a telephone/video consultation with one of our expert physios or osteopaths, or book in face-to-face for an appointment. You can call us on 0208 685 6930 or book online by clicking the link at the top of the page).