Pilates and Osteoporosis

What is osteoporosis and how does Pilates help?

At its most simple, Osteoporosis basically means brittle bone. Bone is naturally porous, and is a living tissue that is simultaneously being made by certain cells, while being broken down others. Up until around the age of 30, the rate at which bone is being made is greater than it is being broken down. After around 30, the rate it is broken down slowly exceeds the rate at which it is made. This gradually results in our bones becoming more hollow and brittle over time.

https://opentextbc.ca/anatomyandphysiology/chapter/6-6-exercise-nutrition-hormones-and-bone-tissue/

As you can see from the graph above, men generally lay down more bone than women, and women are also impacted by the hormonal change around menopause, accelerating the decline in bone mass. But in understanding why we have bone, we can start to understand how best to maintain it. The bones provide the structural framework from which our musculature can attached. Bones are often shaped by the muscles that are attached to them, and by how much and how strongly they are used. That’s why bones around our hips and thick and strong, as we have our big hip muscles attached to them. Compare this to our thin ribs, which have muscles running between them that are much smaller and less often pulled on at a maximum capacity. We also have long and thick arm and leg bones because we regularly transmit force through them when walking, running and using our arms - and this force vibrating up the bones also stimulates the cells to lay down more bone. But in areas that don’t get used very often, the muscles don’t pull on them or they don’t get much vibration so they don’t get encouraged to lay down as much bone as regularly.

Maintaining bone strength

The best thing we can all do to maximise bone growth is to get lots of sunlight which provides us with Vitamin D, a key ingredient for our body in absorbing other vitamins and minerals. This is supported by eating a healthy diet rich in seafood healthy fats. We also need to live an active lifestyle, which mean’s we have to participate in exercise that uses our body weight such as walking, running, hiking, and upper body related activities. It is also recommended to participate in weight-lifting exercises or similar - this creates an exaggeration of our own body weight, and has been shown to have a fantastic impact on maintaining bone density. This is due to the reaction of how your body absorbs the forces coming up through our body as it overcomes the task at hand against gravity, stimulating the brain to lay down more bone and strengthen areas of the are directly under load. With this in mind, it’s integral that we do multiple activities, rather than just one to ensure we are providing varied stimulus to our bodies, to strengthen as many different areas as possible. Without this stimulation, the body just goes in to autopilot and will lay down minimal bone. There are also risk factors that make you more vulnerable, which can be found be reading this article by the Mayo Clinic.

So where does Pilates come in to this?

Up until we start heading in to our 50’s and 60’s, it provides an opportunity to build your general strength and flexibility in the body. Pilates provides a fantastically diverse way of looking at the body, and providing many ways to challenge it which ticks the box for load variability; and it also helps connect them all together through coordination and concentration, so your reactions and reflexes are well organised. Having a strong, reactive and flexible body will serve you very well as you age!

https://www.aranahillsphysiotherapy.com/post/osteoporosis-and-your-t-score-what-does-it-mean

However, as you age and particularly as you start to get towards 60+ years old, it pays to start getting regular bone density scans, called a DEXA scan. There are key markers we keep an eye on to monitor how thick your bones are (called a T-Score), as once they start to decline to certain levels, we have to change how we work with you. The three stages we look at are Normal bone density, Low bone density or Osteopenia, and Osteoporosis. Follow this link if you’d like to understand this more. Once there becomes a diagnosed decline towards low bone density, Pilates can actually be contraindicated in some aspects, due to its high reliance on flexion based activities potentially creating what are called Silent Fractures in the vertebral column. Due to this, a good Pilates practitioner will no longer encourage loaded spinal flexion, instead focusing on gentle spinal mobility in extension and rotation patterns.

Pilates and Osteopenia/porosis

But where some aspects of Pilates are risky for those with Osteopenia/porosis, the many area’s it can be beneficial include: balance and stability work, flexibility in the other areas of the body, and controlled strengthening work. Being in an environment that has the mixed equipment to provide support, but also resistance where necessary will still encourage the body to lay down bone at a rate that will slow down the break down of bone. Finding ways to challenge balance and stability where you can still safely grab a hold of stable structures trains the body to be ready to react when caught off guard. And maintain flexibility in the areas near the spine ensures the spine doesn’t have to be put in compromising positions unexpectedly.

So in summary, Pilates provides a fantastic support for your body while you’re younger, although you need to keep up weight bearing exercises as much as possible, for as long as possible to help lay down bone for later in life. Once you’re diagnosed as lower bone mass, then there are precautions you need to take but again, you must stay active to keep stimulating the body to lay down bone. Pilates can provide an excellent environment to challenge yourself without compromising your bone structures, as well as training your reflexes. So be sure to keep up your Pilates and keep being active!