Pilates and Exercise for Osteoporosis

Rebekah Rotstein on Prevention and Safe Pilates Exercises for Osteoporosis

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Exercise for osteoporosis is a confusing subject. There are exercises for prevention, exercises for rehab, and safety concerns for exercise if you have osteoporosis. Pilates is a form of exercise that is often mentioned with regard to osteoporosis. But in Pilates, there are definite parameters as far as what exercises are appropriate for osteoporosis.

You must have strong bones that can bear your weight and allow you mobility. But you really need to know what you are doing when you use exercise to prevent or live with osteoporosis. Rebekah Rotstein helps clarify the role of exercise, Pilates, and Pilates equipment for osteoporosis and bone strengthening.

Rebekah Rotstein is an expert in osteoporosis, bone health, and Pilates. She is the founder of Incorporating Movement, a Pilates and movement education organization, and the designer of the Pilates for Buff Bones workout. Rebekah is also an educator for the Foundation for Osteoporosis Research and Education.

Weight-Bearing Exercise Helps Osteoporosis

Rotstein explains how weight-bearing exercise plays a role in preventing osteoporosis. "Bone is dynamic tissue, like a muscle, that strengthens in response to forces it has to resist. Gravity is one such force, and working against gravity is what we refer to when speaking of weight-bearing exercise."

But she notes there is more at work than gravity, "The combination of compression and tension from gravity and from your muscles plays a major role in bone strengthening. But the prevention of osteoporosis also comes from impact like jumping or running where the bone is loaded to an extent that it has to accommodate these forces, basically reinforcing itself to sustain future forces." She also points out that if you have the extremely low bone density or you have already experienced a fracture, the high impact could be contraindicated.

Weight-Bearing Exercises vs. Resistance Exercises

Weight-bearing exercises are technically anything done standing. Rotstein would also include the quadruped Pilates exercise, which is done on the hands and knees since you bear the weight of your trunk through your hands and transmit forces via your wrists. "The wrists are a critical site to strengthen because they are the most common site of osteoporotic fractures, along with the spine and hip," says Rotstein.

"Resistance exercises simply involve muscles pulling on the bone to create tension which also fortifies the bone. The resistance can come from weights, elastic bands, or springs. But you can also consider your own body weight as resistance in some instances, like a push-up. In this example, you're using gravity and your own body weight to provide resistance and induce muscle pull."

Rotstein notes that the best formula for bone strengthening, in addition to high-impact exercises, occurs where you combine weight-bearing with resistance training. She says weighted squats, or using an elastic band while standing or performing standing lat pulls, would be good additions to a bone workout regimen.

Is Pilates Enough to Prevent Osteoporosis?

Pilates is a wonderful means for strengthening the body, establishing efficient movement patterns, and aligning the joints and the axial skeleton, according to Rotstein. But she notes that your bones need additional loading to prevent osteoporosis as well as the general bone loss that naturally occurs with age. "This loading comes from weights, squats and high impact exercises like running and jumping. You need to move in new ways and to 'surprise' the bone, as some researchers are now saying. Bone tissue gets lazy so we need to keep it on its toes. We need to move in differing directions and at different speeds to encourage the bone to continue to strengthen."

Pilates to Prevent Falls

She says that Pilates is an invaluable tool to complement bone-loading techniques and to prevent injuries and falls. "We have to remember that the real danger with osteoporosis is the devastating falls that can induce a fracture. Pilates, with its emphasis on posture, alignment and balance as well as full body integrated movements, offers a fantastic platform when combined with other functional (upright), impact-based and resistance exercise." She says that Pilates also establishes a good form for weight training so that the forces best transmit through a well-aligned spine and hips. Other healthy lifestyle habits include proper nutrition to mineralize the bones.

Pilates Exercise Program for Prevention of Osteoporosis

Rotstein says a Pilates osteoporosis-prevention program needs to include sufficient back strengthening (spinal extension and scapular stability) as well as hip and wrist strengthening. She made these elements the basis of her Pilates for Buff Bones program.

"I often see Pilates classes and sessions emphasizing spinal articulation at the expense of the shoulders, back, and hips. I recommend re-evaluating your programming to be sure that the back gets attention—and specifically the upper thoracic." She says that many people cheat by relying on their lumbar spine for the extension.

"That upper back strength has been shown to improve balance and reduce the risk of falls. And, of course, core control is integral in order to achieve that upper back extension. More standing should occur near the end of the workout too to make the work functional, integrating the feet, and for additional weight-bearing."

Using Pilates Equipment When You Have Osteoporosis

Rotstein says the Pilates equipment is valuable for those with osteoporosis because the springs provide the resistance needed for bone strengthening and offer limitless movement possibilities, both within the classical repertoire and beyond. She says a chair is a great machine for weight-bearing functional exercises.

Pilates Movements to Avoid With Osteoporosis

Rotstein says those with osteoporosis should avoid spinal flexion (forward bending)—especially when it's loaded like in rolling like a ball and short spine (where the back bends forward with mid-upper spine bearing the body weight). "They should also avoid motions that incorporate flexion with side bending and rotation. Any side bending should emphasize a lengthening of the spine rather than pure side-bending which many exaggerate and collapse into flexing as well without realizing it. The key is to off-load the front, or anterior portion, of the vertebral body [spine]."

Best Pilates Exercises for People With Osteoporosis

Rotstein recommends side, front and back splits on the reformer (as appropriate for the client's level) since they're weight-bearing and improve balance, just like the standing leg pumps and mountain climber on the wunda chair. She says pulling straps on the reformer is great for the back and shoulders, as are the swan on the chair and Cadillac.

Some exercises good for those with osteoporosis are weight bearing and some include resistance from the Pilates ring or exercise band. They do not include flexion (forward bending) or side bending with rotation. Anyone with osteoporosis should do Pilates or any exercise with an instructor trained in exercise appropriate for osteoporosis.

Rebekah Rotstein teaches a full osteoporosis-safe workout on her DVD "Pilates for Buff Bones."

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  • Rotstein, Rebekah. Interview. October 2010.