The role of physiotherapy in the prevention and treatment of osteoporosis

doi:10.1054/math.2000.0369

Manual Therapy

Volume 5, Issue 4, November 2000, Pages 198-213

https://doi.org/10.1054/math.2000.0369 Get rights and content

Abstract

Osteoporosis is an increasing public health problem that causes loss of life and reduced quality of life in sufferers. Strategies to improve bone density and reduce the likelihood of falls are important in the prevention of osteoporosis. Physiotherapists have a role to play in this condition through exercise prescription, therapeutic modalities, specific techniques and education. Appropriate treatment goals can be established following a thorough assessment of signs and symptoms, risk factors for osteoporosis and functional status. Levels of bone density measured from dual energy X-ray absorptiometry can help guide patient management. Since the aim is to maximize peak bone mass in children and adolescents, participation in a variety of high-impact activities should be encouraged. In the middle adult years, small increases in bone mass may be achieved by structured weight-training and weight-bearing exercise. In the older adult years, particularly if osteopenia or osteoporosis is present, the aim is to conserve bone mass, reduce the risk of falls, promote extended posture, reduce pain, and improve mobility and function.

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Active and Passive ROM assessment is common practice in osteopathic practice. Specific areas for an osteopath to pay attention to in this cohort are: spinal ROM, as this can be a marker of spinal pathology; and also for restrictions in ankle dorsiflexion while weight bearing, which can be an indicator of an increased falls risk [74]. The identification of acute hip or wrist fracture in known osteoporosis may seem simple, care must be taken in order to reliably detect all relevant fractures in clinical practice.
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Rigid and Elastic scapular taping is used in physical rehabilitation of shoulder impingement syndrome (SIS). It is believed to reduce pain and normalise scapular movement patterns. However, there is insufficient evidence to support its use.
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Postural taping applied to the low back influences kinematics and EMG activity during patient transfer in physical therapists with chronic low back pain
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Postural taping is generally used to prevent unwanted trunk posture, especially in thoracic kyphosis. Previous studies demonstrated that postural taping with non-elastic tape applied to the upper back decreased thoracic kyphosis in a static posture (Bennell et al., 2000; Greig et al., 2008). Greig et al. (2008) suggested that the mechanical support provided by non-elastic tape may restrict the thoracic kyphosis posture, resulting in decreased thoracic kyphosis.
We examined the influence of the application of postural taping on the kinematics of the lumbo–pelvic–hip complex, electromyographic (EMG) activity of back extensor muscles, and the rating of perceived exertion (RPE) in the low back during patient transfer. In total, 19 male physical therapists with chronic low back pain performed patient transfers with and without the application of postural taping on the low back. The kinematics of the lumbo–pelvic–hip complex and EMG activity of the erector spinae were recorded using a synchronized 3-D motion capture system and surface EMG. RPE was measured using Borg’s CR-10 scale. Differences in kinematic data, EMG activity, and RPE between the two conditions were analyzed using a paired t-test. Peak angle and range of motion (ROM) of lumbar flexion, EMG activity of the erector spinae, and RPE decreased significantly, while peak angle and ROM of pelvic anterior tilt and hip flexion increased significantly during patient transfer under the postural taping condition versus no taping (p < 0.05). These findings suggest that postural taping can change back extensor muscle activity and RPE as well as the kinematics of the lumbo–pelvic–hip complex in physical therapists with chronic low back pain during patient transfer.
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Scapular taping is frequently used in the management of shoulder pain and as a part of injury prevention strategies in sports. It is believed to alter scapular kinematics and restore normal motion. However, there is little evidence to support its use. The aim of the study was to investigate the effect of shoulder taping on the scapular kinematics of asymptomatic subjects.
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These studies report decreased thoracic kyphosis in association with reduced back extensor muscle activity, and positive effects on pain, mobility, and quality of life. Postural taping is used by physiotherapists in conjunction with exercise to manage individuals with increased thoracic kyphosis (Bennell et al., 2000). Like spinal orthoses, postural taping aims to decrease forward curvature of the spine, reduce pain associated with thoracic kyphosis, and facilitate activity of the postural muscles in a more optimal spinal position.
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Fifteen women with osteoporotic vertebral fractures participated in this within-participant design study. Three taping conditions were randomly applied: therapeutic taping, control taping and no taping. Angle of thoracic kyphosis was measured after each condition. Force plate-derived balance parameters and trunk muscle electromyographic activity (EMG) were recorded during three static standing tasks of 40 s duration.
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View all citing articles on Scopus

^☆: BappSc (Physio), PhD, Associate Professor and Director, Centre for Sports Medicine Research and Education, School of Physiotherapy, University of Melbourne, Australia, Karim Khan MD, PhD, Assistant Professor, Department of Family Practice (Sports Medicine) & School of Human Kinetics, University of British Columbia, Heather McKay, PhD, Associate Professor, School of Human Kinetics, University of British Columbia, Vancouver, Canada.

^f2: Correspondence to KB, School of Physiotherapy, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia. Tel.:+61 3 8344 4171; Fax: +61 3 8344 4188.

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MasterclassThe role of physiotherapy in the prevention and treatment of osteoporosis☆

Abstract

Bone

Australian Journal of Physiotherapy

Bone

Endocrinology and Metabolism Clinics of North America

Archives of Physical Medicine and Rehabilitation

Journal of Pediatrics

Trends in Endocrinology and Metabolism

Lancet

Lancet

Australian and New Zealand Journal of Public Health

Lancet

Lancet

Journal of Biomechanics

Lancet

Journal of Biomechanics

Archives of Physical Medicine and Rehabilitation

Medicine and Science in Sports and Exercise

Medicine and Science for Sports and Exercise

Effects of 1–week head-down tilt bed rest on bone formation and the calcium endocrine system

Aviation, Space, and Environmental Medicine

The Saskatchewan pediatric bone mineral accrual study-bone mineral acquisition during the growing years

International Journal of Sports Medicine

A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: The University of Saskatchewan bone mineral accrual study

Journal of Bone and Mineral Research

Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts

Journal of Bone and Mineral Research

Increase in femoral bone density in young women following high impact exercise

Osteoporosis International

Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise

Journal of Bone and Mineral Research

Continuous loss of bone during chronic immobilization: a monozygotic twin study

Osteoporosis International

Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women

Osteoporosis International

Moderate exercise during growth in prepubertal boys—changes in bone mass, size, volumetric density, and bone strength—a controlled prospective study

Journal of Bone and Mineral Research

Impact of a 12-month exercise program on the physical and psychological health of osteopenic women

Journal of the American Geriatrics Society

Muscular strength and physical function

Medicine and Science in Sports and Exercise

The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults

Journal of Gerontology.

Risk factors for falls in a community-based prospective study of people 70 years and older

Journal of Gerontology

Falls prevention over 2 years: a randomized controlled trial in women 80 years and older

Age and Ageing

Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women

British Medical Journal

Physiotherapy Guidelines for the Management of Osteoporosis

Relationship of kyphosis to physical fitness and bone mass on post-menopausal women

American Journal of Physical Medicine

A study of the clinical test of sensory interaction and balance

Physical Therapy

Bone mineral density in elite junior Olympic weight lifters

Medicine and Science in Sports and Exercise

American Journal of Medicine

Childhood growth, physical activity and peak bone mass in women

Journal of Bone and Mineral Research

The influence of thoracic posture and movement on range of arm elevation

Physiotherapy Theory and Practice

Prevalence of kyphosis in a healthy sample of pre- and postmenopausal women

American Journal of Physical Medicine & Rehabilitation

Effect of exercise on bone: permissive influence of estrogen and calcium

Medicine and Science in Sports and Exercise

Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women

Annals of Internal Medicine

Bone mineral content of amenorrheic and eumenorrheic athletes

The New England Journal of Medicine. 311

Functional reach: a new clinical measure of balance

Journal of Gerontology

Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis

Age and Ageing

Correlates of kyphosis in older women

Journal of the American Geriatrics Society

High-intensity training in nonagenarians

Journal of the American Medical Association

Exercise training and nutritional supplementation for physical frailty in very elderly people

New England Journal of Medicine

Masterclass
The role of physiotherapy in the prevention and treatment of osteoporosis☆