Joints and bones

Osteoporosis: what to load, and what to leave

The guidance for osteoporosis is more specific than avoid bending: back strengthening and spinal extension are recommended, and it is loaded end-range flexion that is held back.

What it is

Osteoporosis means bone has become less dense and more porous, so it fractures more easily than it would otherwise. It is silent until something breaks, which is why it is usually found through a scan rather than through symptoms. The spine, hip and wrist are the common fracture sites, and vertebral fractures in particular can happen through ordinary loading rather than through a fall.

How it behaves day to day

On its own it causes nothing you can feel. What people notice, when they notice anything, follows a vertebral fracture: height loss, an increasingly rounded upper back, or back pain that arrives without an obvious event. The practical daily consequence is usually caution, and caution that goes too far has its own cost, because muscle and balance are exactly what protect against falls.

What tends to feed it

• ·Repeated or loaded end-of-range forward bending, particularly with a twist
• ·Long periods of inactivity, which cost both muscle and bone
• ·Falls risk that goes unaddressed, which is the main route to a fracture

What the research recommends

The clearest practical statement is the UK consensus, Strong, Steady and Straight, endorsed by the Royal Osteoporosis Society and published in the British Journal of Sports Medicine in 2022. It is worth being precise about what it says, because it is routinely simplified into avoid all bending. It recommends exercises to improve muscle strength in the back to improve posture and support the spine, with spinal extension exercise held for three to five seconds, three to five repetitions, at least twice a week. It recommends moderate impact on most days for people without a vertebral fracture. The caution it describes is about sustained, repeated, end-range and loaded flexion, not about every movement in which the spine bends at all. Earlier work by Sinaki established the same shape: back extensor strengthening reduced subsequent vertebral fracture rates, while a flexion-based programme did not.

Sources

1. 1
   Strong, Steady and Straight, UK consensus statement on physical activity and exercise for osteoporosis (Brooke-Wavell et al., BJSM 2022)

   Back muscle strengthening and spinal extension exercise are recommended, held 3 to 5 seconds, 3 to 5 repetitions, at least twice weekly, alongside moderate impact for those without vertebral fracture.

Where Vinys is different

• ·Vinys distinguishes loaded end-range bending from supported and passive positions, instead of removing every forward-bending movement. A blanket rule removes a large part of the library, including gentle supported positions that no guideline asks anyone to give up.
• ·Extension and back strengthening are actively promoted for a bone profile rather than merely permitted, which is the direction the consensus statement points.
• ·Supported balance work is included, because falls are the route to most fractures, and balance is trainable.
• ·The bone profile is kept separate from the menopause profile. They are not the same thing, and treating them as one suppresses higher-energy work that a bone profile actually wants.
• ·Where yoga meets physiotherapy: the extension and strengthening are prescribed like rehab, and the rest of the session still feels like a practice.

A short session to try

1. 1

   Cobra, minimal lift · Hold 3 to 5 seconds, 5 times

   Spinal extension against gravity, at the dose the consensus statement describes.

2. 2

   Locust, arms alongside body · Hold 3 to 5 seconds, 5 times

   Back extensor strengthening, the specific work associated with fewer subsequent vertebral fractures.

3. 3

   Bird-Dog · 5 each side

   Trains the back and deep support with the spine held still rather than bent.

4. 4

   Wall angels · 8 slow reps

   Upper back and shoulder work, aimed at the rounding that follows vertebral change.

5. 5

   Heel raise · 10 to 12 reps

   Loads the legs and trains the ankle strength that balance depends on.

Movements often used for this

Sessions for this lean on the stability / core and balance families in the library. These are the ones most likely to appear, not a prescription: your own session is built from your answers on the day.

Common questions

Speak to your clinician before starting if you have had a fragility fracture, particularly in the spine, or if you have sudden new back pain, which can be the first sign of a vertebral fracture.

Also called low bone density, osteopenia, brittle bones, bone loss. Movements are drawn from the clinically authored Vinys library, and the guidance above is sourced to the publications listed. This page is general movement information, not medical advice, and it is not a diagnosis. How the method works.

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