Pilates Exercises for Individuals

with Osteoporosis

Cassandra Terpening PT, DPT

Chris Rieger PT

Upstate University Hospital

July 23, 2018

Content of Program
 Quick stats on Osteoporosis
 Why exercise is important
 Learn Pilates Principles
 Learn and practice Pilates exercises
 Learn how to make Pilates safe with necessary
modifications to avoid positions that are known to
cause fractures
 Fast Facts
 Osteoporotic bone is more likely to fracture than
healthy bone
 1 in 2 women and 1 in 4 men over age 50 will
break a bone due to Osteoporosis
 Osteoporosis is diagnosed with a DEXA (dual energy
x-ray absorptiometry)
 T score -1.0 or above is normal bone density
 T-score between -1.0 and -2.5 means you have low bone
density or osteopenia
 T-score of -2.5 or below is a diagnosis of osteoporosis
 The lower the T score the lower the bone density
National Osteoporosis Recommends Bone
Density testing if…
 you are a woman age 65 or older
 you are a man age 70 or older
 you break a bone after age 50
 you are a woman of menopausal age with risk factors
 you are a postmenopausal woman under age 65 with risk
factors
 you are a man age 50-69 with risk factors

A bone density test may also be necessary if you have any of the
following:
 an X-ray of your spine showing a break or bone loss in your
spine
 back pain with a possible break in your spine
 height loss of ½ inch or more within one year
 total height loss of 1½ inches from your original height
Its never too late to strengthen your bones!
 Goals of exercise
 Safely strengthen the muscles in your arms, legs and
core
 Stretch muscles as needed to improve/maintain good
posture
 Weight bearing exercise can strengthen the bone
 Putting pressure through the bone can increase bone strength
Things to focus on to help keep our bodies
moving…
 Balance

 Leg strength

 Hip extension

 Thoracic extension
 Pilates
• Pilates is a Method of precise exercise and
physical movement coupled with breathing
patterns designed to stretch, strengthen and
balance the body (www.pilatesmethodalliance.org)
Developed by Joseph Pilates
• A lot of the exercises focus on the core postural
muscles
• Keeps the body balanced
• With some modifications Pilates exercises can be
safely done by those with osteoporosis
 Benefits of Pilates
 Postural awareness and Alignment may help to prevent spinal
fractures

 Pilates exercises in standing are weight bearing, using body

weight for resistance can strengthen bones of the hip

 Pilates exercises on your stomach position strengthen the

back extensor muscles targeting the spinal vertebrae
(Sinaki 1984, 1986, 2002, 2009, Briggs 2004)

 Balance exercises may prevent falls

 Exercise decreases stress hormones that typically increase

bone loss

 Exercise in bare feet stimulates proprioceptors to give better

sensory feedback to our brain for balance reactions
(Koepsell TD et al 2004, Sinaki 1984,1986, 2002, 2009)
Improves Posture
Go from this posture
To
This posture
Weight bearing activity
Exercise modifications are needed when
doing Pilates if you have Osteoporosis
 Exercising is safe if done properly
 Pilates exercises typically involve a lot of flexion
(bending forward) which can cause compression
fracture but the exercises can be modified to avoid
this

 For example roll downs, teaser, curl ups (full list of

exercises to avoid are at the end of this
presentation)
 Avoid excessive spine flexion
 Flexion is the action of bending forward or being bent
(https://www.google.com/#q=flexion&spf=1496234869050)

 Forceful flexion may cause compression

fracture because of the forces through
the vertebrae
Avoid Flexion during exercise- bending
forward through the spine
No sit ups, crunches, never pull on your
neck, don’t tuck chin to chest
 Precaution Continued

 Avoid excessive rotation of the spine

 Do not perform a full twist in the upright position
 Do not force rotation into pain
 May be okay in lying if NO pain occurs

NO!

This is not safe if you

This is ok if not painful, do
have low bone density
not force the movement (www.pilatesanytime.com)
 Precautions Continued

 Avoid heavy lifting overhead

 Can cause excessive compression through the spine
 Avoid jarring through the spine or buttock
 Be cautious with exercises that challenge your balance
 Use external support as necessary
 For example touch wall, back of chair
Does This Look Safe?
 Hopefully you all said NO!

 Toe touches with straight legs can cause undue stress

on the spine
 With decreased bone density this can result in a
fracture of the spine
 Most fractures associated with osteoporosis occur in
the spine and hip, but any bone can be affected
 Spine, hip and wrist are the most common bones broken
Most fragile position for the spine
Stott Pilates 5 Basic Principles
 Breathing

 Head and cervical spine position

 Scapular placement

 Pelvic placement

 Rib cage placement

 Importance of Breath

 Pilates uses breath to coordinate the deep abdominals

and obtain good recruitment of the muscles
 Instructions for each exercise include how to breathe

 Lets practice this now because it is so important!

Breathing in Sitting

Start in your normal seated position.

Elongate spine and lift the sternum and hold.
This will correct posture, decrease stresses
on the spine
Breathing
 In through nose, out
thru mouth with pursed
lips
 Emphasize 3D breath
into lower, posterior
lobes of the lungs
 Deep breathing
promotes engagement
of the transverse
abdominis
 Ribs open up and out
during inhalation, close
in and down during
exhalation
Head and Cervical Placement
 Always maintain natural
curve of neck
 During exercise allow
neck to follow the rest of
the spine
 When flexing neck only a
head nod should be
performed
 Move the head on the first
two vertebrae (tuck chin)
 This will dynamically
stabilize neck and protect it
 May require pillow under
your head to keep head in
line with spine
Pelvic Placement
• In neutral, natural
lumbar lordotic curve is
present
– Absorbs shock well
– Promotes efficient
movement patterns
– Used when feet are
planted
• Imprint is a slight
posterior pelvic tilt with
lumbar flexion
– Used to gain stability
– Used when legs are up
Rib cage placement

Abdominal muscles attach to the lower ribs. A good contraction of the deep
abdominals will keep the ribs from lifting up or “popping”. Think of
maintaining a sense of weight in your ribs during the exercises.
Scapular Movement and Stabilization
 During exercise maintaining scapular stability is
important to maintain balance in the area
 Impaired scapular stability will cause muscles in the neck
and back to work too much
 Scapula can move…
 Up and down
 Forward and back

 Lets practice
 Warmup
 Breathing
 Imprint and release
 Hip release
 Hip rolls
 Scapula isolation
 Arm circles
 Head nods

 Turn the principles into a warm up to get the body

ready for more difficult movements
The Exercises
Modified Hundred

 Head will remain on the

mat- no flexion
 Legs can be in table top
or feet can be on the floor
 If feet flat on floor position
low back in neutral, if feet
are up imprint- engage
abdominals with both
 Inhale and pulse arms for
a 5 count then exhale for
a 5 count
 Repeat until you reach
100 beats
To make the hundred more difficult try…
Modified Single Leg Stretch

 Start with head down, legs

in table top, hands resting
on outside of knees
 Exhale, extend one leg out
to diagonal moving outside
hand to ankle, inside hand
to knee of bent leg
 Inhale, begin to switch legs
 Exhale, extend the other
leg
 Repeat for 8-10 repetitions
One Leg Circle

 Neutral spine, one leg long

and the other reaching
toward the ceiling
 Move leg in circular motion,
moving across body then
away
 Move leg only as much as
you can keep pelvis still
 Inhale first part of circle,
exhale to finish
 Circle 5 times each
direction, perform with both
legs
Modified Scissors

 Start with head down,

both legs extended toward
ceiling
 Exhale, reach one leg
down toward floor and
draw the other closer to
the body for 2 counts
 Inhale, start to switch legs
 Exhale and repeat with
other leg reaching toward
the floor
 8-10 repetitions
Slow double leg stretch
•Inhale to prepare
•Exhale to extend the legs out and move the arms overhead
•Inhale bring the legs back in and circle the arms back to your sides
Shoulder Bridge Prep

 Start lying on you back

with knees bent, feet
hips width apart
 Inhale to prepare
 Exhale, stabilize pelvis
and maintain neutral
spine while lifting hips
off mat
 Inhale, stay
 Exhale, place pelvis
back onto mat
 Repeat 4-6 times
To make the Shoulder Bridge more difficult…

www.pilatesanytime.com
Breast Stroke Prep 1

 Start lying on stomach,

hands on floor just above
shoulders
 Inhale to prepare
 Exhale, stabilize scapulae
and apply pressure through
forearms
 Lengthen the neck and
upper back
 Inhale stay
 Exhale, lengthen back down
to mat
 Repeat 3-5 times
Overhead View of Starting Position
Breast Stroke Prep 2

 Start with hands by hips

 Inhale, open front of
shoulders and stabilize
shoulder blades
 Exhale, reach fingertips
towards your toes and
extend upper back
 Inhale stay
 Exhale lengthen back
down to mat
 Repeat 3-5 times
Breast Stroke Prep 3

 Start with arms bent,

hands under forehead
 Inhale to prepare
 Exhale, reach top of
head away from toes
and extend upper body
up off mat
 Inhale, suspend
 Exhale, lengthen back
down to mat
 Repeat 3-5 times
Breast Stroke

 Start in same position as

breast stroke prep 1
 Exhale, stabilize scapula and
reach arms forward
 Inhale, circle arms out to
sides while extending thoracic
and cervical spine
 Bottom rib should remain in
contact with floor
 To transition to next repetition,
bend elbows and reach hands
to overhead position
 Repeat 5-8 times
Side Kick

 Start side-lying with

spine in neutral, legs
slightly forward, top leg
lifted
 Inhale for 2 counts
while flexing top hip
and reaching foot
forward
 Exhale, extend hip and
reach leg back
 Repeat 8-10 times on
each side
Side Leg Lift 1-hip abduction

 Start side-lying with

body in straight line,
neutral spine
 Inhale, lift top leg with
the foot pointed
 Exhale, flex foot and
bring top leg down to
bottom leg
Side Leg Lift 2-leg lift with circles

 Inhale, reach top leg up

as far as able while
maintaining pelvis
stability
 Exhale, circle top leg
back
 Inhale to finish the circle
 Repeat 5-10 times then
reverse circle and
complete 5-10 times
 Breathing is more rapid
than in leg lift 1
Side Leg Lift 3-lift top leg then lower leg

 Inhale, lift top leg as far

as stability can be
maintained
 Exhale, lift bottom leg to
meet the top leg, then
lower both legs together
 Repeat 5-10 times
Single Leg Extension
 Start lying on stomach,
body long, hands under
forehead
 Inhale to prepare
 Exhale, reach one leg off
mat
 Inhale, lower leg
 Exhale, reach other leg off
mat
 Inhale, lower leg
 Repeat 6-8 times with
each leg
 If you cant lie flat on the
floor position yourself over
pillows
Swan Dive Prep

 Start on stomach, elbows

bent, hands by shoulders,
legs shoulder width apart
and turned out, head
hovering mat
 Inhale stay
 Exhale extend spine as far
as able without loosing
abdominal or scapular
stabilization
 Inhale stay
 Exhale, place chest down
 Repeat 5-8 times
Swan dive
 Perform the prep but as you lower your body down
the hips extend and the legs lift up
Leg Pull Front Prep

 Start on hands and knees,

spine and pelvis neutral,
knees under hips, legs
together
 Inhale stay
 Exhale squeeze knees
together and lift knees off
mat ~2 inches
 Inhale Stay
 Exhale, lower knees to
mat
 Repeat 3-6 times
Plank
 Inhale to prepare
 Exhale to lift the hips up
off the table while
drawing the belly button
toward the spine
 Hold to fatigue while
breathing as needed
 Repeat 5 times
Plank on knees
Plank on Forearms
Push Up Prep

 Start in push up
position, legs together,
feet on or off mat
 Inhale for 3 counts,
flexing elbows more
with each count
 Exhale, straighten
elbows
 Repeat 2-3 times
To make the Push Up more difficult…

www.pilatesanytime.com
 Spine Twist

 Inhale to prepare
 Exhale to slowly drop
Knees out to the side
Moving only as far as is
Comfortable
This is OK
 Inhale stay
 Exhale while moving knees back to start position

This is not safe if

you have low bone
denisty
Sliding Down the Wall
Position with your back on the
wall, feet one foot distance from
the wall and legs hips width apart

Inhale to bend the knees so that

the body slides down the wall- be
sure to keep the knees apart

Exhale while pressing through the

legs to move the body back to the
start position
Squats
 Inhale to prepare
 Exhale to bend the
knees
 Inhale to return to
standing
 Repeat 10-20 times
One legged stance
 Inhale to prepare
 Exhale to shift your weight
to the right leg and
balance
 Hold as long as possible
while using a normal
breathing pattern with
your deep abdominals
engage
 Repeat to the other side
 Stand near something to
use for support as needed
to avoid falling
Heel raise
 Inhale to prepare
 Exhale raise up onto
your toes
 Inhale to lower
 Repeat 20 times
If you take a Pilates Class here are some
names of exercises to avoid…

 Roll up  Bicycle
 Roll over  Boomerang
 Rolling like a ball  Twist part of advanced
 Open leg rocker Side Bend
 Corkscrew  Seal
 Saw  Rocking
 Neck pull  Control Balance
 Scissors  Crab
 Teaser
Here is what some of these look like…

corkscrew Open leg rocker

Teaser
 Summary

 Stretching and strengthening is beneficial for

individuals with Osteoporosis
 Pilates can be done safely by those with Osteoporosis
if modified
 As with any exercise, avoid spine flexion and exercise
safely
 Be careful and do only what you are capable of
 Start slow if these exercises are new to you
 Do not force any movement and modify exercises as
needed
 Thank You!

 The end
 Questions?