Stress Lifestyle and Osteoporosis

Transcription

1 Stress Lifestyle and Osteoporosis Veridiana Piovezana Moreira December 01, 2017 Pretoria, South Africa

2 Abstract Certain aspects of current life such as: making a living in a very competitive society, being multitask, long working hours, less leisure hours, less physical activities, overload of information, increase of population and more chaotic life in cities, etc. Became too demanding on many of us. A huge part of world population has a stressful lifestyle which is the cause of many diseases. The case study in this paper is a male client who lives a high stress lifestyle. He has a demanding job and he works overtime almost every day, having very little time for himself. For being in this situation for several years, he neglected his health for a long period and end up with health issues. He suffers from depression, has fatigue posture and is very underweight. One of the reasons why he sought out for Pilates sessions was the fact that he became very unfit. In the past, he was a very active person and his goal was to regain that condition. However, after a few Pilates sessions, his body awareness increased and he realized that he had to look after his health better. After some appointments with a dietician and doctors he was diagnosed with osteopenia to osteoporosis. From that point on, I planned a modified Basi Pilates Block System program for him. Stress Lifestyle and Osteoporosis 1

3 Table of Contents Abstract... 1 Introduction... 3 What Is Osteoporosis?... 3 Causes of Osteoporosis... 4 Highest Areas of Risk Fracture... 4 A Question of Lifestyle... 5 Anatomical description... 6 Two Types of Bone... 6 Case Study... 7 Conditioning Program... 9 Conclusion Bibliography Stress Lifestyle and Osteoporosis 2

4 Introduction What Is Osteoporosis? Osteoporosis is the gradual and silent loss of bone and not a normal aging process. It is defined as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture (NOF 2005). Osteopenia is mildly reduced bone mass--a loss of approximately 10%-20%--indicating the onset of osteoporosis. Patients who have their bone mineral density (BMD) tested receive a T-score, which tells them how their BMD compares with that of a young adult (25-30 years old). A standard deviation (SD) of -1 to -2.5 below the mean indicates osteopenia. An SD of more than -2.5 indicates osteoporosis. For every 1-point SD drop below the mean, fracture risk doubles. The World Health Organization did not recognize osteoporosis as a disease until Since it is not only a newly recognized illness but also a silent one (bone loss stays hidden until we see its effects through changes such as height loss or kyphosis), our lack of awareness is one of its biggest allies. This lack exists even in the medical field. Studies have found that physicians too commonly fail to diagnose and treat osteoporosis, even in elderly patients who have suffered a fracture (Andrade et al. 2003; Kiebzak et al. 2002; Feldstein et al. 2003). Persons with osteoporosis usually discover bone loss insidiously. Sometimes they find that their pants are too long; or relatives notice that they are shrinking in height, they re developing a dowager s hump or their arms look longer. Other persons complain of waistline pain (caused when the ribs sit on the iliac crests), mid-back pain or neck pain. Hip pain is not common with osteoporosis and is present only after a fracture. 50% of all women over the age of 50 and 25% of men over the age of 65 suffer from osteoporosis-related spine or wrist fracture during their lives. One in every two women over the age of 50 who walk into your Pilates class, has low bone density and it is a risk of fracture. Research has shown that given the fragility of the vertebra, most fractures are caused by the stress of everyday life. As the disease progresses, bones can become so vulnerable that fractures can occur spontaneously through very simple daily tasks like feeding the cat or even coughing or sneezing. Stress Lifestyle and Osteoporosis 3

5 Causes of Osteoporosis - Being Female - Exposure to radiation - Aging - Rheumatoid arthritis - Eating disorder - Type 1 diabetes - Low calcium dietary intake - Genetics Family history of osteoporosis - Insufficient vitamin D - Being thin or underweight - Impaired neuromuscular function - Being white or Asian - Amenorrhea Loss of menstrual cycle - Insufficient Physical activity - Stress - Over activity elite and endurance athletes - Chemotherapy - Smoking - Medications containing steroids - Carbonate drinks - Excessive amounts of alcohol - Menopause induced hormonal changes low estrogen high Testosterone - Some medications used to treat under active thyroid, asthma, arthritis, lupus, anti-seizure and reflux - Metabolism problem that do not allow the body to take in and use enough vitamins and minerals Highest Areas of Risk Fracture - Wrist - Neck of femur from a fall - Thoracic spine T6-T8 - Lumbar spine L4-S1 from compression Stress Lifestyle and Osteoporosis 4

6 A Question of Lifestyle Evidence suggests that lifestyle is a major culprit. Studies have found that Americans do not engage in enough physical activity, are becoming obese and do not take in enough nutrients to support good bone health (Wright et al. 2003, Gordon-Larson et al. 1999). Researchers working on the China-Oxford-Cornell Project studied rural Chinese farm families for incidence of osteoporosis, heart disease and cancer and found that even with low calcium intake the incidence of these diseases was extremely low (Hu et al. 1994; Campbell 2005). In contrast, the researchers found a positive correlation between urbanized cultures and these illnesses, which Campbell has even dubbed diseases of affluence (Campbell 2005). Nowadays, we base our habits of daily living on convenience and time management. We have computers for shopping; TVs to entertain us; and microwaves, washing machines, elevators, escalators, cars and high-tech devices to save time and to make our lives more efficient. But more efficiency means we are increasingly sedentary, and sedentary living is bad for our bones. We walk less, we bear less weight, and we do less physical labor. In short, our high-tech labor-saving lifestyle is destroying our bones! Stress Lifestyle and Osteoporosis 5

7 Anatomical description Two Types of Bone Bone is alive and continuously changing, remodeling itself, storing minerals, forming blood cells and providing a strong and hopefully stable structure that can protect organs and to which muscles and ligaments can attach. There are two main types of bone, cortical and trabecular. Cortical bone is arranged in long, parallel, compact lines and found in the long bones of the femur, tibia, humerus, radius and ulna. Trabecular, or cancellous, bone is sponge-like and found in the vertebral bodies, in the neck of the femur (hip) and at the joint surfaces of all bones. Trabecular bone has an 80% faster metabolic turnover rate than cortical bone and is affected to a much greater degree by osteoporosis. Luckily, trabecular bone makes up only 20% of our total skeletal mass, whereas cortical bone makes up the other 80%. Two cell types are at work in our bones: osteoblasts (bone builders ) and osteoclasts (bone cleaners ). In the healthy skeleton, these two cell types are continuously working in sync, with osteoclasts breaking down old bone and osteoblasts replacing it with new bone. In someone with osteoporosis, however, the osteoclasts continue to break down old bone, while the osteoblasts get lazy. Bone breaks down more quickly than it is remodeled, and over time, bone mass and density decrease. While modern medicine offers significant benefits for those at risk for osteoporosis, studies clearly suggest that individuals can do a great deal to promote their own bone health. Engaging in regular weight-bearing exercise, following a bone-healthy diet and avoiding behaviors such as smoking and drinking excessive amounts of alcohol can all contribute to strong, healthy bones (HHS 2004). Stress Lifestyle and Osteoporosis 6

8 Case Study Stefano is a 57 years old male client. He works extensive hours a day and overtime almost every day. He also travels long distances by car several times a week due to his job. He skips meals because of lack of time in his very hectic work schedule. He came to my studio looking for physical activity. In the past, he was a very active person but he has been sedentary for the last 20 years. He felt unfit. Also, he wanted to alleviate the tension of his lifestyle having a time for himself. He decided for the one-on-one session format. After a few Pilates sessions, his body awareness increased and he realized that his body mass was too low. Once diet advising was out of my attribution scope, I advised him to look for a professional. He had an appointment with a dietician who did an extensive assessment on him. The results showed that his Body Mass Index (BMI) was under normal and his Body Composition Analysis showed a loss in bone mass. A density bone exam was recommended, which he did soon after. The results showed that he was in osteopenia to osteoporosis in several body parts and had mild wedge deformity in the T8 vertebra. From that moment on, I changed his program to a modified Block System. The goals were changed and the priority was the osteoporosis condition. Though I had been working his faulty posture from the beginning, it was also included in the new program. Program focus was on: Posture Breathing Neutral spine Correct body mechanics Balance Weight bearing exercises Resistance training Cardio vascular exercises Upper back extensors Medially rotated shoulders Chin profusion Arm strengthening Counter rotation exercises Flexibility Stress Lifestyle and Osteoporosis 7

9 The exercises to be avoided: Uncontrolled dynamic movements Plyometric exercises Flexion of spine from any position Seated stretches with spinal flexion Spinal flexion with rotation or spinal lateral flexion Applied pressure onto the ribcage and spine Stress Lifestyle and Osteoporosis 8

10 Conditioning Program Warm up: Mat 1. Pelvic curl on wall 2. Spine twist supine in a counter manner 3. Leg lift 4. Leg changes Roll down, chest lift, chest lift rotation excluded as part of the avoided movements Foot work: Reformer 1. Parallel heel and toes 2. V-Position toes 3. Open V-Heels and toes 4. Calf raises 5. Prances 6. Single leg heels and toes An increase of resistance was made gradually through the sessions aiming a muscle hypertrophy Abdominal work: Reformer 1. Hundred head down 2. Flat back on short box All abdominal work that not involved spinal flexion or could be modified to head down As alternative: - Dead bug - Double leg head down - Single leg head down Hip work: Cadillac 1. Frog 2. Circles down/up 3. Walking 4. Bicycle Stress Lifestyle and Osteoporosis 9

11 Spinal Articulation As spinal articulation exercises involve spinal flexion, this block session was replaced by safer exercises such as: 1. Cat stretch 2. Pelvic curl against wall 3. Pelvic clock on ball (performed with a small range) Stretches: Ladder barrel 1. Shoulder stretch 1 2. Shoulder stretch 2 These two stretches promote external rotation of shoulders. Also, they open the chest stretching the related muscles in the area. FBI (F/I): Reformer 1. Elephant The L shape in the hip joint is a very important position for the osteoporotic client in their daily routine. Also, the hamstrings are stretched, which is very important for those with fatigue posture. Amr work: Ped-A-Pull 1. Arms standing series a. Extension b. Adduction c. Circles up/down d. Triceps Arm standing series is a weight bearing exercise performed in a neutral spine. Also, involves resistance. Optimal for osteoporosis. FBI (A/M): It will not be appropriate for Stefano until he reaches the advanced level of competency in the Pilates repertoire. Stress Lifestyle and Osteoporosis 10

12 Leg work: Reformer and Chair 1. Jumping series reformer a. Parallel feet b. V-Position c. Single leg d. Changes 2. Chair a. Leg press standing There are few reasons for a more extensive leg work o Jumps are a great form of cardio vascular high impact exercise in block system o Leg press standing involves balance conditioning o Both exercises focus in big group of muscles strengthening which is valuable for bone mass increase Lateral Flexion/Rotation: This block must be avoided or replaced by counter rotation exercises such as: 1. Super woman/man (4 points kneeling) 2. Hip up or hip walking (standing or sitting) 3. Spine twist counter Back extension: Chair 1. Back extension basic 2. Swan on floor Both exercises contemplate an emphasis in upper back strengthen also helping with arm strengthen. Stress Lifestyle and Osteoporosis 11

13 Conclusion The positive impact of Basi Pilates program in Stefano s life was very quick. During the sessions, he was having the opportunity to focus on himself for the first time in many years. He was amazed with all the possibilities and benefits he could obtain through Pilates and he adhered to the program entirely. Therefore, within few sessions, he was more aware about his body and recognized some actions that had to be taken for the better of his health. That is what he did. He has been treated by a doctor for the osteoporosis and he is under a diet plan given by the dietician. He understands better the role that physical activities play in his life and he is taking it more seriously. He attends Pilates sessions twice a week and alternates these with outdoor walking or gym cardio sessions. It is a great improvement for someone that was sedentary for almost 20 years. In my opinion, besides the physical contribution to his life, Pilates also contributes to a change in his mind. Not only for the fact that he has opened space in his schedule to the physical activities but also the fact that he is re-evaluating his lifestyle. He is even considering to look for a less stressing job! Stress Lifestyle and Osteoporosis 12

14 Bibliography - Sherri R. Betz. PT ( IDEA - APTA American Physical Therapy Association ( - Robert Proulx Heaney G. Donals Whedon Bone. Encyclopedia Britannica Online ( - Rebekah Rotstein ( - Pilates for Osteoporosis Presented by Ashley Ritchie Stress Lifestyle and Osteoporosis 13