OSTEOPOROSIS THERE IS SOMETHING YOU CAN DO ABOUT IT! FOCUS ON BRACING WITH THE SPINOMED SPINAL ORTHOSIS FOR OSTEOPOROSIS THE MEEKS METHOD that, someday in this country and, indeed, around the world, any person, no matter their age, gender, lifestyle, ethnicity, musculoskeletal condition or any other factor, that that person can go into any environment where exercise and movement are being taught and be given a program that is Ideally, it will also be therapeutic. Although there is more awareness now than when I began teaching 12 years ago, there is still a lot to be done. By taking this course, you will help me fulfill my dream. As you learn more about movement that is you can help me take the message of safety and therapeutic intent in movement and exercise into your own life and into the lives of others. WHAT IS THE MEEKS METHOD A COMPREHENSIVE 12-POINT PHYSICAL THERPY INTERVENTION Developed around a population of patients diagnosed with osteoporosis useful for many diagnoses designed with a primary objective of safety in movement from and for the bones--s.a.f.e.* *Skeletally Appropriate For Everyone Complements the use of the Spinomed Orthosis for Osteoporosis IS THE KEY 1
PATTERNS OF POSTURAL CHANGE ALIGNMENT INTERNAL PLUMB LINE Prevent, Arrest or Reverse 2000 SARA MEEKS SEMINARS PERCH POSTURE HIP HINGE STANDING POSTURE FUNCTIONAL MOVEMENT SIT-TO-STAND & STAND-TO-SIT SIT-TO-STAND CHAIR WWW.ENDORPHIN.COM Inability to stand up out of a chair unaided is linked to a 2 fold increase in hip fracture risk Cummings et al 1995 Weakness of lower extremities linked to impending physical frailty Judge et al 1996 Guralnik et al 1995 Low femoral neck bone mineral density is significantly associated with a low sit-to-stand performance assessed by measurement of maximum rising strength in healthy adult women. Blain et al 2008 F R O N T O F T H E B A C K B O N E PRINCIPLES OFTHEMEEKS METHOD JRF GRF Site Specific Exercise BRF UN LOAD the Vertebral Bodies FRONT of the Backbone DECOMPRESSION Single Best Exercise for Most Back Pain TENSILE FORCE 2
What IS OSTEOPOROSIS A musculoskeletal disorder with compromised bone strength that predisposes an individual to increased fracture risk NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 2001: 285:785 795 BONE STRENGTH Bone Density Bone Quality Architecture Mineralization Micro damage accumulation OSTEOPOROTIC BONE Milner, Colin. Making Bone Health A Priority. The Journal on Active Aging. May June 2002. NORMAL BONE PRIMARY CONSEQUENCE OF OSTEOPOROSIS IS FRACTURE PRIMARY OBJECTIVE OF THERAPY AND BRACING IS TO PREVENT FRACTURE OSTEOPOROSIS RELATED FRACTURE Occurs in 1 of 2 women; 1 of 4 men Happens every 20 seconds Can be immediately life altering and life threatening Annual Fracture Incidence Vertebral 700,000 Hip 300,000 Wrist 250,000 Other Sites 300,000 Cost >$46 million per day By 2020 >$178 million per day 3
VERTEBRAL BODY Bones of spine usually first to show signs of osteoporosis Primarily trabecular bone Fractures occur during movement that includes TRUNK FLEXION After one vertebral fracture, the risk for having a 2 nd vertebral fracture increases 5 fold! 1 woman in 5 will sustain a 2 nd vertebral fracture within 1 year Only 20-30% of all compression fractures are symptomatic 1 International Osteoporosis Foundation 2005 Report of the Surgeon General on Bone Health Oct 2004 1 www.nih.org accessed November 30, 2011 CLINICAL CONSEQUENCES OF SPINE FRACTURES SYMPTOMS SIGNS FUNCTION FUTURE RISKS Back Pain (acute/chronic) Sleep Disturbance Anxiety Depression Decreased Self Esteem Fear of future: Falls and Fractures Reduced Quality of Life Early Satiety Height Loss Kyphosis Decreased Lumbar Lordosis Protuberant Abdomen Reduced Lung Function Weight Loss Impaired ADL s Difficulty Fitting Clothes Difficulty Bending, Lifting, Descending Stairs, Cooking Increased Risk of Fracture Increased Risk of Death Source: Papaioannou et al. 2002. Reprinted from The American Journal of Medicine, Diagnosis and management of vertebral fractures in elderly adults.113(3):220 228 Bone Health and Osteoporosis A Report of the Surgeon General October 2004 COMPLICATIONS FROM COMPRESSION FRACTURES OF THE SPINE Constipation Bowel Obstruction Prolonged Inactivity Deep Venous Thrombosis Increased Osteoporosis Progressive Muscle Weakness Loss of Independence (Increase in Thoracic) Kyphosis Crowding of Internal Organs Atalectasis/Pneumonia Prolonged Pain Loss of Body Height Low Self Esteem Emotional & Social Problems Increased Nursing Home Admissions Mortality Old JL. Vertebral Compression Fractures in the Elderly Am Fam Phy Jan 2004 QUESTIONS VERTEBROPLASTY AND KYPHOPLASTY 4
THE PROCEDURES Ananthakrishnan et al. Clinical Biomechanics 20 (2005) 25-31 Vertebroplasty First Use 1995 Large bore needle to cannulate the pedicle(s), followed by injection of polymethylmethacrylate into the vertebral body Kyphoplasty First Use 2001 Large bore needle to cannulate the pedicle(s) Placement of inflatable balloon tamp within the vertebral body Balloon inflated under fluoroscopic visualization, which creates a void in the cancellous bone and elevates the endplate Procedure reduces some of the deformity and height loss associated with the fracture. Because specific void is created, injection pressure is lower and bone filler viscosity higher which likely reduces incidence of cement leakage Good immediate pain relief Immediate return to function RESULTS Improvement in both thoracic and lumbar spinal alignment Restoration of vertebral body height Adjacent fracture is a side effect and appears to be related to the condition and not to the procedure; higher rate of subsequent fractures compared with natural history for untreated fractures Cement augmentation places additional stress on adjacent levels; patients should be carefully evaluated for subsequent fractures 5
PHYSICAL THERAPY MANAGEMENT OF PATIENTS WITH VERTEBROPLASTY AND KYPHOPLASTY Generally the same as for patients with osteoporosis without surgical procedures Goal is prevention of further fracture Therapists should contact surgeons performing these procedures to inform them of the benefits of specific physical therapy intervention Bracing is part of a comprehensive approach to the management of patients with osteoporosis and/or compression fracture PURPOSES OF BRACING Support and protection Control of motion Prevent fracture Allow weight-bearing activities SPINOMED Spinal Orthosis for Osteoporosis Bracing usually associated with weakening of body part it is designed to protect Advantages of the Spinomed After Treatment No Brace After Treatment Clam Shell After Treatment Spinomed olightweight ocan be worn under clothing - inconspicuous oeasy to Don and Doff ostrengthens rather than weakens if the patient experiences discomfort from muscle activation, he/she may have to shorten wear time when first starting with the brace ocan be fit to very severe thoracic hyperkyphosis 6
Details of Fitting & Wear of the Spinomed omake sure the brace is long enough odo not cut the straps too early owear o When people are up and active, can also be worn when sitting but more benefit obtained when up and active o When walking, working out, as well as when puttering around the house, doing gardening, housework etc ofit is critical o o o o should conform exactly to curves of the back pelvic strap below iliac crests abdominal support in lower abdomen serpentine strap DOES NOT pull shoulders back Other Details of the Spinomed Backed up by a peer-reviewed research study Michael Pfeifer, Bettina Begerow, Helmut Minne 2004 Ordered by Physician Fit by Orthotist orthotist should make sure patient understands how to don/doff Spinomed before leaving the office Physician, Orthotist, Physical Therapist, & Patient work together for ultimate best fit and satisfaction Combine with The Meeks Method Exercises for optimum results Covered by Medicare BRACING (with the Spinomed brace) 2 Groups of Women with Osteoporosis and Compression Fracture 6 month trials with and without the brace Women who had been wearing the brace did not want to give it up Pfeifer, Begerow, and Minne 2004 BRACING with the Spinomed 73% Increase Back Extensor Strength 58% Increase Abdominal Strength 11% Decrease Thoracic Kyphosis 25% Decrease Body Sway 7% Increase Vital Capacity 38% Decrease in Pain 15% Increase in Well-Being 27% Decrease in Limitations ADL s Increase in Body Height Pfeifer, Begerow, and Minne 2004 BRACING WITH THE SPINOMED Spinal Orthosis for Osteoporosis The Spinomed orthosis is the single, most significant advancement in the conservative management of osteoporosis and compression fracture EVER. Sara M. Meeks, PT, MS, GCS Use of the Spinomed is part of the comprehensive approach of The Meeks Method Goal of Management is to Prevent the Next Fracture Protocol for Compression Fracture Management PROTOCOL FOR COMPRESSION FRACTURE MANAGEMENT Start early on day of fracture if possible UN-load the spine position in supine or as close to supine as possible, hips and knees bent and supported to relieve pull of leg muscles on the spine Position from least to most compression supine, sidelying, prone, standing Pain relief with positioning, ice, moist heat, electrical stimulation along erector spinae muscles Isometric Back Extensor, Gluteus Maximus, Abdominal Exercises NO OUT-OF-BED-TO-CHAIR ORDERS If seated, use reclined chair, avoid hammock effect Initiate weight-bearing with standing, weight shifting, gait training using rolling walker or other support as soon as possible Consider bracing with Spinomed-Spinal Orthosis for Osteoporosis 7
Thoracic Kyphosis JAMES Chan et al. Bulletin of the World Health Organization 2003, 81 (11) The World s Osteoporosis is Habitual Posture Best Posture Best Posture 1 Hour Later Ticking Best way to diffuse the world s OSTEOPOROSIS TIME BOMB is to THINK BONE!! TAKE ACTION NOW!! WHEN YOUR PATIENT FIRST COMES THROUGH THE DOOR BOTTOM LINE PREVENTION OF THE NEXT FRACTURE WHAT IS YOUR NEXT STEP 8
Mikki Raven Rosie For PDF s of PowerPoint (color) Presentation Slide on Compression Fracture Management Re Alignment Routine (beginning exercises of The Meeks Method) send email to sara@sarameekspt.com Reference list available through www.ptseminars.net Check website www.sarameekspt.com for more seminars by Sara Meeks, PT, MS, GCS Additionally, for books, DV D and other products designed to enhance your practice please visit www.sarameekspt.com QUESTIONS 9