What to do for osteoporosis?


5 Pilates Exercises for Osteoporosis

Osteoporosis, derived from the term “porous bones,” means having low bone mass or brittle bones. The condition, which occurs in over 50 million Americans alone, can lead to fractures and breaks, mostly in the spine and hips. Caution is key, even for mild conditions, including Osteopenia (the pre-cursor to Osteoporosis).

For an Osteoporosis-safe Pilates Mat workout, avoid forward and loaded Flexion, and focus on extension (bending slightly backwards, not forwards) and hinging from the hip with flat back instead.

Get started with these five Osteoporosis-safe Pilates exercises for seniors, and watch our program on Bone Health for more Pilates exercises and tips on building strong bones.

Single Leg Kick

Strenghten back extensors (the muscles attached to your spine that faciliate lifting and standing), while strengthening hamstrings and glutes.

Double Leg Kick

Create extension in the thoracic spine (upper back), and open the chest while engaging glutes, abdominals, and stretching the shoulder girdle.

Shoulder Bridge

Strengthen your glutes and hamstrings; engage your triceps. Precaution: Plank up to bridge, plank down to the Mat, and avoid rolling the spine down.

Modification: If you are not yet strong enough to lower and lift your legs, pulse your hips to the ceiling, while engaging the glutes.

Leg Kicks

Stabilization of the powerhouse and to strengthen the glutes, hips, abdominals, and back extensors.


Lengthen your spine and engage your abdominals and glutes.

Osteoporosis and Pilates

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By Rebekah Rotstein

As baby boomers segue from child-rearing to retirement, they find themselves bombarded by the media with information about osteoporosis. It makes sense, considering that more than 44 million American men and women age 50 and older have osteoporosis or its precursor, osteopenia. So between news articles about calcium and vitamin D, Sally Field promoting the drug Boniva on TV commercials and the now-ubiquitous term “weight-bearing exercise,” we are all hearing a great deal about this epidemic.

Yet controversy abounds, with new findings questioning the benefits of calcium as well as the risks versus benefits of osteoporosis medications. The conflicting information is enough to overwhelm even the most media-savvy consumer. But the one continuously advocated method of addressing the condition is exercise. Not only does exercise help to maintain and build strong bones, but it can improve balance and reflexes and thereby prevent falls, the most dangerous threat to those with fragile bones. According to the International Osteoporosis Foundation, 60 percent of those who fracture a hip still cannot walk independently a year later. Clearly, the goal should be to stay strong, agile and upright.

As Pilates has gained recognition in the medical and mainstream realms as a beneficial form of exercise to address every concern from back pain to love-handles, boomers have jumped on the bandwagon. Specifically, many have heard that Pilates can be a great bone-strengthening addition to a fitness regimen. But beware – traditional Pilates, especially when done in a mat class (on the floor) involves an excess of motion for the spine that can actually INDUCE spinal fractures. In fact, 75 percent of Pilates mat exercises are contraindicated – advised AGAINST – for those with osteoporosis and osteopenia. Why is that? A 1984 Mayo Clinic study determined that flexing the spine (forward bending) can result in vertebral fractures, the type that lead to loss of height and eventually even to a “dowager’s hump.” Those who have taken a Pilates class know that most of the exercises involve lifting your head off the ground while lying on your back and rolling up and down.

So why would people recommend Pilates? One emphasis within Pilates is the alignment of the body – elongating the spine and aligning it with the pelvis, hips, legs, feet, shoulders and head. What better way to combat slouching than to focus on posture and spinal decompression? Additionally, breathing and concentration are pivotal to every exercise. If you are more “grounded” and centered in your mind, your body will respond accordingly and you may even be less likely to trip. Furthermore, balance and control play a large role in the Pilates repertoire, regardless of whether you are on the mat or using the machines. Pilates is a whole-body experience and promotes symmetry of the musculature along with proper body mechanics. Along those lines, all exercises emphasize “the core” – the deep stabilizing muscles of the lower back and pelvis, including the deepest layer of abdominals. When those are strong and can support the body, there is less effort to maintain an upright (or non-upright) position and also less risk of falling.

So should you avoid Pilates if you have osteoporosis or osteopenia? Certainly not. But you may be best to attend a mat class that is geared toward those with the condition. At least, avoid the rolling exercises or ones that involve front or side bending and rotation of the spine. Also, while lying on your back, keep your head on the ground, perhaps with a small towel underneath, when others are lifting their heads off the mat.

On the positive side, all exercises done lying on your side or stomach, as well as on hands and knees, are excellent to do. Just inform the instructor before class of your situation. Additionally, private Pilates sessions are outstanding for those with osteoporosis and osteopenia for the reasons mentioned above as well for the increase in flexibility. We simply need to be aware of necessary modifications to this popular exercise form. The benefits of Pilates are numerous and great – let’s just be sure to stick to safe movement.

Pilates instructor Rebekah Rotstein is the founder of Incorporating Movement and is a member of the teacher training faculty at the Kane School of Core Integration in New York City.

Ever think of your bones in terms of architecture? Well, health professionals do — bone is a living tissue that is constantly breaking down and rebuilding. Diseases that change bone architecture, such as osteoporosis, spell trouble.

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“In osteoporosis, more bone gets broken down than built up,” explains physical therapist Maribeth Gibbon, PT. “Osteoporosis is a major health concern. Half of all women and one-quarter of all men over age 50 will have a fracture caused by osteoporosis in their lifetime.”

Fortunately, exercise done properly can help to rebuild bone and reduce the likelihood of fracture, says Ms. Gibbon. Here are her recommendations for people with osteoporosis who have not had a fracture:

Cardiovascular conditioning

Cardiovascular workouts should involve bearing weight. “So walking, jogging and dancing are preferable to swimming or biking,” she says. It’s also important to dial up your exercise intensity.

  • To see improvements in bone density, heighten the intensity of your normal walking pace. “Increasing your pace for short intervals or going up and down hills will place appropriate forces on your bones,” she notes.
  • Alternating higher-intensity exercises two to three days a week with lower-intensity activities four to five days a week is most effective.

Strengthening exercises

Work with free weights, use weight machines at the gym or do floor exercises to gain strength. “Recent studies have confirmed that it’s important to lift enough weight to stimulate bone growth,” Ms. Gibbon says. “Therefore, you will need to do fewer reps with heavier weights.”

  • Most of us don’t lift as much weight as we could. To determine how much weight you should be lifting, search for a “1-Rep Max” calculator available on many websites. Then aim for 70 to 80 percent of your 1 Rep Max.
  • Remember that exercise is site-specific. So target the areas most prone to fracture: spine, hips and wrists.
  • Weight training is recommended two to three times a week.
  • Strengthen your spinal extensor muscles, which lie over the spine, to improve posture and reduce fracture risk by doing the following exercise daily:
  • Stomp your feet to increase bone density in your hips. Do four stomps on each foot twice a day using enough pressure to crush a can.


Lengthening tight muscles will reduce back pain, and promote good spinal mechanics and posture. Muscles that are commonly tight include those you use to arch your back (spinal extensors); raise and rotate your shoulders (shoulder elevators and external rotators); lift your knees (hip flexors); and pull your feet toward your body (ankle dorsiflexors).

  • Perform stretches slowly and smoothly, “to a point of stretch, not pain,” Ms. Gibbon advises.
  • For maximum benefit, do stretches once or twice a day.

Yoga, Pilates: Helpful or not?

You may have wondered if yoga or Pilates (core-strengthening) classes would be safe to do if you’ve got osteoporosis.

Ms. Gibbon advises caution: “Yoga and Pilates are helpful for stretching and lengthening but include many flexion-based (forward-bending) moves.” If you are interested, she advises being careful and working with knowledgeable yoga and Pilates instructors.

Fortunately, everyone with osteoporosis can develop a safe, effective personal exercise program — even if they have had a fracture, she says. Ask your doctor whether a referral to a physical therapist might be worthwhile.

What to avoid

Exercises that keep the spine in a straight or slightly arched position are generally safer than exercises that involve bending forward. That’s because most spine fractures occur in a position of forward bending, says Ms. Gibbon. If you have already had an osteoporotic fracture, avoid exercises that involve forward bending or rotating the trunk.

Proper strengthening of your lower abdominal and back muscles will help attain the optimal spinal position.


Osteoporosis is a disease that weakens bones to the point where they break easily—most often, bones in the hip, backbone (spine), and wrist. Osteoporosis is called a “silent disease” because you may not notice any changes until a bone breaks. All the while, though, your bones had been losing strength for many years.

Bone is living tissue. To keep bones strong, your body breaks down old bone and replaces it with new bone tissue. Sometime around age 30, bone mass stops increasing, and the goal for bone health is to keep as much bone as possible for as long as you can. As people enter their 40s and 50s, more bone may be broken down than is replaced.

A close look at the inside of bone shows something like a honeycomb. When you have osteoporosis, the spaces in this honeycomb grow larger, and the bone that forms the honeycomb gets smaller. The outer shell of your bones also gets thinner. All of this makes your bones weaker.

Who Has Osteoporosis? Risk Factors and Causes

Although osteoporosis can strike at any age, it is most common among older people, especially older women. Men also have this disease. White and Asian women are most likely to have osteoporosis. Other women at great risk include those who:

  • Have a family history of broken bones or osteoporosis
  • Have broken a bone after age 50
  • Had surgery to remove their ovaries before their periods stopped
  • Had early menopause
  • Have not gotten enough calcium and/or vitamin D throughout their lives
  • Had extended bed rest or were physically inactive
  • Smoke (smokers may absorb less calcium from their diets)
  • Take certain medications, including medicines for arthritis and asthma and some cancer drugs
  • Used certain medicines for a long time
  • Have a small body frame

The risk of osteoporosis grows as you get older. At the time of menopause, women may lose bone quickly for several years. After that, the loss slows down but continues. In men, the loss of bone mass is slower. But, by age 65 or 70, men and women are losing bone at the same rate.

What Is Osteopenia?

Whether your doctor calls it osteopenia or low bone mass, consider it a warning. Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life. That way you will be less likely to break a wrist, hip, or vertebrae (bone in your spine) when you are older.

Can My Bones Be Tested?

For some people, the first sign of osteoporosis is to realize they are getting shorter or to break a bone easily. Don’t wait until that happens to see if you have osteoporosis. You can have a bone density test to find out how strong your bones are.

The U.S. Preventive Services Task Force recommends that women aged 65 and older be screened (tested) for osteoporosis, as well as women under age 65 who are at increased risk for an osteoporosis-related fracture.

A bone mineral density test compares your bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells you how strong your bones are, whether you have osteoporosis or osteopenia, and your risk for having a fracture.

How Can I Keep My Bones Strong? Preventing Osteoporosis

There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and vitamin D is important. So is regular weight-bearing exercise, such as weight training, walking, hiking, jogging, climbing stairs, tennis, and dancing.

If you have osteoporosis, avoid activities that involve twisting your spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club. Learn how to exercise safety with Go4Life, the exercise and physical activity campaign from the National Institute on Aging.

Those are the best ways to keep your bones strong and healthy. Learn more about keeping your bones strong to prevent falls.

What Can I Do for My Osteoporosis?

Treating osteoporosis means stopping the bone loss and rebuilding bone to prevent breaks. Healthy lifestyle choices such as proper diet, exercise, and medications can help prevent further bone loss and reduce the risk of fractures.

But, lifestyle changes may not be enough if you have lost a lot of bone density. There are also several medicines to think about. Some will slow your bone loss, and others can help rebuild bone. Talk with your doctor to see if medicines might work to treat your osteoporosis.

In addition, you’ll want to learn how to fall-proof your home and change your lifestyle to avoid fracturing fragile bones.

Can I Avoid Falling?

When your bones are weak, a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery. It might also mean being laid up for a long time, especially in the case of a hip fracture. So, it is important to prevent falls. Learn how to prevent falls.

Do Men Have Osteoporosis?

Osteoporosis is not just a woman’s disease. Not as many men have it as women do, maybe because most men start with more bone density. As they age, men lose bone density more slowly than women. But, men need to be aware of osteoporosis.

Experts don’t know as much about this disease in men as they do in women. However, many of the things that put men at risk are the same as those for women, including family history, not enough calcium or vitamin D, and too little exercise. Low levels of testosterone, too much alcohol, taking certain drugs, and smoking are other risk factors.

Older men who break a bone easily or are at risk for osteoporosis should talk with their doctors about testing and treatment.

For more information about osteoporosis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

For More Information on Osteoporosis

National Osteoporosis Foundation
1-800-231-4222 (toll-free)

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.

Content reviewed: June 26, 2017

Osteopenia: When you have weak bones, but not osteoporosis

Bone density test score determines whether you have osteopenia or osteoporosis

Updated: August 20, 2018Published: June, 2009

Like their names suggest, osteopenia and osteoporosis are related diseases. Both are varying degrees of bone loss, as measured by bone mineral density, a marker for how strong a bone is and the risk that it might break. If you think of bone mineral density as a slope, normal would be at the top and osteoporosis at the bottom. Osteopenia, which affects about half of Americans over age 50, would fall somewhere in between.

Osteopenia and bone density test

The main way to determine your bone density is to have a painless, noninvasive test called dual-energy x-ray absorptiometry (DXA) that measures the mineral content of bone. The measurements, known as T-scores, determine which category — osteopenia, osteoporosis, or normal — a person falls into (see graphic).

Fracture risk increases as bone mineral density declines. A study published in the Journal of the American Medical Association in 2001 reported that a 50-year-old white woman with a T-score of -1 has a 16% chance of fracturing a hip, a 27% chance with a -2 score, and a 33% chance with a -2.5 score.

But there isn’t a huge difference between, say, a -2.3 T-score and -2.5, although the former would be labeled osteopenia and the latter, osteoporosis. “The label matters less than the number. These distinctions are to some extent arbitrary lines in the sand,” says Dr. Maureen Connelly, a preventive medicine expert at Harvard Medical School. Regardless of your exact score, if your bone density results fall into the osteopenia category, your doctors will probably schedule you for a bone mineral density test every two to five years.

What’s your bone density score?

A T-score ranging from -1 to -2.5 is classified as osteopenia. The lower the score, the more porous your bone.

Osteopenia Prevention

Everybody’s bones get weaker as they get older. But certain choices and habits accelerate the process. They include:

  • not getting enough calcium and vitamin D
  • smoking
  • drinking too much alcohol
  • using certain medications, such as corticosteroids and anticonvulsants
  • not getting enough weight-bearing exercise (at least 30 minutes on most days). If your feet touch the ground during an exercise, it’s probably weight bearing. Running and walking are weight bearing. Swimming and biking are not.

Women are far more likely to have low bone density than men, but it’s no longer viewed as solely a women’s condition. About a third of white and Asian men over age 50 are affected. The percentages for Hispanics (23%) and blacks (19%) are lower, but still sizable.

Should I get a bone mineral density test?

Experts disagree about who should get their bone mineral density measured because it’s not clear that the benefits justify the cost. Consider this: 750 tests of women between the ages of 50 and 59 would need to be done to prevent just one hip or spine fracture over a five-year period. From a societal point of view, is that worth it?

Currently, the National Osteoporosis Foundation (NOF) recommends testing for:

  • women 65 and older
  • postmenopausal women younger than 65 who have one or more risk factors, which include being thin
  • postmenopausal women who have had a fracture

If you aren’t in one of these categories yet, don’t wait until you are to start doing some weight-bearing exercise. Some “uplifting” activity now might prevent frail bones later.

For men, testing is done more on a case-by-case basis.

Osteopenia treatment

Osteopenia can be treated either with exercise and nutrition or with medications. But some doctors are increasingly wary about overmedicating people who have osteopenia. The fracture risk is low to begin with, and research has shown that medication may not reduce it that much. We also don’t know if the medications might have some long-term effects. So if your T-score is under -2, you need to be sure you are doing regular weight-bearing exercise, and you are getting enough vitamin D and dietary calcium. If you’re closer to -2.5, your doctor may consider adding medication to keep your bones strong.

Image: © Ridofranz | GettyImages

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.


Calcium and vitamin D supplements

Calcium is the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones.

For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium.

However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements.

Vitamin D is needed to help the body absorb calcium. It’s difficult to get enough vitamin D from your diet alone because few foods contain vitamin D. In the UK, most healthy adults obtain vitamin D from exposing the skin to summer sunlight.

However, for people at risk of not getting enough vitamin D, supplementation with 10 micrograms of vitamin D a day (400 international units ) is recommended to prevent deficiency.

At-risk groups include people over 65 years of age, and people who aren’t exposed to much sunlight because they cover their skin for cultural reasons, are housebound, or who stay indoors for long periods.

If you’re found to lack vitamin D, your GP may prescribe supplements at a higher dose than the above recommendation to correct the deficiency.

Hormone replacement therapy (HRT)

HRT is sometimes recommended for women who are experiencing the menopause, as it can help control symptoms.

HRT has also been shown to maintain bone density and reduce the risk of fracture during treatment.

However, HRT isn’t specifically recommended for treating osteoporosis and it isn’t often used for this purpose.

This is because HRT slightly increases the risk of developing certain conditions, such as breast cancer, endometrial cancer, ovarian cancer, stroke and venous thromboembolism more than it lowers the risk of osteoporosis.

Discuss the benefits and risks of HRT with your GP.

Read more about the risks of HRT.

Testosterone treatment

In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism).

Safe Pilates Exercises for Osteoporosis

You’ve probably heard that weight-bearing exercises — such as walking — can help reduce the risk of a broken bone when you have osteoporosis. But don’t overlook Pilates as a potential skeleton-saving workout for those with low bone density.

“The fundamentals of Pilates offer a terrific platform for strengthening bones and preventing fractures if done properly,” says Rebekah Rotstein, a Pilates instructor at Kinected in New York City. Rotstein is the creator of Buff Bones, a movement system that draws on Pilates to manage and prevent bone and joint problems.

But not just any Pilates routine will do. In fact, many basic Pilates exercises are not safe for people with osteoporosis because of the strain they put on the spine. Here’s what you need to know before you hit the mat or machines:

How Pilates Can Help Someone With Osteoporosis

Pilates is a set of exercises first developed by Joseph H. Pilates while interned in a British camp for German citizens during World War I. Over the years, he refined his methods for strengthening the core muscles of the body that support the spine and help to keep the body balanced. Pilates also incorporated breath awareness into his exercises, a practice that is emphasized in many Pilates classes today.

Done correctly, Pilates exercises can help people with weakened bones by:

  • Increasing bone density when body parts move against the force of gravity
  • Increasing strength and muscle mass, which in turn help to support the bones
  • Improving balance, which can help prevent falls that might result in a bone fracture
  • Improving range of motion and posture, which can help keep the bones in alignment and prevent painful pinched nerves and muscle spasms in the back

Still, according to Rotstein,”Three-quarters of the exercises in traditional Pilates need to be modified for someone with osteoporosis. The traditional Pilates mat class is not advisable.”

But modified classes, which omit the mat exercises listed below and are under the direction of a trained instructor, can be safe.

RELATED: How to Exercise Safely With Osteoporosis

Which Pilates Exercises Are Safe for a Person With Osteoporosis?

Exercises that work the back, shoulders, legs, and hips are the most beneficial for people with osteoporosis.

“The most damaging type of injury one can incur is a fracture of the hip,” Rotstein says. “Strengthening the hips should be a big goal.”

But people with osteoporosis should avoid Pilates exercises that involve bending forward or rolling on their backs, and should be very cautious about performing exercises that involve twisting the spine.

“Pilates has a large proportion of motions that involve bending forward through the spine,” Rotstein warns. “That is the most dangerous motion for someone who has bone loss. It could lead to a fracture of the spine.”

Safe Pilates Mat Exercises for Someone With Osteoporosis

  • Single and double leg kicks
  • Side-lying series
  • Leg pulls and circles
  • Push-ups
  • Chest expansion

Unsafe Mat Exercises

  • Roll up
  • Roll over
  • Jackknife
  • Spine twist
  • Saw

Some Pilates exercises involve the use of equipment such as the reformer, which somewhat resembles a rowing machine and provides resistance for the person exercising.

The trap table, or trapeze table, is another piece of Pilates equipment found in some studios that enables certain stretches and strength-training exercises.

Equipment-based Pilates can be just as safe as mat exercises, Rotstein says, and perhaps more effective because they add an element of strength training to your workout.

Safe Pilates Machine Exercises for People With Osteoporosis

  • Foot work (using the reformer)
  • Leg and arm circles (reformer)
  • Pulling straps (reformer)
  • Side splits (reformer)
  • Leg-spring series (trap table)
  • Chest expansion (trap table)

Unsafe Machine Exercises

  • Short spines
  • Tower
  • Overhead
  • Mermaid

Questions to Ask a Pilates Instructor if You Have Osteoporosis

With the rise in popularity, it’s easier than ever to find Pilates classes, but people with osteoporosis need to look for classes that are specifically geared to their condition, or at least be familiar with which exercises to leave out when attending a general Pilates class.

You can also ask the instructor for help identifying which exercises are safe for someone who has osteoporosis. Some questions you may wish to ask include:

  • Are you familiar with which exercises are safe and unsafe for people with osteoporosis?
  • Will the planned workout include any of the exercises listed above as unsafe?
  • Will exercises aimed at balance and fall prevention be included in the workout routine?

You can also look on the Buff Bones website for instructors trained in this workout in your area.

An Introduction

Osteoporosis is bone loss or “thinning” of the bones. The early stage of bone loss is referred to as Osteopenia, and research shows that more fractures occur during the Osteopenia stage than in the Osteoporosis stage.
Treat bone loss seriously. A quarter of all men and half of all women over 50 will break a bone due to Osteoporosis. Get a DXA scan if you have not had one yet. A DXA scan is a special type of x-ray that measures the amount of bone you have in your body. A proper reading of your DXA scan is essential for the accurate diagnosis and treatment of Osteopenia and Osteoporosis.
Exercise is good for osteoporosis, however, you should check with your doctor before you start any exercise programme to confirm that it is suitable for you.

The General Principles were developed as a guideline towards exercises in general because it is impossible to provide a list of safe exercises because no exercise is 100% safe. A patient with osteoporosis could sustain a fracture turning in bed or simply sneezing. However, exercising is generally safer than allowing your osteoporosis to get worse. Follow the General Principles and the motto “when in doubt don’t” Avoid activities that involve forward bending or twisting the spine as well as those that place you at high risk of losing your balance. Always follow these General Principles and guidelines when exercising:

Why is no exercise safe?

Some patients with osteoporosis get fractures after they fall, or while exercising, but others fracture simply turning in bed, lifting groceries, swinging a golf club, or even sneezing. It follows that no one can give you a list of exercises that they can guarantee are “safe”. Follow the General Principles as these will help you avoid exercises which are dangerous, inadvisable or unsafe.
Does this mean I should avoid exercising?
No. Exercising is good for your bone density, and it is also good for your strength and fitness, your balance and co-ordination and reflexes. Exercise always carries a risk – but overall, not exercising is likely to be more risky. If you lose strength and fitness, and your balance, co-ordination and reflexes deteriorate, you are more likely to fall and break a bone.

The General Principles of Exercising with Osteoporosis

Follow these six basic guidelines:

  1. Start your exercise programme “where you are”.
  2. Progress gradually and safely.
  3. Do weight bearing exercises i.e. exercises or activities in which your body weight is born on your limbs. These stimulate bone.
  4. When it is wet, rainy, windy or ice on the paths, you need to be very careful. Ensure to wear shoes with non-slip soles and use a stick or cane for extra support.
  5. When you do an exercise, it should not hurt doing it, or immediately afterwards. Many people experience some mild soreness the next day (or the day after that).
  6. Avoid the “Four C’s” Contact, Compression, Collision and Contortion (by contortion I mean excessive or repeated forward bending of the spine).

Avoiding the “Four C’s”:

  1. Contact – sports like soccer, hockey, basketball, martial arts and so on.
  2. Compression – heavy lifting, squats, dead-lifts.
  3. Collision – skiing, skating, skateboarding, water-skiing. ANY activity jumping from a height (even low heights like 30cm steps).
  4. Contortion – avoid all activities involving bending, particularly forward bending of the spine. e.g. some Yoga postures, some Pilates exercises, ALL types of sit-ups, trunk curls, crunches, toe-touches whether done in sitting, standing, lying OR on a machine or piece of equipment.

The Good News:

Bone density in some patients improves quickly, in others more slowly – in some, not at all. If your bone density reverts to normal with the correct treatment, you can progress to some of the “higher risk” exercises. Not all patients recover enough bone density for this, but some do. Remember to follow up on your DXA scans (and make sure a proper reading of the DXA scan is carried out by a qualified healthcare professional) to confirm the state of your bone density.

If you are thinking of joining a pilates class at Pilates Lifestyle and you have been diagnosed with either Osteopenia or Osteoporosis you will need a private class first so that you can be assessed and taught modifications to some of the exercises we do in a Pilates class as not all Pilates exercises are suitable for clients with Osteoporosis.

Why Pilates?

There are several reasons why Pilates is recommended for clients with either osteopenia or osteoporosis, however, just because your healthcare professional has recommended Pilates does not mean that all exercises are safe. They are not.

If you consider that the goal of exercising when you have either osteopenia or osteoporosis is to:

  • stimulate your bones to produce more bone;
  • improve your muscular strength and endurance;
  • improve your co-ordination and balance;

then yes, regular supervised pilates classes will help you to achieve all three of these goals.
However, there will always be exercises you will need to avoid completely and some which will need to be modified. The last of the Four C’s as discussed above under the General Principles becomes the most important one to be aware of in any Pilates class. To remind you, here it is again: Contortion – activities involving bending, particularly forward bending of the spine.

At Pilates Lifestyle, we modify these types of exercises so that you can still strengthen your abdominal muscles and mobilize your spine but these will always be within the accordance of the General Principles. These General Principles are guidelines set out by the Osteoporosis Society of Ireland and endorsed by Chartered Physiotherapists who specialize in patients with Osteoporosis.

The do’s and don’ts in a Pilates Class:

To help you in your Pilates class, what follows is a set of rules for participating in a pilates class and a list of exercises and photographs showing you what movements and positions do not contravene the General Principles.

  1. The head always needs to stay on the mat when performing exercises lying on your back. Raising your head off the mat flexes (forward bends) the spine and this contravenes the General Principles and is therefore advised against. So any exercise like sit ups, chest lifts, single leg stretch, double leg stretch are advised against, unless modifications are made where the head stays on the mat.
  2. Any rolling exercises are to be avoided as these too contravene the General Principles as the spine is flexed. These include rolling like a ball, the roll up, the roll down, the c-curve, the seal, jackknife, neckpull – in fact any exercise which involves a forward bending or c-curve movement of the spine.
  3. Any simultaneous twisting and forward bending movement contravene the General Principles therefore the Saw, the Spine Stretch Forward and the Spine Twist for example all need to be avoided.

So what is there left to do? Plenty!!

A few Golden Rules in your Pilates class:

It is really important to let your teacher know if you have either Osteopenia or Osteoporosis before you start. It is equally important to notify your teacher when your DXA scan results change as this may affect what you currently can and can’t do.

  • Never lift your head up off the mat when lying supine (on your back) to perform an exercise.
  • Avoid any movement which may require you to flex (forward bend and/or forward bend and twist the spine at the same time).
  • Avoid putting yourself in situations where your balance might be compromised.
  • Always adhere to the General Principles when exercising.
  • Remember, no exercise is 100% safe
  • Remember there is NO list of “safe” exercises. When in doubt, don’t do it. Consult your Chartered Physiotherapist.

I have written this article based on research I have undertaken in my role as a Pilates teacher. I am not a chartered physiotherapist. For this reason, I would like to especially thank Mr Richard Shortall, MISCP, of the Dublin Spine and Sports Physiotherapy Clinic (https://www.physiotherapyclinic.ie/) as well as my clients with whom I have worked to produce this information sheet. Should you require any further information on Osteoporosis or Osteopenia please visit http://www.irishosteoporosis.ie. or contact your healthcare professional.

The types of Pilates classes we offer:

  • Pilates for Men – strength & flexibility
  • Barre Pilates
  • Matwork Pilates class
  • Private Pilates class
  • Reformer Pilates class
  • Antenatal Pilates class
  • Postnatal Pilates class

Also please refer to our Medical Pilates section regarding specific injuries or ailments

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