Times of India
23 Jully 2011
By Zoha Tapia

The Importance of Physiotherapy in Treating Osteoporosis and Increasing Bone Strength
Osteoporosis is an increasing health problem which causes a reduced quality of life in those who suffer from it. Hence, preventing, delaying or treating it in a timely manner is of utmost importance. This is where physiotherapy comes into action. Physiotherapists have a role to play through exercise prescription, therapeutic modalities, specific techniques and education which helps prevent excess loss of bone mass density.

The Wolff's Law states that when stress or mechanical load is applied to the bone via the muscle and tendons, it has a direct effect on bone formation and remodelling. Hence, we can say that weight bearing exercises help in the bone formation, which helps combat osteoporosis.

Sonali Apte, physiotherapist, Chaitanya Hospital says, "The bone undergoes various processes within it and physiotherapy triggers a mechanism which ultimately stimulates a situation at which the bone itself demands more calcium, phosphorus and other minerals from the body and absorbs them. This in returns gives us stronger bones."

When Should One Start Physiotherapy?
Exercise should be a part and parcel of everyone's life as it helps delay most bone related problems. However, for osteoporotic people, not all exercises are suitable and hence physiotherapy is advised due to the light exercises associated with it. Dr Nirad Vengsarkar, orthopaedic consultant and joint replacement specialist, Bhatia and Jaslok Hospital says, "If the patient is physically young then they can be guided by orthopaedic surgeons or doctors as to which exercises would be best suited. However, if the patient is old or has some disability then a physiotherapist would definitely help."

Before starting a physiotherapy sessions it is important for the patient to sit with the physiotherapist. This is done so that the bone health can be evaluated, which enables the physiotherapist to make out an exercise program pertaining to your health needs.

"During the first session the physiotherapist will evaluate the patient in terms of balance and gait and to assess joint movements and individual muscle strength. This can help them assess the patient t h o ro u g h ly and plan out the exercise schedule," says Dr Vengsarkar.

Along with medical reports, there are other factors which a physiotherapist has to keep in mind. According to Apte some of the factors are:

• "Age of the patient
• Current health status
• Family history and past medical history
• Cardio-pulmonary status of the patient
• The lung capacity and whether the patient gets out of breath"

Type of Exercises
Dr Vengsarkar says, "There are three essential areas that are prone to osteoporosis - the hip, forearms and spine. For the spine simple spine isometric exercises on a mat would help. For the hips - walking and half squats helps and for the forearms - standing or normal push ups are beneficial. One can also use a theraband or resistance band for building muscle mass."

Adding on the exercises ideal for patients suffering from osteoporosis Apte says, "Walking, low impact aerobics, weight training using free weights or 1-2kg dumbbells and barbells, resistance training with the help of rubber tubes and swimming are helpful. Also exercises which improve ones postures, balance and body strength are recommended." However, it is important that the person suffering from osteoporosis at least for the initial few weeks performs the physiotherapy exercises with the physiotherapist; however, once they know the exercises and are strong enough, they can do it by themselves without any supervision.

G e n e r a l ly, there is no start or stop time for a physiotherapy treatment, however, Apte says, "It's an old age disease which requires time to time visits to a physiotherapist in order to asses the condition.

But roughly a month or two regular s u p e r v i s e d sessions and then regular timely follow ups is the right way to go."

Exercises to Avoid
A person with osteoporosis has weakened bones which are prone to fracturing. Hence, there are certain activities they should to avoid. Some of these include:

High impact aerobics or running or jogging " Any exercise that requires sudden, forceful movement Abdominal sit-ups Any exercise that requires a twisting motion, such as a golf swing Any exercise requiring sudden jolts, stops and starts, such as tennis or squash.

Importance of Physiotherapy

• Physiotherapy for osteoporosis patients is important because:
• Unlike normal exercises, physiotherapy is tailor made for fragile bones
• It restores a persons balance and trains them to support themselves better
• It prevents frequent falls and injuries
• Pays attention to gait and balance issues in older people
• Makes the bone stronger, and helps its absorb minerals faster.

Setbacks of Physiotherapy
Though there are no setbacks of physiotherapy unless the exercises aren't conducted in the right manner, Dr Vengsarkar says, "Physiotherapy in the form of short wave diathermy cannot be done for more than a certain number of sittings, as this modality in turn can cause mobilisation of calcium from the bones."

Post Surgery
The main of a surgery for osteoporosis is to prevent further deterioration of the bones, and due to the inactivity because of the surgery exercising in the form of physiotherapy should be commenced as soon as possible. Dr Vengsarkar says, "The kind of exercise depends on the fracture involved. Initially the patient can begin with static exercises and then move on to isometric and range of movement exercises."