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Osteoporosis: Flexion vs. Extension

Written by: Angelie Melzer, BS, CPT

Exercise and an active lifestyle are essential factors in bone health.  By age 18, skeletal growth is nearly complete and 97% of bone mass has probably been achieved.  By age 20 bone mass has reached it's peak.  The amount of peak bone mass achieved and the subsequent rate of bone loss are key determinants of bone density later in life.

In some cases, increases in bone density has been achieved through the third decade of life with moderate increases in physical activity.  The ideal exercise is weight bearing, as it places necessary stresses on the bones.  Skeletal and muscle mass decrease with age, but preventative measures can be taken with moderate weight bearing exercise and higher impact activities.

Pilates includes a range of exercises that are appropriate in maintaining bone health.  Flexion vs. extention exercises have been the focus of numerous studies in post-menopausal and osteoporotic women.  One such study was conducted by Sinaki M. Mikkelsen BA in her study: "Postmenopausal spinal osteoporosis: flexion versus extension exercises."

This study was conducted over six years with a control group of 59 women with postmenopausal osteoporosis, ages 49-60.  The women were placed into three exercise treatment groups.  (E) 25 patients were placed in an all extension exercise treatment program, (F) 9 were placed in an all flexion exercise treatment program, (E+F) 19 were placed in a combined program and (N) 6 were given no therapeutic exercise.

The study revealed that pre and post spinal x-rays showed group (E) at 16% additional fracture rate, group (F) at 89% additional fracture rate, (E+F) at 53% additional fracture rate and (N) at 67% additional fracture rate.  Thus, the fracture rate was significantly less in the all Extension exercise group.  Those who followed all Flexion exercises had a large increase in fracture rates. 

Pilates practioners need to keep in mind that each individual they work with over age 50 should be considered for a DEXA scan or other bone density testing prior to starting a Pilates exercise program.  It is the responsibility of the Pilates practioner and profession as a whole to be considerate of the safety of these individuals when designing an appropriate Pilates program for them.  Extension versus flexion exercises and recognizing the specific needs of these individuals is of the utmost importance.  This becomes especially important in group mat and exercise programming.  Not all bodies are the same and thus individual needs should be addressed, especially in a group setting.

Please Note: It is recommended that prior to working with women over 50 and men over 60 years of age, you request their results of a BMD test.  If their results or T-score deviates from the norm by -1 to -2.5 this indicates Osteopenia.  A T-score deviation of -2.5 or higher indicates Osteoporosis.

(References: National Institute of Health Osteoporosis and Related Bone Diseases-National Resourse Center.  Pub Med: Arch Phys Med Rehabil. 1984 Oct; 65(10):593-6.)