SYMPOSIUM 1. Osteoporosis, Nutrition and Fragility Fractures (RJ)(2).pptx
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Role of Physiotherapy: Preventing & Managing fragility fractures Bex Morant Physiotherapist Specialising in Osteoporosis www.StrongerFitterBones.co.uk About Bex Bex Morant BSc (hons) Physiotherapist MCSP HCPC 12 years running the Osteoporosis Physiotherapy service at Princess Royal Hospital in...
Role of Physiotherapy: Preventing & Managing fragility fractures Bex Morant Physiotherapist Specialising in Osteoporosis www.StrongerFitterBones.co.uk About Bex Bex Morant BSc (hons) Physiotherapist MCSP HCPC 12 years running the Osteoporosis Physiotherapy service at Princess Royal Hospital in Haywards Heath. Set up Education Groups, Osteoporosis Exercise Classes, One to One treatment, worked with Dr Wheatley June 2016 set up Stronger Fitter Bones - community based exercise classes for people with Osteoporosis. June 2019 left NHS role to pursue Stronger Fitter Bones privately. Physiotherapist, Pilates instructor, PSI (Postural Stability Instructor/Otago), Healthy HIIT instructor. PASSIONATE ABOUT OSTEOPOROSIS - EDUCATION, EXERCISE & ENCOURAGEMENT = DRAMATICALLY IMPROVE QUALITY OF LIFE & CREATE POSITIVE OUTCOMES. HIP FRACTURE (fall) Traumatic – painful – confused – wait for surgery on bed rest – catheterised – depending on # site DHS/Hemriarthroplasty(head)/THR – risk of dislocation – wound healing – nerve damage – stiffness – altered leg length – physio get you up day 1 – daily physio in H – team involved orthogeriatrician, OT, falls service – stay 7-30 days - home with ICT or to rehab centre – supported with aids/hydro/pain - community led falls teams provide evidence based exercise groups (OTAGO) - outpatients MSK if required. Devastating for patient but should be a good care pathway in place but long wait lists & people get missed. VERTEBRAL FRACTURE (spontaneous) Hard to diagnose – shock of having OP – no care plan – no virtual fracture clinic - no team to talk too – hopefully find a good Physiotherapist - understanding & managing pain – starting posture exercises (rest positions) – teach DON’T list - identify any other risk factors (balance/medication/nutrition/why/refer on) – start on DO’s list (Strengthening and Impact) – address other factors limiting exercise potential….encourage encourage encourage. VERY OFTEN MISSED BUT ESSENTIAL WE DIAGNOSE VERTBRAL FRACTURES TO START OP TREATMENT (Medication/Exercise)…….. To stop the HIP # as recovery statistic very poor IMAGINE : T7 & T9 Fracture Personal Impact of Vertebral Fracture Alone How long? Can’t see it (1) . Healing Scared to move Rib rub Drive Depression fatigue/chronic pain Sleep deprivation Decrease activity Feel frail Washing/ Dressing Isolation Family role Cooking standing for too long Bowel/bladder Swallowing Weight loss Breathing Body image Pain PAIN Eiffel tower analogy – mechanics permanently changed. Soft tissues: ligaments, joint capsules, nerves, tendons, muscles, fascia. Healing times - ?longer, no plaster cast, using/loading whilst healing, surgical intervention rare. Physio - Manage Pain (meds/HEAT/massage/TENs/Hydro) - Address posture (exercise/walking aid) - Rest positions (pacing/support) Posture: Seriously hard work…… but must try but must try Reduce personal impacts Decrease pressure on other vertebra. Decrease risk of falls (64% of people with Kyphosis had a fall in the previous year) (2). Enable muscles strengthening = bone strengthening. Body image ‘look like mother’. Constant job ‘Under management’ - body will take path of least resistance. Can get amazing results! IMPACTS & STRENGTHENING Osteoblast are mechanoreceptors Bone is constantly repairing & regenerating , changes & adapts to forces exerted on it. IMPACT (Weight bearing) – low (one foot on floor)/medium (both feet just off floor) (no high - basketball) 50 medium impacts, or 20 mins of low - on most days Walking alone does not improve BMD or Prevent falls (7) . STRENGTH TRAINING (resistance) - Variable, dynamic, multidirectional, high intensity, progressive. 2 or 3 x week minimum 20 mins Increases spine & hip BMD . (8 & 9) Need to be pushing people - graded & with care BALANCE FREQUENCY OVER 65: 2-3 TIMES Week min 30 minutes (strength and flexibility part of balance but must include 5 minutes challenging balance exercises) Frequent faller MUST: FALLS TEAM REFERRAL I recommend DAILY 5 mins Best evidence: Otago and FaME / PSI 30 mins: 1 x group, 2 x HEP for 9 months (10) . TAI CHI (11) HIGHLY CHALLENGING INDIVIDUALISE D SUPERVISED SMALL GROUP<10 DO NOT”S Heavy Lifting Different shared for everyone job arms/legs/back Some yoga moves – STILL DO (just modify) Learn HIP HINGE End or Range Repetitions ?? Microscopic architectural breakdowns MUST MOVE THOUGH!!! Few Key Messages Look out for vertebral fractures Do’s POSTURE, STRENGTH, IMPACT, BALANCE Don’ts Heavy lifting /EOR repetition DO MORE not LESS – benefits of physical activity outweighs the risks. Be creative/can still go to a class and miss out 1 bit.. Walking alone does not reduce falls risk or improve bone density Strong muscles = strong bones Use positive language - don’t scare into inactivity. Build your ‘Bone Bank’ NOW. EDUCATION, EXERCISE & ENCOURAGEMENT = DRAMATICALLY IMPROVE QUALITY OF LIFE & CREATE POSITIVE OUTCOMES Patient Experience: Clare 73 Diagnosed Osteoporosis 2015 with spontaneous fractures L4 & L5. 2018 new pain reported, and 5 more fractures found T6,9,10,11,12. Fractures are a mix of wedge and compression. PMH Menopause age 56, Mother known OP (no hip , took Phenytoin for Epilepsy for 30 years…now known side effect Osteoporosis. 2023 June having Left TKR. Stroke 2017 completely recovered. High BP. Right total knee replacement 2014. Hysterectomy (2005). Epilepsy (30 years since last fit). DH Prolia (Denusomab – started 3 years), Lamotrigine (epilepsy), Clopidopgrel (blood thinner), Losartan (high BP), Vit D, Calcium. References 1 - Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103(2):S12-S19 1. 2 - McDaniels-Davidson C, Davis A, Wing D, et al. Kyphosis and incident falls amount community-dwelling older adults. Osteoporosis Int. 2018;29(1):163169. 3 - https://www.iofbonehealth.org/facts-statistsics 4 - Clinical guidance for the effective identification of vertebral fractures. https://theros.org.uk/media/3daohfrq/ros-vertebral-fracture-guidelines-november-2017.pdf 5 - Gentry T et al. Falls and Fracture Consensus Statement Supporting Commissioning for Prevention. London, Public health England:2017. 6 – Strong, Steady and Straight: An Expert Consensus Statement on physical activity and exercise for osteoporosis. Publication date: Dec 2018, version 1. 7 – Pereira MA, Kriska AM, Day RD, Cauley JA, LaPorte RE, Kuller LH. A Randomised Walking Trail in Postmenopausal Women. Arch Intern Med. 1998; 158(15):1695. 8 - Rubin C. Bone Remodelling in Response to Applied Dynamic Loads.: 2015 https://www.researchgate.net/publication/281228212 9 - Watson SL, Weeks BK, Weis LJ, Horan SA, Beck BR. Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trail, Osteoporosis Int. 2015;26(12):2889-2894. 10 - Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: An updates systematic review and meta-analysis. Be J Sports Med. 2017;51(24):1749-1757. 11 - Wolf SL, Sattin RW, Kutenai M, O’Grady M, Greenspan AI, Gregor RJ. Intense Tai Chi Exercise Training and Fall Occurrences in Older, Transitionally Frail Adults: A Randomized Control Trial. J Am Geriatric Soc. 2003;52(12):1693-1701. 12 - Otago booklet sources from - https://www.laterlifetraining.co.uk/llt-home-exercise-booklets. 13 - Strong, Steady and Straight: An Expert Consensus Statement on physical activity and exercise for osteoporosis. Publication date: Dec 2018, version 1. Page 23 fig 3.
