Down Regulating Your Osteoporosis Patient

Since I started working with patients with osteoporosis or osteopenia almost 20 years ago, I've noticed an interesting phenomenon. Initially, most patients I saw were in their late 70s and 80s. But within the last 10 to 15 years, the age of my patient population has decreased. I begin receiving referrals for people in their 50s and 60s with osteopenia or osteoporosis after getting their first DEXA scan. Many were traumatized by the diagnosis. They were women who exercised regularly, ate healthily, and took responsibility for a positive lifestyle. It was almost as if they were experiencing PTSD. They were shocked, nervous, and questioning why it happened to them.

One of my first priorities in their care plan was to help calm or down-regulate their sympathetic nervous system. They were in a fight or flight state, and the cortisol running through their bodies was not kind to their bones. I educated them that the DEXA scan only measures bone density and not quality. Quality has come to the forefront as an important component of the lattice-like structures of our bones, yet we still don't have a good way to measure it. I wanted them to understand that the DEXA scan, although it is the gold standard, is only one piece of the puzzle. I used to say, “Let’s pretend your T score is exactly the same as another individual, but that individual is a couch potato who smokes, eats junk food, and basically follows an unhealthy lifestyle. Do you really think your risk of fracture is identical? I wanted them to feel that their actions had had a positive influence on their health, even with the diagnosis. And I truly believe that it does.

Following the evaluation, they started in the Decompression position, also known as hook-lying, and based on the work of Sara Meeks. We explored belly breathing, intercostal breathing, and found the neutral spine position. They were invited to completely relax, allowing the surface of the mat to support them. Not only did this help calm their sympathetic nervous system by activating their “rest and digest” parasympathetic nervous system, but it also placed them in a gravity-eliminated position. Sitting is compressive to the vertebral bodies and discs. Supine positioning allows the anterior aspect of the vertebral bodies (where most spinal compression fractures occur) to decompress. Thus, the name “Decompression position.”

This is the part of physical therapy where it sometimes feels we are doing more mental than physical therapy. But it is an important step. Educating patients is one of the greatest gifts that we can offer in rehabilitation. It not only helps them understand the diagnosis, it also empowers them. Many people with osteoporosis or osteopenia assume their only option is medication. While we certainly do not recommend one option over another, we do educate them that there are multiple ways to manage their disease. A few include site-specific exercises, body mechanics, stress management, and encouraging an educated discussion with their medical provider on the pros and cons of osteoporosis medications. These are steps they can take to feel they have control back in their lives.

From there, we gradually increase their challenges in terms of exercise, balance, and help them return safely to the life they deserve.

Osteoporosis Management: An Introductory Course for Healthcare Professionals provides tools to help your patients move forward with their chronic disease. We hope you'll join us on November 8th for this one-day seminar.

References:

1. Jia-Sheng Ng¹, Kok-Yong Chin. Potential mechanisms linking psychological stress to bone health. Int J Med Sci. 2021 Jan.

AUTHOR BIO
Deb Gulbrandson, PT, DPT, Balance and Falls Professional (Geriatrics Academy of the APTA)

Dr. Deb Gulbrandson has been a physical therapist for over 48 years, with experience in acute care, home health, pediatrics, geriatrics, sports medicine, and consulting to businesses and industries. She owned a private practice for 27 years in the Chicago area, specializing in orthopedics and Pilates. She and her husband, Gil, a former certified orthotist, “semi-retired” to Evergreen. They teach Osteoporosis management to physical therapists around the country. Deb also works for Mt Evans Homecare and Hospice and sees private patients for physical therapy as well as Pilates clients in her home studio. In her spare time, she skis and is busy checking off her Bucket List of visiting every national park in the country-currently 46 out of 63.

Deb is a graduate of Indiana University with a BS in Physical Therapy and a former NCAA athlete, where she competed on the IU Gymnastics team. She has always been interested in movement and function and is grateful to be able to combine her skills as a PT and Pilates instructor. In 2011, she received her Doctorate in Physical Therapy from Evidence in Motion.

Dr. Gulbrandson frequently presents community talks on topics related to Osteoporosis and safe ways to develop Core Strength. She is a certified Pilates Instructor through Polestar Pilates since 2005, a Certified Osteoporosis Exercise Specialist using the Meeks Method, and has her CEEAA (Certified Exercise Expert for the Aging Adult) through the Geriatric Section of the APTA.