Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 5/2017

01-05-2017 | Orthopaedic Surgery

Biomechanics of the osteoporotic spine, pain, and principles of training

Authors: Guido Schröder, Andreas Knauerhase, Holger S. Willenberg, Guenther Kundt, Detlef Wendig, Hans-Christof Schober

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2017

Login to get access

Abstract

Introduction

A fracture is a clinical manifestation of osteoporosis and is one of the main causes of functional limitations and chronic pain in patients with osteoporosis. Muscle and coordination training are recommended to the patients as general measures. We inquired whether sling training is better than traditional physiotherapy in relieving pain and improving abilities of daily living.

Methods

Fifty patients with osteoporosis were divided into two groups. Group A performed conventional physiotherapy, while Group B performed sling training exercises. Data were collected before and after the intervention and after 3 months. The registered parameters were stamina, posture, and pain. Posture, torques, and the associated strength of spinal muscles were studied in a biomechanical model in order to estimate the forces acting on the spine. Furthermore, the factors that exerted a positive impact on the success of therapy were registered.

Results

Forty-four patients (88%) completed the study. Positive effects of the training were noted in both groups, but significantly better effects were observed in the group that performed sling training. A reduction of pain independent of the number of fractures, significantly reduced torques, and reduced muscle strength were registered.

Conclusions

Specific training programs helped to increase muscle strength and straightening the back thereby reducing the force needed on a permanent basis and decreasing torque in the spine. Sling training was more effective in that than traditional physiotherapy.
Literature
2.
go back to reference Heaney RP (1992) The natural history of vertebral osteoporosis. Is low bone mass an epiphenomenon? Bone 13(Suppl 2):S23–S26CrossRefPubMed Heaney RP (1992) The natural history of vertebral osteoporosis. Is low bone mass an epiphenomenon? Bone 13(Suppl 2):S23–S26CrossRefPubMed
4.
go back to reference Sinaki M (1998) Musculoskeletal challenges of osteoporosis. Aging (Milano) 10(3):249–262 Sinaki M (1998) Musculoskeletal challenges of osteoporosis. Aging (Milano) 10(3):249–262
5.
go back to reference Mika A, Unnithan VB, Mika P (2005) Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976) 30(2): 241–246CrossRefPubMed Mika A, Unnithan VB, Mika P (2005) Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976) 30(2): 241–246CrossRefPubMed
7.
go back to reference Rosenberger WF, Lachin JM (2002) Randomization in clinical trials: theory and practice. Wiley series in probability and statistics. Wiley, New YorkCrossRef Rosenberger WF, Lachin JM (2002) Randomization in clinical trials: theory and practice. Wiley series in probability and statistics. Wiley, New YorkCrossRef
8.
go back to reference Begerow B, Pfeifer M, Minne HW (2004) Sport und Bewegungstherapie in der Rehabilitation der Osteoporose: Teil II: Bewegung und Therapie. Deutsche Zeitschrift für Sportmedizin 55(11):301–302 Begerow B, Pfeifer M, Minne HW (2004) Sport und Bewegungstherapie in der Rehabilitation der Osteoporose: Teil II: Bewegung und Therapie. Deutsche Zeitschrift für Sportmedizin 55(11):301–302
9.
go back to reference Schröder G, Knauerhase A, Kundt G et al (2014) Trunk stabilization with sling training in osteoporosis patients—a randomized clinical trial. Eur Rev Aging Phys Act 11(1):61–68. doi:10.1007/s11556-013-0128-6 CrossRef Schröder G, Knauerhase A, Kundt G et al (2014) Trunk stabilization with sling training in osteoporosis patients—a randomized clinical trial. Eur Rev Aging Phys Act 11(1):61–68. doi:10.​1007/​s11556-013-0128-6 CrossRef
10.
go back to reference Basler H-D (2011) Akutschmerztherapie in Padiatrie und Geriatrie—Schmerzmessung: Welche Schmerzskala bei welchen Patienten? (Acute pain management in paediatrics and geriatrics—pain assessment: which scale for which patient?). Anasthesiol Intensivmed Notfallmed Schmerzther 46(5): 334–341; quiz 342. doi:10.1055/s-0031-1277977 CrossRefPubMed Basler H-D (2011) Akutschmerztherapie in Padiatrie und Geriatrie—Schmerzmessung: Welche Schmerzskala bei welchen Patienten? (Acute pain management in paediatrics and geriatrics—pain assessment: which scale for which patient?). Anasthesiol Intensivmed Notfallmed Schmerzther 46(5): 334–341; quiz 342. doi:10.​1055/​s-0031-1277977 CrossRefPubMed
12.
go back to reference Liljenqvist U, Halm H, Hierholzer E et al (1998) Die dreidimensionale Oberflachenvermessung von Wirbelsaulendeformitaten anhand der Videorasterstereographie (3-dimensional surface measurement of spinal deformities with video rasterstereography). Z Orthop Ihre Grenzgeb 136(1):57–64. doi:10.1055/s-2008-1044652 CrossRefPubMed Liljenqvist U, Halm H, Hierholzer E et al (1998) Die dreidimensionale Oberflachenvermessung von Wirbelsaulendeformitaten anhand der Videorasterstereographie (3-dimensional surface measurement of spinal deformities with video rasterstereography). Z Orthop Ihre Grenzgeb 136(1):57–64. doi:10.​1055/​s-2008-1044652 CrossRefPubMed
13.
go back to reference Bergmark A (1989) Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 230:1–54CrossRefPubMed Bergmark A (1989) Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 230:1–54CrossRefPubMed
14.
go back to reference Berry JL, Moran JM, Berg WS et al (1987) A morphometric study of human lumbar and selected thoracic vertebrae. Spine (Phila Pa 1976) 12(4): 362–367CrossRef Berry JL, Moran JM, Berg WS et al (1987) A morphometric study of human lumbar and selected thoracic vertebrae. Spine (Phila Pa 1976) 12(4): 362–367CrossRef
15.
go back to reference Duval-Beaupere G, Robain G (1987) Visualization on full spine radiographs of the anatomical connections of the centres of the segmental body mass supported by each vertebra and measured in vivo. Int Orthop 11(3):261–269CrossRefPubMed Duval-Beaupere G, Robain G (1987) Visualization on full spine radiographs of the anatomical connections of the centres of the segmental body mass supported by each vertebra and measured in vivo. Int Orthop 11(3):261–269CrossRefPubMed
16.
go back to reference ASMUSSEN E, KLAUSEN K (1962) Form and function of the erect human spine. Clin Orthop 25:55–63PubMed ASMUSSEN E, KLAUSEN K (1962) Form and function of the erect human spine. Clin Orthop 25:55–63PubMed
17.
go back to reference Jäger M, Luttmann A, Göllner R et al (2001) The Dortmunder—Biomechanical Model for Quantification and Assessment of the Load on the Lumbar Spine. In: SAE International400 Commonwealth Drive, Warrendale, PA, United States Jäger M, Luttmann A, Göllner R et al (2001) The Dortmunder—Biomechanical Model for Quantification and Assessment of the Load on the Lumbar Spine. In: SAE International400 Commonwealth Drive, Warrendale, PA, United States
18.
go back to reference Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5(4):383–389 (discussion 397) CrossRefPubMed Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5(4):383–389 (discussion 397) CrossRefPubMed
19.
go back to reference Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5(4):390–396 (discussion 397) CrossRefPubMed Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5(4):390–396 (discussion 397) CrossRefPubMed
21.
go back to reference Schröder G, Knauerhase A, Kundt G et al (2014) Neue Aspekte der physikalischen Therapie der Osteoporose. Osteologie 23(2):123–132 Schröder G, Knauerhase A, Kundt G et al (2014) Neue Aspekte der physikalischen Therapie der Osteoporose. Osteologie 23(2):123–132
22.
go back to reference Colloca CJ, Keller TS (2001) Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain. J Manip Physiol Ther 24(8):489–500. doi:10.1067/mmt.2001.118209 CrossRef Colloca CJ, Keller TS (2001) Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain. J Manip Physiol Ther 24(8):489–500. doi:10.​1067/​mmt.​2001.​118209 CrossRef
26.
go back to reference Karunanayake AL, Pathmeswaran A, Wijayaratne LS (2017) Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study. Int J Rheum Dis. doi:10.1111/1756-185X.13026 PubMed Karunanayake AL, Pathmeswaran A, Wijayaratne LS (2017) Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study. Int J Rheum Dis. doi:10.​1111/​1756-185X.​13026 PubMed
27.
go back to reference Kapandji IA, Koebke J (2009) Funktionelle Anatomie der Gelenke: Schematisierte und kommentierte Zeichnungen zur menschlichen Biomechanik; [einbändige Ausgabe: obere Extremität, untere Extremität, Rumpf und Wirbelsäule], 5., [unveränd.] Aufl. Thieme, Stuttgart Kapandji IA, Koebke J (2009) Funktionelle Anatomie der Gelenke: Schematisierte und kommentierte Zeichnungen zur menschlichen Biomechanik; [einbändige Ausgabe: obere Extremität, untere Extremität, Rumpf und Wirbelsäule], 5., [unveränd.] Aufl. Thieme, Stuttgart
28.
go back to reference O’Sullivan P, Twomey L, Allison G et al (1997) Altered patterns of abdominal muscle activation in patients with chronic low back pain. Aust J Physiother 43(2):91–98CrossRefPubMed O’Sullivan P, Twomey L, Allison G et al (1997) Altered patterns of abdominal muscle activation in patients with chronic low back pain. Aust J Physiother 43(2):91–98CrossRefPubMed
29.
go back to reference Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976) 21(22):2640–2650CrossRef Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976) 21(22):2640–2650CrossRef
30.
go back to reference Richardson C, Hodges P, Hides J (2009) Segmentale Stabilisation im LWS- und Beckenbereich: [therapeutische Übungen zur Behandlung von Low back pain]. Elsevier Urban & Fischer, München Richardson C, Hodges P, Hides J (2009) Segmentale Stabilisation im LWS- und Beckenbereich: [therapeutische Übungen zur Behandlung von Low back pain]. Elsevier Urban & Fischer, München
31.
go back to reference Ross PD, Ettinger B, Davis JW et al (1991) Evaluation of adverse health outcomes associated with vertebral fractures. Osteoporos Int 1(3):134–140CrossRefPubMed Ross PD, Ettinger B, Davis JW et al (1991) Evaluation of adverse health outcomes associated with vertebral fractures. Osteoporos Int 1(3):134–140CrossRefPubMed
Metadata
Title
Biomechanics of the osteoporotic spine, pain, and principles of training
Authors
Guido Schröder
Andreas Knauerhase
Holger S. Willenberg
Guenther Kundt
Detlef Wendig
Hans-Christof Schober
Publication date
01-05-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 5/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-017-2669-z

Other articles of this Issue 5/2017

Archives of Orthopaedic and Trauma Surgery 5/2017 Go to the issue