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Postmenopausal spinal osteoporosis: flexion versus extension exercises

PainSci » bibliography » Sinaki et al 1984
Tags: back pain, injury, pain problems, spine

One article on PainSci cites Sinaki 1984: Don’t Worry About Lifting Technique

PainSci notes on Sinaki 1984:

This 1984 experiment divided 60 osteoporotic women with back pain into four groups doing three different kind of exercise, plus a “lazy” control group that did nothing. One group did spinal flexion exercises, another did spinal extension exercises, and a third did a combination. On follow-up an average of 1.4 years later, 33% of the control group was worse off — more compression fractures had developed in that time. But in the flexion group? 89% were in worse condition! The combo-group roughly split the difference at 53% worse. The authors concluded: “Exercises that place flexion forces on the vertebrae… tend to cause an increased number of vertebral fractures in these patients.”

Oddly, this seems to be the only data of its kind.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Fifty-nine women with postmenopausal spinal osteoporosis and back pain were instructed in a treatment program that included extension exercises (E) for 25 patients, flexion exercises (F) for 9, combined (E + F) exercises for 19, or no therapeutic exercises (N) for 6. Ages ranged from 49 to 60 years (mean, 56 years). Follow-up ranged from one to six years (means for the groups, 1.4 to 2 years). All patients had spine x-ray studies before treatment and at follow-up, at which time any further wedging and compression fractures were recorded. Additional fractures occurred as follows: group E, 16%; F, 89%; E + F, 53%; and N, 67%. In comparison with group E, the occurrence of wedging or compression fractures was significantly higher in group F (p less than 0.001) and group E + F (p less than 0.01). This study suggests that a significantly higher number of vertebral compression fractures occur in patients with postmenopausal osteoporosis who followed a flexion exercise program compared with those using extension exercises. Extension or isometric exercises seem to be more appropriate for patients with postmenopausal osteoporosis.

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