Archives of Orthopaedic and Trauma Surgery

, Volume 137, Issue 5, pp 617–624 | Cite as

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

  • Guido Schröder
  • Andreas Knauerhase
  • Holger S. Willenberg
  • Guenther Kundt
  • Detlef Wendig
  • Hans-Christof Schober
Orthopaedic Surgery

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.

Keywords

Osteoporosis Fracture Biomechanics Sling exercises 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures were performed in accordance with the ethical standards of the authorized ethics committee for human experimentation (institutional and national) and the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Goldstein CL, Brodke DS, Choma TJ (2015) Surgical management of spinal conditions in the elderly osteoporotic spine. Neurosurgery 77(Suppl 4):S98–S107. doi: 10.1227/NEU.0000000000000948 CrossRefGoogle Scholar
  2. 2.
    Heaney RP (1992) The natural history of vertebral osteoporosis. Is low bone mass an epiphenomenon? Bone 13(Suppl 2):S23–S26CrossRefPubMedGoogle Scholar
  3. 3.
    Broy SB (2016) The vertebral fracture cascade: etiology and clinical implications. J Clin Densitom 19(1):29–34. doi: 10.1016/j.jocd.2015.08.007 CrossRefPubMedGoogle Scholar
  4. 4.
    Sinaki M (1998) Musculoskeletal challenges of osteoporosis. Aging (Milano) 10(3):249–262Google Scholar
  5. 5.
    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): 241–246CrossRefPubMedGoogle Scholar
  6. 6.
    De Smet AA, Robinson RG, Johnson BE et al (1988) Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis. Radiology 166(2):497–500. doi: 10.1148/radiology.166.2.3336728 CrossRefPubMedGoogle Scholar
  7. 7.
    Rosenberger WF, Lachin JM (2002) Randomization in clinical trials: theory and practice. Wiley series in probability and statistics. Wiley, New YorkCrossRefGoogle Scholar
  8. 8.
    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):301–302Google Scholar
  9. 9.
    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 CrossRefGoogle Scholar
  10. 10.
    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 CrossRefPubMedGoogle Scholar
  11. 11.
    Drerup B (2014) Rasterstereographic measurement of scoliotic deformity. Scoliosis 9(1):22. doi: 10.1186/s13013-014-0022-7 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    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 CrossRefPubMedGoogle Scholar
  13. 13.
    Bergmark A (1989) Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 230:1–54CrossRefPubMedGoogle Scholar
  14. 14.
    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): 362–367CrossRefGoogle Scholar
  15. 15.
    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):261–269CrossRefPubMedGoogle Scholar
  16. 16.
    ASMUSSEN E, KLAUSEN K (1962) Form and function of the erect human spine. Clin Orthop 25:55–63PubMedGoogle Scholar
  17. 17.
    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 StatesGoogle Scholar
  18. 18.
    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) CrossRefPubMedGoogle Scholar
  19. 19.
    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) CrossRefPubMedGoogle Scholar
  20. 20.
    Roberts N, Hogg D, Whitehouse GH et al (1998) Quantitative analysis of diurnal variation in volume and water content of lumbar intervertebral discs. Clin Anat 11(1):1–8. doi: 10.1002/(SICI)1098-2353(1998)11:1<1:AID-CA1>3.0.CO;2-Z CrossRefPubMedGoogle Scholar
  21. 21.
    Schröder G, Knauerhase A, Kundt G et al (2014) Neue Aspekte der physikalischen Therapie der Osteoporose. Osteologie 23(2):123–132Google Scholar
  22. 22.
    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 CrossRefGoogle Scholar
  23. 23.
    Kim J-J (2016) An analysis on muscle tone and stiffness during sling exercise on static prone position. J Phys Ther Sci 28(12):3440–3443. doi: 10.1589/jpts.28.3440 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Roh HS, Cho WJ, Ryu WJ et al (2016) The change of pain and lumbosacral sagittal alignment after sling exercise therapy for patients with chronic low back pain. J Phys Ther Sci 28(10):2789–2792. doi: 10.1589/jpts.28.2789 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lee S-B, Cho W-J (2016) The effect of sling exercise on sagittal lumbosacral angle and intervertebral disc area of chronic low back pain patients. J Exerc Rehabil 12(5):471–475. doi: 10.12965/jer.1632676.338 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    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 PubMedGoogle Scholar
  27. 27.
    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, StuttgartGoogle Scholar
  28. 28.
    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):91–98CrossRefPubMedGoogle Scholar
  29. 29.
    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):2640–2650CrossRefGoogle Scholar
  30. 30.
    Richardson C, Hodges P, Hides J (2009) Segmentale Stabilisation im LWS- und Beckenbereich: [therapeutische Übungen zur Behandlung von Low back pain]. Elsevier Urban & Fischer, MünchenGoogle Scholar
  31. 31.
    Ross PD, Ettinger B, Davis JW et al (1991) Evaluation of adverse health outcomes associated with vertebral fractures. Osteoporos Int 1(3):134–140CrossRefPubMedGoogle Scholar
  32. 32.
    Sinaki M, Wollan PC, Scott RW et al (1996) Can strong back extensors prevent vertebral fractures in women with osteoporosis? Mayo Clin Proc 71(10):951–956. doi: 10.1016/S0025-6196(11)63768-3 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Guido Schröder
    • 1
  • Andreas Knauerhase
    • 2
  • Holger S. Willenberg
    • 2
  • Guenther Kundt
    • 3
  • Detlef Wendig
    • 1
  • Hans-Christof Schober
    • 1
  1. 1.Department of Internal MedicineKlinikum Südstadt RostockRostockGermany
  2. 2.Division of Endocrinology and Metabolism, Department of Internal MedicineRostock University Medical CenterRostockGermany
  3. 3.Institute for Biostatistics and Informatics in Medicine and Aging ResearchUniversity of RostockRostockGermany

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