Nova Health
NOVA HEALTHHome nursing and physiotherapy

Physiotherapy for spinal compression fractures · home visits across Hong Kong

Physiotherapy for spinal compression fractures,
and why the direction of exercise matters

The acute pain of a vertebral compression fracture mostly improves within 6 to 12 weeks as the bone heals. Many people still get one thing wrong: exercises that bend the back forward (such as sit-ups and bending to touch the toes) increase the risk of another fracture, and only strengthening the back extensor muscles reduces fractures. A registered physiotherapist visits the home to teach exercises in the safe direction and to improve posture, to break the vicious circle of fracture, stooped posture and further fracture.

  • Registered physiotherapists in Hong Kong
  • Home visits across Hong Kong
  • 1 hour $1,000 · 1.5 hours $1,300
  • Back extension exercise and refracture prevention
WhatsApp for a free enquiry and home assessment

Rehabilitation points for spinal compression fractures

Common misunderstandings about spinal compression fractures

A spinal fracture is different from other fractures. Resting to recover is not enough by itself, and it does not mean the patient cannot move at all. If the wrong direction of exercise is chosen, another vertebra can break at any time. But if the patient lies in bed and does not move at all, bone loss speeds up. Knowing clearly which movements can be done and which cannot is therefore the key to rehabilitation.

Common misunderstandings
  • Thinking that a healed bone means full recoveryOnce the bone has healed, back strength and correct posture do not come back by themselves
  • Thinking that wearing a brace means no exercise is neededA brace only supports the spine and eases pain, and it is not the treatment itself
  • Thinking that the patient should stay in bed and not moveLong bed rest speeds up bone and muscle loss, and moving safely and early is better
  • Thinking that sit-ups strengthen the core musclesMovements that bend the spine forward increase the risk of a new fracture, and they do not strengthen or protect the spine but are very dangerous
What works
  • After the pain eases with bone healing, function still needs rebuildingAcute pain mostly eases within 6-12 weeks, but physical function has to be rebuilt separately through training
  • Exercise is what reduces fracturesStrengthening the back extensor muscles and improving posture is the core of physiotherapy
  • Safe movement is possible even in the pain stageMuscle-strengthening exercise without large joint movement (isometric exercise) and posture adjustment can already be started in the acute pain stage
  • Extension, not flexionExtending the back backwards is the safe direction, and bending forward is the high-risk direction

How pain is controlled and how medical treatment is arranged are decisions for the treating doctor, and this page does not make judgements on them. In physiotherapy, the key to lasting improvement is choosing the right direction of exercise, improving posture and preventing a series of further fractures (breaking the fracture cascade), and rehabilitation is not complete just by wearing a brace and waiting for the pain to pass.

Focus of physiotherapy

Key points of treatment in compression fracture rehabilitation

Our physiotherapy has four focuses: choosing the right direction of exercise, improving how force is used in daily movements, preventing further fractures, and stepping in early in the acute pain stage.

01

Choose the right direction of exercise: back extension, not forward bending

The most important thing after a spinal fracture is choosing the right direction of exercise. Movements that bend the spine forward (such as sit-ups and bending to touch the toes) increase the risk of another fracture. Strengthening the back extensor muscles is what reduces fractures. We only teach exercises in the safe direction.

Cohort studySinaki 1984 · refracture 89% in the flexion group vs 16% in the extension group (small sample, n=59)
02

Adjust how force is used in daily movements

The acute pain of a spinal fracture mostly fades within 6 to 12 weeks as the bone heals. During this time, however, frequent bending or carrying heavy things keeps pressing on the front of the vertebra. We first teach the patient to change how they use force when getting up, picking things up and bending, so that the spine is not loaded again while it heals.

Clinical courseAcute pain mostly improves within 6 to 12 weeks as the bone heals
03

Break the fracture cascade

The goal of rehabilitation is more than waiting for this one fracture to heal. Once a spinal fracture has happened, the risk of another one rises greatly. By strengthening the back extensor muscles and improving posture, we help the patient break the vicious circle of fracture, stooped posture and further fracture.

Cohort studyLindsay 2001 · new vertebral fracture in the first year after a previous vertebral fracture 19.2%
04

Home physiotherapy in the acute pain stage

In the acute pain stage, even turning over in bed hurts and movement is greatly limited, which is just when it is hardest to go out to see a doctor. We come to the patient's home and teach safe daily movements and better posture in the real home setting. We also teach the carer how to help the patient turn over safely and put on a back brace.

Consensus guidelineStrong, Steady and Straight (BJSM 2022) · UK consensus on exercise for osteoporosis

Why treatment at home

Training spots at home after a compression fracture

Rehabilitation after a spinal fracture needs guidance in the real setting. Which daily movements injure the spine, and how to use force when getting up and lifting things,have to be demonstrated in person at the real bed, chair and kitchen heights at the patient's home before they can be done properly. In the acute pain stage even turning over hurts, and home physiotherapysaves the patient the difficulty of going out for treatment in pain.

Training map of the home TRIGGER MAP

Bed and pillowSafe getting-up spotThe therapist demonstrates on the spot how to turn over and get up in bed using the log roll, to avoid twisting or compressing the spine, so that the patient learns the safe way in the acute pain stage.
Dining chair and wallBack extension spotPractising sitting upright, back extension against the wall, and isometric exercise in which the muscles tighten but the joints do not move. These safe backward-extending movements can be done at home without any equipment.
Kitchen and floorBody mechanics spotIn the real home setting the therapist teaches the patient to bend at the hips and knees (hip hinge) instead of bending the back directly, and how to use force correctly when carrying things, to avoid high-risk movements that bend the spine too far.
Corridor and thresholdsFall-proofing spotBalance training and a home fall-risk assessment are carried out, because a fall is often the biggest cause of the next fracture.
Carers learn together:The therapist teaches family members hands-on how to log roll the patient safely, how to put on and take off a back brace, and how to recognise movements that must stop. Only if the support is given correctly will another vertebra not be injured.

Clinical evidence

Research on compression fracture rehabilitation

Research data EVIDENCE

89% vs 16%The group that did forward-bending exercises had a much higher rate of another fracture than the group that did back extension exercisesBack exercise study in women with osteoporosis (Sinaki, 1984; early small sample, n=59)
19.2%Cumulative risk of a new vertebral fracture within the following year in patients who had already had a vertebral fractureProspective study of the fracture cascade (Lindsay et al., JAMA 2001)
10.5→38.1%The risk of a new vertebral fracture within 3 years rises with the severity of the first fractureMORE trial (Delmas et al., Bone 2003; mild 10.5% → severe 38.1%)

Research evidence shows that the key to rehabilitation after a spinal fracture is choosing the right direction of exercise and preventing further fractures early. The practical approach supported by scientific evidence is therefore back extension-based exercise, better posture and prevention of further fractures. It does not rest on wearing a brace alone, or on lying still for a long time waiting to recover.

Just had a fracture and not sure which exercises are safe and which are not? Contact us and tell us the situation, and a physiotherapist will answer your questions directly.

WhatsApp for a free enquiry and home assessment

Related topics

Related physiotherapy topics

For other fractures, rehabilitation after spinal surgery and muscle loss, see the pages below.

Fractures at other sites 01

Physiotherapy after hip fractureFragility fractures at other sites and how they are managed

After spinal surgery 01

After spinal decompression or fusionRehabilitation after major open spinal surgery

Muscle loss 01

Physiotherapy for sarcopeniaMuscle strength assessment and rebuilding training after a fracture

Common questions: conservative rehabilitation and exercise

Frequently asked questions about spinal compression fractures

NOVA HEALTH・FAQ01 – 05
What exercise should be done after a spinal fracture? Are sit-ups allowed?

No. Sit-ups are not allowed. The direction of exercise is critical after a spinal fracture. Forward bending (flexion) movements such as sit-ups and toe touches increase pressure on the front column of the vertebra and raise the risk of a new fracture, while strengthening the back extensor muscles does the opposite. A classic study showed that the refracture rate was 89% in the flexion exercise group and only 16% in the extension exercise group (Sinaki 1984, an early small sample of n=59, but the direction of the finding is robust). The exercises to do are back extensor strengthening, posture correction and isometric exercise, carried out safely under a therapist's guidance.

Is a lumbar brace or back brace needed? For how long?

The role of a brace is support and pain relief, and it is not the treatment itself. What really reduces refracture is exercise and posture. The evidence on hard braces, soft braces or no brace is still debated, and long-term use of a hard brace may weaken the back muscles. It is reasonable to use a brace to help with movement in the acute pain stage so that the patient can get moving again early, but the patient should not depend on it for long, and should not skip exercise because a brace is being worn. The exact choice and the wearing time should be decided by the doctor and physiotherapist for the individual patient.

After the fracture, should the patient rest in bed or get moving early?

As long as the pain can be controlled, getting moving early is better than long bed rest. Long bed rest itself speeds up the loss of bone and muscle and sets up a vicious circle. In physiotherapy, safe isometric exercise and posture correction begin in the acute pain stage. As pain improves, back extensor strengthening, balance and progressive weight bearing are added step by step, and the patient does not wait until there is no pain at all before starting to move.

Will the back become more and more hunched after a compression fracture? What are the effects?

A hunched back is not just a matter of appearance. When one vertebra is compressed, spinal mechanics change and the load on neighbouring vertebrae increases. If this is not dealt with, a fracture cascade can develop. In people who have already had a vertebral fracture, the risk of a new vertebral fracture in the following year rises clearly (Lindsay 2001). Marked forward curvature of the upper spine (thoracic hyperkyphosis) is also linked to a higher risk of death (Kado 2009). The goal of rehabilitation is therefore not only to heal this one vertebra. It is to break the cycle of fracture, hunched back and further fracture through back extensor strengthening and posture correction.

How does home physiotherapy help with a spinal compression fracture?

Rehabilitation after a spinal fracture most needs guidance in the real setting. Which daily movements injure the spine, how to use force when getting up and lifting things, and how to correct posture all have to be demonstrated at the real bed, chair and kitchen heights at home before they can be put into practice. In the acute pain stage an older person can barely move, and even turning over hurts, so a home visit saves going out for treatment in pain. The therapist can also teach the carer on the spot how to log roll the patient safely and how to put on a back brace. 1 hour $1,000, 1.5 hours $1,300, no minimum charge, with a registered physiotherapist visiting in person.

If you have any questions about the spine, message us at any time and ask.

WhatsApp for a free enquiry and home assessment

1 hour $1,000 · 1.5 hours $1,300 · no minimum charge · All service fees at a glance

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Sinaki, M., & Mikkelsen, B. A. (1984). Postmenopausal spinal osteoporosis: flexion versus extension exercises. Archives of Physical Medicine and Rehabilitation, 65(10), 593–596. PubMed
  2. Lindsay, R., Silverman, S. L., Cooper, C., et al. (2001). Risk of new vertebral fracture in the year following a fracture. JAMA, 285(3), 320–323. PubMed
  3. Delmas, P. D., Genant, H. K., Crans, G. G., et al. (2003). Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone, 33(4), 522–532. PubMed
  4. Kado, D. M., Lui, L.-Y., Ensrud, K. E., et al. (2009). Hyperkyphosis predicts mortality in community-dwelling older women and men. Annals of Internal Medicine, 150(10), 681–687. PubMed
  5. Brooke-Wavell, K., Skelton, D. A., Barker, K. L., et al. (2022). Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine, 56(15), 837–846. PubMed