Interview with Teresa Maldonado Marchok:
We’ve all heard about the dangers of osteoporosis but did you know you should be doing different exercises for osteoporosis? It is known as a silent disease, so, unless you’ve had a bone density test done lately, you may not even know you’ve slipped into that precarious area of low bone mass (aka osteopenia) or even full on osteoporosis.
Teresa discovered Pilates while dancing professionally with the Martha Graham Dance Company. The rigors of rehearsing and touring worldwide take a toll on a dancer’s body. She credits Pilates’ emphasis on length, strength, breath, and precision with keeping her relatively injury free throughout her dance career.
After leaving the MG Dance Company, she became a physical therapist. It was while she was a PT that she used many of the Pilates mat exercises with her patients and saw profound results. With a herniated disc in her own lower back, Teresa learned that the principles of alignment, recommended for osteoporosis, applied to her condition, as well, and have helped her to control her symptoms. To keep herself healthy, she incorporates these alignment modifications during her daily activities as well as during the dance, yoga, and Pilates classes that she takes and teaches. In a recent interview, I had a chance to ask Teresa about what she believes PRiME women need to know about protecting their bones and how exercises for osteoporosis need to be altered.
Why are we hearing so much about the dangers of osteoporosis lately?
TM: With the rise in aging boomers, we are seeing increasing rates in osteoporosis. The young are not immune either. I got a call this week from a 30 year old woman with osteoporosis that fractured her rib from just a sneeze.
It’s easy to miss osteoporosis, as it’s a silent disease. You might notice your height is no longer what it displays on your driver’s license or your ribs may be sitting on your pelvis, causing pain. You might notice an increased kyphosis (rounding) of the upper back as a result of broken bones there because fractures in the upper back often occur without any symptoms or can be mistaken for a pulled muscle. According to the national organization American Bone Health, 70% of people with osteoporosis have never been screened and don’t know they have it.
A recent report from the U.S. Surgeon General warned that by 2020, 1 in 2 Americans over the age of 50 will be at risk for fractures from osteoporosis and low bone mass. It’s important to be screened and if you have risk factors for the disease. Request a DXA scan, which is the gold standard for measuring bone density and diagnosing osteoporosis.
The good news is that there are proactive steps that you can take to prevent or reduce the effects of osteoporosis. Choosing the right kind of exercise is my area of focus.
Isn’t there medication to take care of osteoporosis?
TM: Controversy exists around different bone medications, but the one undisputed method of addressing this condition is exercise. The strength you develop in your legs, arms, and core, as well as the balance and improved reflexes you cultivate, will decrease your risk of falling and help you recover if you do lose your balance. Should you hit the ground, you’ll have the upper body strength to decelerate, minimize impact, and avoid a possible hip fracture.
Recently a woman in her prime and Pilates student of mine tripped and lost her balance at a wedding reception. She went into automatic and landed like Spiderwoman, crediting her core strength and quick responses for not injuring herself or ruining her expensive outfit!
What are some examples of types of exercise that build bone?
TM: Some good choices include backpacking, tennis, dance (particularly Zumba and Flamenco), weight training, and high impact aerobics. Activities like walking and low-impact aerobics may not build bone, but they are protective against further bone loss. Biking and swimming are great aerobic choices but have no benefit for building bone due to their lack of impact. In fact, a study showed that endurance cyclists risk hipbone loss because so much of the exercise they do is non-weight bearing.
Why do women with osteoporosis need a different exercise program than a woman without any bone issue?
TM: Osteoporosis literally means “porous bones.” Their bones are fragile and at risk of fracture. Exercises for osteoporosis require that you put mechanical stressors on the bone to help stimulate growth. Examples include: weight bearing exercise, resistance exercise where the tendons of the muscles that are contracting pull on the bone, stimulating a growth response, and impact exercise such as aerobics, stomping, and jumping.
I saw a presentation recently with results from the Bone Research Lab at the University of Oregon showing that stomping 100 times for 3 times a week improved bone mineral density in the hip. The stomping was done with a force about equal to popping bubble wrap.
Of the sites that fracture, the spine, hip, and wrist are the most susceptible. With that in mind, if someone has been diagnosed with osteoporosis of the hip, but has normal bone density scores everywhere else, then their exercise program should specifically target standing exercises that provide impact translated to the hip bones, strengthening exercises for the muscles surrounding the hip joint, and balance exercises to prevent falling.
On the other hand, if you have low bone density in your upper back (thoracic region), target prone exercises like cobra in yoga or swan in Pilates to strengthen the upper back muscles, which in turn will strengthen those bones. Sinaki has done several informative studies on the link between strong back muscles and the reduction of vertebral fractures.
What exercises should women avoid who have osteoporosis?
TM: There was a landmark study done by the Mayo clinic in 1984 that changed the landscape of the way we address exercise for osteoporosis. In this study, the researchers found that flexion exercises resulted in increased vertebral fractures for women with osteoporosis. The results were so startling that to replicate this study today would be unethical. With this understanding, it is imperative that those with osteoporosis avoid flexion-based moves such as sitting slumped at the computer, rounding over to tie your shoes, touching your toes, or doing abdominal crunches. Those with osteoporosis are also encouraged to avoid extreme end of range side bending and rotation as those movements can put excessive compressive forces on the spine.
Tell us about your BoneSmart Pilates® method?
TM: My BoneSmart Pilates® method, in a nutshell, hones down the bone safe principles of exercise into a simple ABC format.
A stands for Alignment. When you have osteoporosis, you need to be aware of keeping your spine in optimal alignment, avoiding flexion. With exercises for osteoporosis, you must be able to bend safely so we incorporate hip hinging, where you bend forward from your hips rather than rounding your spine. I often use a dowel to teach this principle, where the dowel is used as an alignment tool, held vertically behind your back. You try and maintain 3 points of contact with the dowel at your head, upper back, and your sacrum as you hip hinge. Using the dowel to practice hinging or getting up and down from a chair is a great exercise. It reinforces good posture and strengthens your legs and gluteal muscles.
B stands for Balance. 90% of hip fractures and 1/3 of vertebral fractures are caused by a fall. Balance is critical for preventing falls that can be devastating if you have fragile bones. A 2008 study by Sakamoto showed that standing on one leg for just one minute, 3x/day actually improved bone density. An easy way to start fitting balance into your day is to brush your top teeth for a minute while standing on one leg, and the bottom teeth while balancing on the other leg. Do that twice a day and you’re already at 4 minutes!
C represents Contraction of muscle while doing the following 3 kinds of exercise: weight-bearing exercise, resistance exercise, and impact exercise. This gives your bones the signals to grow and rebuild.
For more information and to see a short preview of her award-winning DVD, please visit Teresa Maldonado Marchok’s website at www.BoneSmartPilates.com.
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