One of my clients this week told me of an encounter with a specialist doctor regarding weight training with osteoporosis. Upon showing her doctor footage of her performing a heavy deadlift, the doctor expressed shock and concern, and advised her that she was at risk of fracturing her spine doing this.
So lets be clear here: A woman with osteoporosis, a condition for which has demonstrated proof that heavy lifting can improve, told her doctor that she was engaging in said health activity in order to improve her condition, and was met with shock by the doctor who then suggested that she may fracture her spine doing so.
To the doctor’s credit, I have read numerous studies that state a flexed position under load (bending forward and picking something up, particularly while twisting) can cause a vertebral crush fracture in those with osteoporosis, and should be avoided. But as often is the case with these claims, it was not quantified (how much bending is too much? How heavy is too heavy?), or backed with evidence. I find these blanket statements telling people not to move to be incredibly problematic. What if a lady with osteoporosis lives alone and needs to pick up her cat, or bag of cat food, or heavy handbag, or grandchild? Are we truly telling her never to do any of those things lest she fractures her spine? I understand being aware of risks is important, but when it means making people scared to move, and in this circumstance, scared to load their bones - the one thing they absolutely need to be doing! - I feel frustrated.
Who decided that our bodies are fragile and we need to treat them so carefully? If we were that fragile, how do people play rugby? Box? Survive major traumas such as car accidents? If we used to hunt and gather and catch our food, why would we have evolved to need to wrap ourselves in cotton wool and avoid lifting anything more than a 2kg dumbbell?
I understand that a rugby player who batters himself so much that he is hobbling around by the time he is 40 isn’t a great example to use here, but considering most of us are doing MUCH LESS than that, the point still stands. I think a lot of it stems from the idea that we ‘wear out’ and ‘too much exercise will wear us out’ (not true, the opposite is actually true, the more you use your body the stronger the tissues in it become (all of them). Think callouses on hands.). It also stems from a fear that there may be a ‘no turning back’ injury, like if you just move wrong one time, you will be condemned to pain forever (highly unlikely, and if so, it is rarely (almost never) because the injury is extremely severe, but often due to a complexity of other factors I have discussed in other blogs). The body is very good at healing itself and getting used to what it has been dealt. We are amazing creatures!
But back to the osteoporotic women and spine fractures.
There are SO many barriers in place to exercise. The WHO suggests that more than 80% of adults do not do enough exercise. Let alone women exercising, let alone middle aged and older women, let alone doing exercise heavy and strenuous enough to promote real strength, balance, and bone density changes required to create a positive impact on their health. I’m going to go out on a limb here and suggest that a doctor telling patients that lifting may fracture their spines is a pretty substantial barrier here!
It would be irresponsible of me to claim that it is actually safe to lift heavy weights with osteoporosis without any evidence to back it up. Luckily, I have just that.
A study completed in 2017 compared high impact, high intensity training with a low intensity home based program for women with low bone mass. The high intensity program included barbell back squats, deadlifts, overhead press, and jumping chin ups with a focus on a ‘stiff’ landing. The lifts were performed up to 85% 1RM, which basically means they are lifting HEAVY - a weight that they can only complete for 5 repetition (note: it takes practice to work up to a true 85%/5RM effort). The home program was a low intensity strength program with a maximum of 3kg hand weights. Results showed a significant improvement in bone mineral density in the high impact group compared with the conservative home program group. There was essentially no improvement in the home group. And, importantly, NO adverse events (i.e. no fractures).
This is very interesting. When I was at uni, in one of the first few subjects I did (in 2007 or 2008) we learned it was not possible to increase your bone density once you reached a certain age. But this was obviously just because no one had really pushed people to lift heavy enough to make a difference! Now, we have research indicating that we can actually make a difference, even in those already with osteoporosis. And it is SAFE to do so. Provided you learn appropriate technique and are guided as to your weight selection.
Let’s try to reduce the stigma around movement, particularly around weight lifting, and help get ourselves and those around us moving and lifting and maximising our health!
PLEASE NOTE: This is not to be taken as medical advice. Lifting should be individualised and supervised by a health professional.
Reference: Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial [https://doi.org/10.1002/jbmr.3284]. Journal of Bone and Mineral Research, 33(2), 211-220. https://doi.org/https://doi.org/10.1002/jbmr.3284