FAQ’s about Movement & Osteoporosis

The answers to your burning questions about posture and exercise for osteoporosis or post menopausal women

What is the difference between posture and alignment?

I prefer to use the term alignment because the word posture implies to me an aesthetic choice whereas I am focused on optimal functionality!  You can use either word.  

What do you mean by optimal alignment?

Your body is designed to have the path of weight from gravity fall through your head , evenly through your shoulders and spine to your hips and then heels. 

The heels are big and broad and strong for a reason.  The heels were designed for impact and ground reaction force. 

Simply put, the muscle and bone targeting forces of “weight-bearing” exercise are activated by the ground reaction force of gravity. 

Logically, if your hips are forward of your ankles, your weight is more in your toes, not great for your foot, but also the path of weight is now falling more through your knees than your backside.  Hello, knee problems and weak gluteus muscles. 

Not only do our glutes and hamstrings play an important role in hip bone building but they are key for sitting and getting out of a chair, a very important movement that we do not want to lose as we age. 

Another less talked about area is the rib cage.  We want the ribcage to be sitting above the hips and not tipped or tilted forward.  Such a position makes it difficult to engage one’s core and it also puts pressure on your low back.  There is so much more to be said, but this is a good overview.

How important is it to keep your shoulder blades together and down your back so your shoulders are back? 

This is a very common question. And I would like to dispel the myth that pulling your shoulder blades down and back will actually improve your posture. What it may in fact do is just add more tension to an already sub optimal spinal alignment. The easiest way I can show this is with a photograph. 

As you can see, in the first photograph, I have a kyphotic posture or an upper spine that rounds forward.  I can alter what you the viewer observe, by merely pulling my shoulder blades back and looking more upright. This is the second photo!  But in fact, I haven’t changed that forward posture.  Pulling the shoulder blades back via the rhomboid muscles when I’m standing doesn’t actually make my spine more elongated period.  Yet, I will suggest that you use your rhomboids in exercises. The third photograph is standing more erect without so much forward shoulder and head.  My shoulders are NOT pulled back, they are sitting easily.  I have externally rotated my arms to find a bit more openness in my chest.

  1. Work on your shoulder blade mobility by doing rhomboid push ups.  The goal is to decrease the kyphotic curve and getting more active movement in protraction and retraction will be a big help.
  2. Elongate your spine. Sometimes we talk about reaching the crown of your head more towards the ceiling. But we want to do that without extreme extension in the neck.
  3. The bottom line is that I suggest people work on getting their hips back first, before worrying about their shoulder blades.  We want to have a more stacked alignment from their heels to their hips. And then to work on the stacked alignment in the upper body. 
  4. We are really looking at doing more thoracic extension. So it’s a slow process. You look for small, small changes, maybe 1% at a time. Here are some good exercises for encouraging more thoracic extension.  Baby Cobra. Cactus arms at the wall facing away from the wall. You will work on getting your arms on the wall completely while also keeping the back of your ribs on the wall.  Gentle rotations side to side.  

What’s the principle behind hip hinge?

The principle behind the hip hinge is to keep your spine in neutral. 

This means that the natural curves of your spine are kept intact. 

A hinge is where we keep that neutral arrangement and move your torso including your pelvis over your legs. I used to teach taking a fig leaf at your pubic bone and imagine drawing the fig leaf down in between your legs moving it to almost face the ground. I have also suggested moving your sitting bones to the wall behind you. 

In either visual suggestion, the individual will sometimes move the spine at various points above the pelvis and that is when I began using a broomstick or a dowel.

The 3 important points on the dowel are the head, the rib cage and the sacrum or the back of the pelvis. For some people a forward head posture makes it difficult to get their head on the stick. There’s still a lot of good work to be done. Try to keep the relationship of your head exactly the same vis a vis the stick.  Keep your ribs and your sacrum on the stick.

By doing so, you are protecting your lumbar spine and your thoracic spine.  The biggest issue is unhinging or raising back up.  Every individual really needs to have a good core strategy.

So even if your hamstrings are very flexible, you should only hinge over as far as you have the strength to bring yourself back up without changing your spine.

For people who don’t have a good core connection yet, we start very small and progress to bigger hinges over time. A hip hinge is a great exercise to strengthen your back when done properly.

It basically strengthens the entire back chain of your body

Is it better to focus on Pilates and yoga or weights at the gym?

I will answer this in parts:

  1. How often should you strength train?
    We all should strength train.  I acknowledge up front that this does not mean heavy lifting and may be 1 pound weights for some individuals. We know that 2 to 3 days a week with a heavy for you weight is optimal for hypertrophy or building muscle.
  2.  How often do you do more endurance based exercises?
    This type of work can be aerobic for heart health or it can be longer, slower core work such as pilates or yoga.  Many people suggest 2 or 3 times a week for this kind of exercise for either your heart or your mobility and balance or both.

I recently heard some scientific literature explained on a podcast that suggests a plan like this:

  • Strength train 3 times a week.   
  • Endurance train, 2 times a week 
  • Rest two days a week.  
  • For 10 weeks. 

Next you start a new cycle where you:

  • Endurance train for 3 days a week 
  • Strength train for 2
  • Rest for 2 during that cycle.  

Of course you may choose one day of rest with a more restorative practice on day 6. 

The most important thing is to listen to your own body. 

You should be able to determine your own level of fatigue. 

If you try strength training three days a week, do you still feel energetic on the 6th day? 

I have clients who start out strength training with such light weights for safety reasons, that they really need three days a week. But other clients really push themselves and 2 days a week is optimal. These people may choose to not alter their training schedule every 10 weeks because they know what works for them.

As we age, we know our repair functions work more slowly than when we were younger, so we must be vigilant about listening to our own body and its signals. We must prioritize rest!

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What is the protocol for weighted vests 

A weighted vest is not appropriate for everyone. 

In the end it is your personal decision, and I am not a medical professional. 

Here is what I say to my clients.  It would be an informed decision if you know your bone quality as well as your bone density.  Additionally, you want to take spinal conditions into account.  If you have severe scoliosis or spondylothesis or any number of other disc or spine deformities or degenerations, you must take these into account.  It may be that you will choose to walk with a weighted belt and only add load to your hips and not your spine in the interest of safety.

Should you decide to use a vest the protocol is to progressively load slowly.

One would start with a half pound, and if the first walk with a half pound was successful, then one would load another half pound each time they took a walk.

As you get to a heavier load the point that something is “heavy” is very individual, you would be wise to take more time to adjust to the load before increasing your weight. It may well be that you would walk for a week, with five pounds for instance, and the following week, see if five and a half pounds is okay. So, your progression would slow down. 

The suggested maximum in the medical community is 10% of your body weight.

Have you found a vest that places the weight near the center of gravity?

I’m going to make the assumption that the question is directed towards a person having a center of gravity somewhere in front of the sacrum when standing. 

So, if you were looking to carry most of your weight in that spot, you would want to be able to wear a weighted belt that sits a little lower than your natural waist.

But I do think another good option is the hyper vest elite. 

It is made so that you can put two weights in any one pocket so you could redistribute the weight to try to get more of the weight near that theoretical center of gravity. From that perspective, I think the Ironwear Fitness Vest is not as good because it’s a much shorter vest. I’ve had clients who are taller than five seven tell me that the Ironwear Fitness Vest is too short, so be cautious if you are tall. 

I think when you look at a lot of inexpensive vests, they tend to be centered all near up near the rib cage. I like the Hyper Vest Elite because it is longer and its pockets are more flexible, allowing them to take more than one weight in a pocket.  

What are Good yoga poses 

Tree, Chair, triangle if done with a neutral spine, Warrior I, II, II with a neutral spine.

When I deadlift my knees crack, is that okay? 

Consistent cracking is an indication of either hydrogen pop or a tendon moving over a bone or two things rubbing together. 

I am not fond of letting that happen consistently over time as it seems like there would be a wear and tear event at some point. However, I recently listened to a lecture where this notion was dispelled when it involves your Iliopsoas complex because that is a big strong muscle set that is unlikely to be eroded in this way.  

Nonetheless, I would experiment with a lower weight and see if the knees still crack. 

Additionally, I would also take a slow motion video of yourself while performing the deadlift.  You may discover that you are either hyperextending your knees or maybe they are drifting inwards or outwards. I do think it needs another look.