‘Fracture Proof’ Yourself: The Hip Hinge and Posture Training for Osteoporosis
Osteoporosis is characterized by low bone mass, which leads to bone weakness and risk of bone fracture. More than 50% of women and 20% of men over the age of 50 will experience osteoporosis related fractures, and one in six women will experience hip fracture as a result of the disease (American Council on Exercise, 2012; van Staa et al., 2002). Exercise is an important treatment for osteoporosis. A balance program helps improve indices of falling and provides stimulus to bone, thereby increasing its structure and strength.
A balanced fitness program for osteoporosis treatment and management includes several components: posture and balance training to reduce the risk of fractures, and weight bearing and resistance training exercise to increase bone strength. Flexibility and mobility training will also increase ability to move properly and with ease, thus improving the ability to do other beneficial forms of exercise.
Posture and balance exercises are the foundation of exercise to prevent fractures. Moving the wrong way or falling can cause fractures in those who have osteoporosis. Thus, it is important to know what movements or positions are risky, and how to improve one’s balance when developing a fitness program for osteoporosis. Posture exercises should focus on neck and shoulder positioning, spinal alignment, and also include back and hip alignment. All individuals with osteoporosis (or osteopenia) should learn how to practise spinal alignment techniques to reduce spinal loads, and avoid rapid/forceful, repetitive/sustained, end-range or weighted forward bending or twisting of the spine (Osteoporosis Canada, 2016.)
Movements to Avoid:
• Rounding the Back: If you have Osteoporosis, you should be careful about bending forward to the end of the range of motion (such as when bending forward to reach a shoe or lift something from the floor) in a way that rounds your spine. Instead, bend at the knees and reach with a straight spine. In addition, you should avoid repetitive forward thoracic (upper back) rounding, such as during sit-ups, and especially when the movement is rapid.
• Twisting of the spine: Those who have Osteoporosis should avoid twisting is to the end of the range of motion, such as turning to reach something behind you and especially when you are carrying a load (weighted movement). Repetitive and rapid twisting should also be avoided.
Spinal Alignment and the Hip Hinge: It is important when bending, to do so in ‘neutral spine’. This means that when you bend over or lean forward you should use a movement known as the ‘hip hinge’, which allows you bend at the hips while keeping a straight spine.
Preparation: To hip hinge’, bend your knees slightly while keeping your back straight from the hip to the shoulder with no bending or rounding of the lower back
Execution: Maintaining a neutral spine, stick out your tailbone behind you to bend forward from the hips. This movement may feel awkward at first but it will become more comfortable once you master the technique. Your usual movement patterns will need to be retrained to learn how to use the hip joint and the strong buttock muscles along with the leg muscles to allow you to bend and lean over with less stress, or load, on the spine.
This exercise can be done daily, as it is the same movement as a squat, and will train posture and safe, functional daily movement. The more you practice bending and squatting this way, the more normal it will feel. The muscles involved will strengthen, and it will become your natural way to move.