Osteoporosis: Wolff's Law

As defined in Wikipedia, Wolff's law is a theory developed by the German Anatomist/Surgeon Julius Wolff (1836–1902) in the 19th century that states that bone in a healthy person or animal will adapt to the loads it is placed under.^[1] If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading. The internal architecture of the trabeculae undergoes adaptive changes, followed by secondary changes to the external cortical portion of the bone,^[2] perhaps becoming thicker as a result. The converse is true as well: if the loading on a bone decreases, the bone will become weaker due to turnover, it is less metabolically costly to maintain and there is no stimulus for continued remodeling that is required to maintain bone mass.<sup>[3(See Wikipedia Wolff's Law)

Basically, this means that resistive training will help to "strengthen" and improve bone density.  Therefore, if you have a client with the diagonsis of osteoporosis, you need to incorporate strength training, especially in  upright functional positions in order to assist the recovery from, as well as reduce their chance of fractures.  See prior postings for exercises that should be avoided with client's who have osteoporosis.  So if your client with osteoporosis seems hesitant to train with you, now you can explain the benefits to them.</sup>

Osteoporosis & Posture

Osteoporosis, or loss of bone density, may lead to "brittle bones" and fractures, particularly in the spine, hips, and pelvis.  When the vertebrae are affected, 'wedging' of the anterior portion of the spinal bones may occur, which leads to a flexed or kyphotic posture.  With a rounded trunk, you will also see protracted shoulders, and a forward head posture, with excessive capital (head) extension.  Just by observing someone, you will have multiple treatment ideas. 

First and most importantly is to correct their posture by stretching the short, tight muscles and strengthening the stretched out weaker muscles.  Lets start at the head and neck.  With a forward head posture, you will have weak capital (head) flexors, and tight capital extensors.  To counteract this, teach your client chin tucks.  This will stretch the tight suboccipitals while strengthening the capital/head flexors.  It will also realign your ear with your acromion on both sides. 
Now for the shoulders and Scapulae.  We need to stretch our pectorals which have been tightened due to the constant protraction of the shoulders.  The posterior muscles have been stretched out and are weak due to this protracted posture, so you will need to work the retractors such as the rhomboids, rear delts and middle traps..."Bring those shoulders back!"

Most likely there will be a flat lower back, with loss of the lordotic curve.  Pelvic tilts are helpful to reintroduce flexibility and motion to this region.  you will also want to incorporate core stability training to your client, progressing from static to dynamic postures.  Focus on glute training with bridges and glute sets, as the glutes assist in lower back stabilization. 

Integrating the above techniques into each of your client's sessions will help them to correct their current posture, prevent any future injuries and impove their overall results, as it enhances efficiency of all movement.  Once you have corrected posture, then you can move into body mechanics and training movement patterns. 

Osteoporosis: Gym Machines to Avoid

Many women are diagnosed with osteoporosis, which is basically loss of bone density.  With "weak bones," there are a few movements and machines that you should avoid using in the gym, because they place excessive strain on certain bones of the body.  First, the seated hip abductor machine may apply too much stress on the hips/femurs.  This may actually create femur or hip fractures, resulting in a total hip replacement.  The crunch machine as well as the seated trunk extension machine may cause spinal fractures due to vertebral shearing anterior/posterior upon muscle contraction.  Lastly, the seated row machine, especially without chest support may cause compression/spinal fractures.  So if you are working with a client with the diagnosis of Osteoporosis, beware of these machines.  Use your imagination and find other ways to work these hip and trunk muscles.