Physical Therapist's Guide to Spinal Compression Fractures
A compression fracture in the spine occurs when the vertebrae (small bones) that form the spine collapse or break. These fractures occur most commonly in people who have osteoporosis, women over the age of 50 who are postmenopausal, or any individuals over the age of 60 who may have weakened bones. Spinal compression fractures can also occur when cancer affects the spine. Approximately 700,000 cases of spinal compression fractures per year occur in the United States due to osteoporosis. It is estimated that 25% of women who are postmenopausal in the United States have had a vertebral compression fracture due to weakening of the bones from changes in hormones that occurred during this period of their lives. Physical therapists help people with spinal compression fractures reduce their pain and improve their strength, flexibility, and overall function.
What is Spinal Compression Fractures?
The entire spine is made up of 24 bones, called vertebrae. There are 7 cervical (neck) vertebrae, 12 thoracic (upper and middle back) vertebrae, and 5 lumbar (lower back) vertebrae. Compression fractures occur most commonly in the middle back or thoracic spine in the T10, T11, and T12 vertebrae, and in the lower back or lumbar spine at the L1 vertebra.
When the spinal bones are weakened, even a simple activity such as bending to lift an object, twisting, or even coughing, laughing, or sneezing can cause a compression fracture. These small compression fractures can gradually cause the spine to lose height and stability, and can weaken the entire spine. Compression fractures often cause the bone to break down in the front area of a vertebra, while the back portion of the vertebra remains solid. This frontal breakdown causes the upper spine to round forward, a condition known as thoracic hyperkyphosis, or “dowager’s hump.”
A spinal compression fracture also may be caused by trauma to the spine such as a car accident, a hard fall, a fall from a height of more than 15 feet landing on the feet, or a blow to the head. Physical therapy begins after the compression fracture has been cleared as stable by a physician. Physical therapists help people with spinal compression fractures reduce their back pain and improve their flexibility, strength, and overall function. Physical therapy also can help reduce the risk of falling to help lessen the chance of future fractures.
How Does it Feel?
The symptoms of a spinal compression fracture are often overlooked, dismissed as common back pain that occurs with a muscle strain or with aging. Approximately two-thirds of nontraumatic compression fractures of the spine go untreated. If you are experiencing a spinal compression fracture, you may feel:
- Back pain that may be sudden or may worsen over time
- Pain, numbness, or paralysis that occurs in the legs
- Back pain that worsens with upright postures, such as standing and walking
- Pain felt with coughing, sneezing, laughing, or breathing deeply
- Back pain that relieves with lying down
- Pain and difficulty with bending or twisting
- Tenderness over a specific region of the spine
- A stooped-over posture
- Loss of overall height
- In severe cases: numbness, tingling, difficulty walking, loss of bowel and/or bladder control
How Is It Diagnosed?
Several diagnostic tests may be ordered by a physician to determine if a spinal compression fracture has occurred. They may include:
- Spinal X-rays
- Bone density testing to measure the thickness of the bone
- CT scan or MRI imagery (in severe traumatic cases)
How Can a Physical Therapist Help?
Your physical therapist will perform a complete evaluation, including your past medical history, any medications you may be taking, and your current symptoms. Your regular activities of daily living will be discussed, so your physical therapist can design a treatment plan specific to your personal needs and goals.
Your physical therapist will perform a physical examination of your spine. Your physical therapist may touch points along the spine to determine any areas of pain or tenderness, and check your spinal movements; the strength in your spine, legs, and shoulders; and your balance.
Surgery is rarely needed in cases of compression fracture. It may take weeks or months after your diagnosis for the spinal compression fracture to heal. During the healing process, your physician may recommend that you wear a back brace for extra support, reduce your overall activity level, and even try a short period of bed rest, depending on the severity of the fracture.
During the healing process when your activity is limited, muscles in the core, hips, and back can become weak. This weakness can make it difficult to resume your regular activities, and the weakness can put you at greater risk for falls.
Your physical therapist can help you regain the strength and mobility that you may have lost while the fracture healed. Your treatment may include:
Pain reduction. Your physical therapist may use different treatments and technologies to control and reduce your pain, and help you avoid the need for pain medications, including opioids.
Flexibility exercises. Your physical therapist may teach you gentle spinal range-of-motion exercises for the neck, thoracic, lumbar, hip, and shoulder areas.
Strengthening exercises. Your physical therapist will prescribe gentle strengthening exercises to help stimulate your bone strength. Exercises may include upper- and lower-body, abdominal, and back muscle-strengthening activities.
Posture. Your physical therapist will teach you how to maintain safe posture and spinal positions to protect the vertebrae from undue stress when sitting, standing, walking, and even while you are sleeping. You also will learn proper body mechanics for performing tasks at home, such as bending and lifting. Your physical therapist will also design an individualized home-exercise program, which you can continue after you have completed your physical therapy program.
Fall prevention. Your physical therapist will teach you exercises to improve your balance and steady your walking gait to prevent falls. You may perform gentle exercises on a variety of surfaces. You also will learn ways to modify your home to make it safer and reduce the risk of a fall.
Can this Injury or Condition be Prevented?
There are several ways in which a spinal compression fracture can be prevented. Physical therapists recommend that you:
- Eat a well-balanced diet to promote bone health.
- Stop smoking.
- Keep alcohol consumption moderate.
- Take calcium and vitamin D supplements as recommended by your physician.
- Exercise regularly, including weight-bearing activities, such as walking and using light weights.
- Reduce fall risks with home modifications and balance exercises, as recommended by your physical therapist.
- Maintain proper posture and body mechanics when performing activities of daily living.
Real Life Experiences
Louise is a 72-year-old retired teacher who volunteers at her local senior center and meets with a social walking group twice a week. Over the past year, Louise has been experiencing low back pain that has steadily gotten worse. Sometimes, the pain is so severe that she cannot stand up straight. Just yesterday, Louise cancelled her date with her walking group because she was in too much pain. She decided to speak with the physical therapist who visits the senior center. He immediately scheduled an appointment for an evaluation.
During Louise's evaluation, her physical therapist takes her health history, and notes that she has lost 2 inches in height over the past few years. She reports that she has difficulty standing and walking, and that she feels her legs have been steadily getting weaker. She also notes that she has more difficulty climbing stairs than ever before, and that she even has trouble getting up from her chair.
Her physical therapist performs an evaluation of her spine. He notes that she has a forward-bend posture with a rounded upper back. He identifies a tender spot on her back at the T12 region of her spine. He determines that, due to the weakness in her legs and arms, she is at risk for falls.
Louise also consults with her physician and undergoes an X-ray and a CT scan. She is diagnosed with a thoracic (T-12) spinal compression fracture.
Several weeks later, after Louise reduces her activity level to rest her spine in order to allow it to heal, her physician deems her compression fracture to be stable. She begins physical therapy to help her manage pain and regain strength, function, and balance ability.
Louise's physical therapist uses gentle massage techniques and ice to help reduce her back pain. As the pain subsides, Louise begins performing some gentle spinal, hip, and shoulder range-of-motion exercises. She does well, and her physical therapist adds strengthening exercises with weights to her routine.
After a few physical therapy sessions, Louise notices that she can rise from a chair with much less difficulty. With her physical therapist standing at her side, she begins gait stability and balance exercises as well as other exercises. She begins to feel much steadier on her feet. Her physical therapist recommends safety modifications for her home, such as removing throw rugs and keeping her house well-lit to reduce her falls risk.
Louise learns new movement techniques to minimize stress to her spine, such as how to properly bend to pick up an object from the floor.
After a few weeks of steady work, Louise completes her physical therapy sessions. She continues to perform a home-exercise program to improve and maintain her strength and agility. She is overjoyed to be able to resume walking with her club, and has started volunteering again at the senior center. Louise enrolls in a new balance class at the center—and promises herself that, as she continues to build her strength, she'll be on the lookout for more new activities to enjoy!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat spinal conditions and injuries. However, you may want to consider:
- A physical therapist who is experienced in treating spinal conditions and trauma. Some physical therapists have a practice with an orthopedic, geriatric, or sports focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic, geriatric, or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have spinal conditions and injuries.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of spinal compression fractures. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Medline Plus. Compression fractures of the back. Updated July 9, 2018. Accessed July 16, 2018.
Sinaki M. Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention. PM R. 2012;4(11):882–888. Article Summary in PubMed.
Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine: current options and considerations for treatment. Spine J. 2006;6(5):479–487. Article Summary in PubMed.
Pfeifer M, Sinaki M, Geusens P, et al. Musculoskeletal rehabilitation in osteoporosis: a review. J Bone Miner Res. 2004;19(8):1208–1214. Free Article.
Old JL. Calvert M. Vertebral compression fractures in the elderly. Am Fam Physician. 2004;69(1):111–116. Free Article.
National Osteoporosis Foundation. Health Professional’s Guide to Rehabilitation of the Patient with Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2003.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.
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